Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania: A Mixed Method Community Based Study

Infant and young child feeding practices among mothers in the pilot Micronutrient Powder Initiative in four geographically and ethnically diverse districts in Ghana

In Ghana, breastfeeding and complementary feeding counselling have been used as a nutritional intervention to promote optimal Infant and Young Child Feeding (IYCF) and nutrition. This study examined IYCF practices in four geographically and ethnically diverse districts (Ho West, Tain, Talensi and Tolon). A qualitative study involving key informant interviews (KIIs) and focus group discussions (FGDs) was conducted between November and December 2019 among women who participated in a pilot micronutrient powder intervention for children 6-23 months of age. The KIIs and FGDs were audio-taped, transcribed verbatim, and analyzed thematically using NVivo 10. Three themes emerging from the KIIs and FGDs were: level of adherence to IYCF recommendations among mothers and caregivers; IYCF recommendations perceived as the hardest to follow; and perceived motivators, facilitators, and barriers to IYCF practices. Mothers in the four districts generally followed the eight IYCF recommendations. Mothers in the Tolon district demonstrated adherence to IYCF practices, often citing the need for early initiation of breastfeeding, timely introduction of complementary feeding, and feeding children aged 9-23 months 3 times daily in addition to breastfeeding. In contrast, mothers in other districts faced challenges that hindered adherence. Giving children 4 or more food groups and timely introduction of complementary feeding were perceived as the hardest practices to follow. The main facilitators of IYCF practices include midwives and frontline nurses teaching mothers how to breastfeed, and midwives ensuring mothers initiate breastfeeding immediately after delivery. The main barriers to IYCF practices identified were insufficient breastmilk; mothers-in-law giving water to children before six months; resumption of work; and lack of financial means. Mothers in the Ho West district reported more barriers to IYCF practices, followed by mothers in the Tain, Talensi, and Tolon districts. Health practitioners, stakeholders, and policymakers should design targeted interventions that address the contextual barriers to improve IYCF practices in the various districts.

Factors associated with stress among pregnant women with a second child in Hunan province under China's two-child policy: a mixed-method study

OBJECTIVE

The purpose of the study was to investigate the status of pregnancy stress and to explore factors associated with pregnancy stress among women by China's two-child policy.

METHODS

A mixed-method study involving both quantitative and qualitative methods was conducted using questionnaires and semi-structured interviews. The questionnaires encompassed socio-demographic and obstetric characteristics, as well as the Pregnancy Stress Rating Scale (PSRS) and the Social Support Rating Scale (SSRS). Initially, the participants were required to complete the questionnaires, enabling us to assess their respective pregnancy stress statuses. Subsequently, we selectively interviewed pregnant women with a second child and exhibited at least mild pregnancy stress. The qualitative study sought to uncover the factors contributing to their stress during pregnancy.

RESULTS

A total of 463 subjects were enrolled; of the subjects, 22 (4.8%) had no stress, 407 (87.9%) had mild stress, 34 (7.3%) had moderate stress. Generalized linear regression analysis revealed significant factors (P<0.05) related to pregnancy stress, including family financial burden, subjective support, fertility desire, gender of the first child, and gender preference. Additionally, 16 subjects were interviewed, and through analysis, three major themes emerged, each comprising 12 sub-themes associated with pregnancy stress. These themes were identified as fertility factors (worry about maternal and child health, birth experience, and parenting stress), family factors ( financial burden, second child care problems, first child's acceptance of the second child, family concerns, fertility desire, and gender preference) and social factors (involving life events, career development and workload).

CONCLUSION

The diver factors contribute to pregnancy stress among pregnant women under China's two-child policy. Our study could be used to develop appropriate interventions to reduce pregnancy stress and to enhance the mental health of women pregnant with a second child.

Infant and Young Child Feeding in the Context of HIV: An Exploration of Barriers in Exclusive Breastfeeding Practice in Dar Es Salaam, Tanzania

Background

Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam.

Methods

The study used a hospital-based qualitative approach, focusing on HIV-positive mothers with infants aged 3-6 months in Dar es Salaam city. This involved reviewing mothers' files, conducting interviews with them, and interviewing Reproductive and Child Health clinics (RCH) and community healthcare providers. In total, 27 In-depth interviews were conducted until data saturation was reached, and thematic analysis was used to analyze collected data.

Findings

The study identified various barriers to exclusive breastfeeding, encompassing individual factors like work schedules, postpartum depression, and breast conditions. On the household level, barriers included limited access to resources, family influence, and HIV status disclosure reluctance due to stigma. In the community, low retention in the Prevention of Mother-to-Child Transmission (PMTCT) programs plays a pivotal role in hindering exclusive breastfeeding support for HIV-positive mothers.

Conclusion and Recommendations

HIV-positive mothers face diverse barriers ranging from individual, household, and community-based barriers. Policies supporting breastfeeding, early detection of postnatal depression and breast problems, and peer support for young mothers are of paramount importance. Food insecurity and HIV stigma should be tackled through income-generating activities, family involvement in PMTCT programs, and awareness campaigns. Community-based counselors play a crucial role in supporting HIV-positive mothers in their exclusive breastfeeding journey to improve PMTCT care retention.

The effect of low-fidelity simulation training on breastfeeding knowledge, practice, and self-efficacy among young lactating mothers in Tanzania: A quasi-experimental study

BACKGROUND

Exclusive breastfeeding (EBF) is of paramount importance for the survival, growth, and development of neonates. Lack of EBF puts mothers and their babies at high risk of many complications. Mothers may end up having breast engorgement, cracked nipple, mastitis, breast pain, and backache. Babies may acquire postnatal HIV transmission, reduce weight, stunting, poor cognitive and motor development, and increase the risk of diarrhea disease and respiratory infection. Breastfeeding training has been provided immediately after a women's birth. However, young mothers are still staggering with breastfeeding.

RESEARCH AIM

We aim to assess the effect of low-fidelity simulation training on breastfeeding knowledge, practice, and self-efficacy among young lactating mothers and we will also assess the impact of simulation on infants' weight in Tanzania.

METHODS

The study will be a health facility-based quasi-experimental design. The study will have four phases: baseline survey, intervention, immediate assessment, and two-month end-line follow-up. The assessment will focus on participants' breastfeeding knowledge, practice, and self-efficacy. Furthermore, infant weight will also be assessed during baseline and end-line. A total of 261 young lactating mothers who have first baby with their infants aged 0 to 2 months will be included, whereby 87 young lactating mothers will be in an interventional group and 174 will be in the control group. The intervention will have four packages: 1) group lecture education and interactive on the importance of breastfeeding 2) videos, 3) pictures, and 4) simulation in the umbrella LVPS using the wearable Lactation Simulation Model (LSM) and newborn manikins (Global Health Media and Laerdal baby). At the end of the study, all groups will be given education brochures which will be in the Swahili language for easy understanding. Data will be analyzed using SPSS version 23. An independent T-test and repeated measures ANOVA will be used in this study to compare the difference between the mean of the 2 groups.

DISCUSSION

This study aims to generate evidence of the effect of simulation on improving breastfeeding knowledge, practice, and self-efficacy. We expect the study findings to inform the stakeholders and policymakers on formulating breastfeeding education and simulation training that will improve women's breastfeeding knowledge, practice, and self-efficacy and improve infant health.

Sociocultural Factors as Predictor to Exclusive Breastfeeding (EBF) Practice among Nursing Mothers in some Communities in Eastern, Nigeria

This study examined the demographic and sociocultural influences on the level of exclusive breastfeeding (EBF) practices in Enugu state. The major instrument for data collection was a uniform set of structured questionnaire and in-depth interviews with the husbands, grandmothers/mothers-in-law, health workers, women leaders, and traditional/community leaders. Data were analyzed using frequencies, percentages and chi-squared test. Qualitative data were analyzed with ATLAS.ti. The study established that the prevalence level of EBF practice was relatively low (27%) in all the local government areas in the state. The result also showed that several sociocultural factors affected EBF practice. Some of them were: influence of TBAs (91%); poor nutrition in family menu (82%); campaign/marketing of artificial feed (78.3%), unfavorable conditions in the work place (66.8%); belief that lack of water can kill a baby (64.6%) and influence of grandmothers/mothers-in-law (64.2%). The results further revealed that age, occupation, parity, and educational qualification of the mothers influences the level of EBF practice. The findings also revealed that majority of mothers practice mixed feeding in the name of EBF practice. It is suggested that more efforts are needed in giving proper and adequate education and skilled counseling on EBF practice and sociocultural factors associated with the practice.

Essential newborn care practices and associated factors among home delivered mothers in Guto Gida District, East Wollega zone

BACKGROUND

Essential Newborn Care is a set of strategic and cost-effective interventions planned to improve the health of newborns through the care they receive from birth up to 28 days. In the current study area, little is known about the prevalence of essential newborn care practices and its associated factors. This study was aimed to assess the prevalence of essential newborn care practice and its associated factors among home-delivered mothers in Guto Gida district, western Ethiopia.

METHODS

A community-based cross-sectional study was conducted in Guto Gida district from September 5 to 15, 2020. Data were collected by interviewing 601 systematically selected home-delivered women. Descriptive statistics were employed to describe frequency and percent. Binary logistic regression analysis was employed to identify candidate variables for the final model. Variables with p-value less than 0.25 at bivariate logistic regression were considered as the candidate variable and entered into multivariable logistic regression model. Finally, multivariable logistic regression was employed to identify associated factors at p-value less than 0.05, and the strength of association was described by adjusted odds ratios with 95% CI.

RESULTS

The study shows that the level of essential newborn care practices was 168 (28%) (23.9-31.4). In this study, women in the first wealth quantile (AOR [95% CI] = 0.64 [0.34-0.97]), women who had one live birth (AOR [95% CI] = 0.51 [0.22-0.87]), women who lost their neonate before the study period (AOR [95% CI] = 0.11 [0.05-0.22]) were less likely to practice essential newborn care. Women who were advised on essential newborn care practice during a home visit by health extension workers (AOR [95% CI] = 3.45[1.56-7.26]), women who attended antenatal care during their current pregnancy (AOR [95% CI] = 1.79 (1.21-3.36]), and women who were attended at their birth by health extension workers (AOR [95% CI] = 3.29 [2.13-5.94]) were more likely to practice essential newborn care.

CONCLUSIONS

In this study, the prevalence of essential newborn care practice was low (28%), as compared with the World Health Organization recommendation that it should be 100%. The wealth quantile, number of live births, home visits by health extension workers, antenatal care, birth attendant, and neonatal death were independent predictors of essential newborn care practices.

Exclusive breastfeeding practice and associated factors among mothers of infants age 6 to 12 months in Somali region of Ethiopia

In Ethiopia, only 58% of the mothers practice exclusively breast feeding, which is far from recommended; therefore, identifying factors associated with exclusive breast feeding helps to fill this gap. Community-based mixed cross-sectional study was conducted on 532 mothers. Binary logistic regression was performed and Variables with p value ≤ 0.05 in multivariable analysis declared as statistically significant variables. For the qualitative part focused group discussion was performed, and a thematic framework analysis was done. Finally the results were presented with narration. Prevalence of exclusive breastfeeding was 52%. Husband education (AOR = 2.9; 95% CI 1.6, 5), colostrum feeding (AOR = 2.3; 95% CI 1.3, 3.9), antenatal care (AOR = 2.1; 95% CI 1.1, 4.3.), place of delivery (AOR = 2.1, 95% CI 1.2, 3.6), residence (AOR = 0.3; 95% CI 0.2, 0.6), counseling during postnatal care (AOR = 2; 95% CI 1.2, 3.3) were associated with exclusive breastfeeding. As most discussant explained reason for not exclusive breastfeeding were due to different perceptions such as breast milk not sufficient, giving water decrease infantile colic and fear of food refusal. Prevalence of breastfeeding is low. Husband education, residence, colostrum feeding, antenatal care, institutional delivery, counseling during antenatal and postnatal care were significantly associated variables.

Exclusive breastfeeding practice among HIV infected mothers in the southern highlands of Tanzania; assessing the prevalence and factors associated with the practice, an analytical cross-sectional survey

Background

There is no other better way to safeguard an infant’s health in the first 6 months of life than exclusive breastfeeding (EBF). Breast milk is valuable in all aspects of an infant’s physical and mental growth as well as immune development. The study aimed to assess the prevalence and factors associated with EBF practice among HIV-infected mothers in the Southern Highlands of Tanzania.

Method

A hospital-based analytical cross-sectional study was conducted among lactating HIV-infected mothers. A random sampling procedure was used to obtain 372 HIV-infected mothers of infants from 6 to 12 months of age who were still breastfeeding at the time of data collection. An interviewer-administered structured questionnaire was used for data collection. Bivariate and multivariable logistic regression was used to assess factors associated with EBF practice. Statistical package for social science (SPSS volume 20) software was used for data entry and analysis.

Results

The prevalence of EBF practice was 58.1% at 95% Confidence Interval of 52.9% to 63.1%. More than half of the respondents 199 (53.5%) had adequate knowledge while 173(46.5%) had inadequate knowledge about EBF. After adjusting for confounders, factors associated with EBF practice were knowledge about EBF [Adequate knowledge (AOR = 5.11 at 95% CI 3.2–8.17, p < 0.001)], ANC visits [Adequate (AOR = 1.76 at 95% CI 1.09–2.82, p = 0.002)], Income per day [1 0r more USD (AOR = 1.83 at 95% CI 1.14–2.94, p = 0.013)], positive perception of EBF [ positive perception (AOR = 3.51 at 95% CI 2.25–5.47, p < 0.001) and having ever experienced a breast problem AOR = 3.91 at 95% CI 1.89–8.08, p < 0.001.

Conclusion

More than half of interviewed mothers with HIV practiced EBF. The EBF practice among HIV lactating mothers was significantly influenced by adequate knowledge of EBF, positive perception toward EBF, adequate ANC visits, and having never experienced breast problems. Strengthening adherence to ANC routine visits, counseling on breastfeeding, and improving mothers’ knowledge about exclusive breastfeeding would contribute to the enhancement of EBF practice in this region. An innovative interventional study is recommended to develop more effective strategies to improve EBF knowledge and practice among HIV-infected mothers.

Client Experiences in a Mobile-Phone Counseling Intervention for Enhancing Access to Prevention of Mother To-Child Transmission (PMTCT) Services in Kenya

Background

The prevention of mother-to-child transmission (PMTCT) is considered one of the most successful HIV prevention strategies in detecting and reducing HIV acquisition in utero or at birth. It is anticipated that with the increasing growth of digital technologies mobile phones can be utilized to enhance PMTCT services by improving provider-client interactions, expanding access to counseling services, and assisting in counteracting social and structural barriers to uptake of PMTCT services. Understanding the subjective experiences of women accessing PMTCT services in different settings has the potential to inform the development and promotion of such methods. This paper explores the perspectives of HIV-positive pregnant women attending maternal and neonatal clinic services in Kisumu, Kenya.

Methods

Data are reported from in-depth interviews with women, following a longitudinal study investigating the impact of a structured, counselor-delivered, mobile phone counseling intervention to promote retention in care and adherence to ARV prophylaxis/treatment, for HIV-positive pregnant women. Thematic content analysis was conducted.

Results

Discussions indicated that mobile-phone counseling provided useful health-related information, enhanced agency, and assisted mothers access critical PMTCT services across the cascade of care. Similarly, mobile-phone counseling offered personalized one-to-one contact with trained health providers including facilitating discussion of personal issues that likely affect access to services. Findings also identified barriers to the uptake of services, including a lack of partner support, poor health, poverty, facility-related factors, and provider attitudes.

Discussion

Overall, findings show that mobile-phone counseling is feasible, acceptable, and can enhance access to PMTCT services by overcoming some of the individual and facility-level barriers. Although mobile-phone counseling has not been routinized in most health facilities, future work is needed to assess whether mobile-phone counseling can be scaled-up to aid in the effective use of HIV and PMTCT services, as well as improving other related outcomes for mother and child dyad.

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

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual‐, household‐ or population level, has implications for both health and the economic development of a community and country. This paper describes a large‐scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu‐Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children.

The double burden of malnutrition is severe in KwaZulu‐Natal with high rates of maternal obesity and increasing prevalence of stunting and obesity among infants in the first 6 months of life.

Breastfeeding and complementary feeding practices are suboptimal and additional support for breastfeeding is required in the post‐natal period and in the workplace to address breastfeeding challenges.

Growth monitoring is inadequate in health facilities leading to many lost opportunities for early identification of malnutrition. Hence, anthropometric practices and interpretation of findings need to be strengthened.

A systematic review of hot weather impacts on infant feeding practices in low-and middle-income countries

BACKGROUND

Increased rates of exclusive breastfeeding could significantly improve infant survival in low- and middle-income countries. There is a concern that increased hot weather due to climate change may increase rates of supplemental feeding due to infants requiring fluids, or the perception that infants are dehydrated.

OBJECTIVE

To understand how hot weather conditions may impact infant feeding practices by identifying and appraising evidence that exclusively breastfed infants can maintain hydration levels under hot weather conditions, and by examining available literature on infant feeding practices in hot weather.

METHODS

Systematic review of published studies that met inclusion criteria in MEDLINE, EMBASE, Global Health and Web of Science databases. The quality of included studies was appraised against predetermined criteria and relevant data extracted to produce a narrative synthesis of results.

RESULTS

Eighteen studies were identified. There is no evidence among studies of infant hydration that infants under the age of 6months require supplementary food or fluids in hot weather conditions. In some settings, healthcare providers and relatives continue to advise water supplementation in hot weather or during the warm seasons. Cultural practices, socio-economic status, and other locally specific factors also affect infant feeding practices and may be affected by weather and seasonal changes themselves.

CONCLUSION

Interventions to discourage water/other fluid supplementation in breastfeeding infants below 6 months are needed, especially in low-middle income countries. Families and healthcare providers should be advised that exclusive breastfeeding (EBF) is recommended even in hot conditions.

Time to cessation of exclusive breastfeeding and associated factors among women with children aged 6-24 months in Kilimanjaro region, northern Tanzania: A community-based cross-sectional study

Background

Exclusive breastfeeding (EBF) up to six months is sub-optimal globally. Tanzania has surpassed the World Health Assembly (WHA) target of increasing the rate of exclusive breastfeeding among children below six months to at least 50% by the year 2025 the median age of cessation of EBF is only three months.

Objective

To determine the time to cessation of exclusive breastfeeding and its associated factors among women with children aged 6–24 months in Kilimanjaro region, Northern Tanzania.

Methods

This was a secondary analysis of data from a community-based cross-sectional study conducted between April 2016 and April 2017 in Kilimanjaro region, northern Tanzania. In the parent study, a multistage sampling technique was used to select study participants and interviewed using a questionnaire. Data for 1291 mother-child pairs were analyzed using STATA version 15. Kaplan-Meier method with the log-rank test estimated and compared the survivor functions across covariate levels. Cox regression proportional hazards models estimated the hazard ratios (HR) and their 95% confidence intervals (CI) for factors associated with time to cessation of exclusive breastfeeding.

Results

The prevalence of cessation of exclusive breastfeeding before six months was 68.7%, with a median age of cessation of four months (95% CI: 3, 4). In comparison to women living in Siha district, women living in Moshi Municipal (HR = 1.61; 95% CI = 1.24, 2.09), Same (HR = 1.32; 95% CI = 1.06, 1.65) and Mwanga (HR = 1.53; 95% CI = 1.20, 1.96) districts, had higher hazards of cessation of exclusive breastfeeding before six months. Women who received breastfeeding counselling at antenatal care had a lower hazard to cease EBF (HR = 0.76, 95% CI 0.65, 087) compared to those who did not receive breastfeeding counselling.

Conclusion

The median age of cessation of EBF is unsatisfactory but at least higher (four months) than the national level estimate of three months. District specific interventions and breastfeeding counselling at antenatal care are essential for improving time to cessation of exclusive breastfeeding. Promotion of adequate ANC visits remains one of the critical interventions to improve BF practices and other reproductive health outcomes.

Missed opportunity for family planning counselling along the continuum of care in Arusha region, Tanzania

INTRODUCTION

Adequate sexual and reproductive health information is vital to women of reproductive age (WRA) 15 to 49 years, for making informed choices on their reproductive health including family planning (FP). However, many women who interact with the health system continue to miss out this vital service. The study aimed to identify the extent of provision of FP counselling at service delivery points and associated behavioral factors among women of reproductive age in two districts of Arusha region. It also determined the association between receipt of FP counselling and contraceptive usage.

METHODS

Data were drawn from a cross-sectional survey of 5,208 WRA residing in two districts of Arusha region in Tanzania; conducted between January and May 2018. Multistage sampling technique was employed to select the WRA for the face-to-face interviews. FP counseling was defined as receipt of FP information by a woman during any visit at the health facility for antenatal care (ANC), or for post-natal care (PNC). Analyses on receipt of FP counseling were done on 3,116 WRA, aged 16-44 years who were in contact with health facilities in the past two years. A modified Poisson regression model was used to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders.

RESULTS

Among the women that visited the health facility for any health-related visit in the past two years, 1,256 (40%) reported that they received FP counselling. Among the women who had had births in the last 30 months; 1,389 and 1,409 women had contact with the service delivery points for ANC and PNC visits respectively. Of these 31% and 26% had a missed FP counseling at ANC and PNC visit respectively. Women who were not formally employed were more likely to receive FP counselling during facility visit than others. WRA who received any FP counseling at PNC were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.28; 95% Confidence Interval [CI]: 1.09, 1.49).

CONCLUSION

Overall, only 40% women reported that they received any form of FP counseling when they interfaced with the healthcare system in the past two years. Informally employed women were more likely to receive FP counselling, and women who received FP counselling during PNC visits were significantly more likely to use contraceptive in comparison to the women who did not receive FP counselling. This presents a missed opportunity for prevention of unintended pregnancies and suggests a need for further integration of FP counseling into the ANC and PNC visits.

Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters' Community in Tanzania; A Community Based Cross-Sectional Study

BACKGROUND

Initiating breastfeeding during the first hour after birth and continuing breastfeeding exclusively for 6 months prevents childhood infections such as diarrhoea. Exclusive breastfeeding (EBF) for the first 6 months of life of the baby is recognised globally as the best and the most effective intervention to ensure the survival of babies. The aim of this study was to determine the prevalence of EBF and its predictors among mothers of 0 to 6 months infants from pastoralists and hunters' community in Manyara region-Tanzania.

METHODS

This was a community-based analytical cross-sectional study that involved 342 mothers of 0 to 6 months infants who were randomly selected through 4 stage multistage sampling technique. Data was collected using an interviewer-administered questionnaire. Collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Binary Logistic Regression analysis was used to establish factors associated with EBF practices.

RESULTS

The prevalence of EBF among postnatal women from hunters and pastoralists societies was 47.1% at 95% CI=41.7%-52.5%. After adjusted for confounders, the predictors of EBF practice were age of infants (0-1 months, AOR = 2.838 at 95% CI = 1.326-6.075, p=.007), age of mothers (26-35 years, AOR=1.851 at 95% CI= 1.059-3.234, p=.031), Level of education of infants' mothers (primary education, AOR= 2.374 at 95% CI= 1.321-4.265, p=.004) and knowledge on exclusive breast feeding, AOR=2.51 at 95% CI= 1.435-4.393, p=.001.

CONCLUSION

Majority of mothers from pastoralists' and hunters' societies were not practising EBF. Predictors of EBF practice were; the age of infants, maternal age, level of education of the mother and knowledge on exclusive breastfeeding. Poor EBF practice was mainly contributed to low level of knowledge about the EBF. The low level of knowledge could have been contributed by poor access to maternal services. Nature of living (lack of permanent settlement) of the study population could have contributed to low access to maternal services. An innovative interventional study is highly recommended to come up with strategies that will improve knowledge on EBF and practice of EBF.

Determinants of exclusive breastfeeding for the first six months in China: a cross-sectional study

Background

Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China.

Methods

Data were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding.

Results

About 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding.

Conclusions

The exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains.

Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Northern Tanzania: Cohort study

INTRODUCTION

Childhood undernutrition is a major public health problem especially in low and middle-income countries (LMIC). The prevalence of early introduction of complementary feeding, low meal frequency, and low dietary diversity are frequent in LMICs. The effect of inappropriate complementary feeding practices on the nutritional status of children is not well documented in East African countries including Tanzania. Therefore, this study aimed at determining the effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Tanzania.

METHODOLOGY

A retrospective cohort study was done using the Pasua and Majengo cohorts of mother-child pairs in urban Moshi who were enrolled from 2002 to 2017. About 3355 mother-child pairs were included in the analysis. Appropriate complementary feeding practices were assessed using WHO IYFP indicators such as age at introduction of solid, semi-solid, or soft foods, minimum dietary diversity, and minimum meal frequency. Nutritional status (stunting, wasting, and underweight) was determined. Multilevel modeling was applied to obtain the effect of inappropriate complementary feeding practices on the nutritional status of children and to account for the clustering effect of mothers and children and the correlation of repeated measures within each child.

RESULTS

Majority of the children (91.2%) were given soft/semi-solid/solid foods before six months of age, 40.3percent had low meal frequency, and 74percent had low dietary diversity. Early introduction of complementary food at age 0-1 month was statistically significantly associated with higher risks of wasting and underweight (ARR 2.9, 95%CI 1.3-6.3; and ARR 2.6, 95% CI 1.3-5.1 respectively). Children with low minimum meal frequency had higher risks of stunting, wasting, and underweight (ARR 2.9, 95%CI 2.3-3.6; ARR 1.9, 95%CI 1.5-2.5 and ARR 1.9, 95%CI 1.5-2.4 respectively). Children with low minimum dietary diversity were more likely to be stunted than is the case with their peers who received the minimum dietary diversity (ARR 1.3, 95% CI 1.01-1.6).

CONCLUSION

There were a high proportion of children, which were fed inappropriately; Inappropriate complementary feeding practices predisposed children to undernutrition. Our study supports the introduction of complementary feeding, providing minimum dietary diversity, and minimum feeding frequency at six months of age as important in improving the nutritional status of the children.

Complementary feeding in Kongwa, Tanzania: Findings to inform a mycotoxin mitigation trial

Complementary feeding of 6‐ to 24‐month‐old infants and young children with adequate, safe and developmentally appropriate food is essential to child health. Inappropriate complementary foods and feeding practices are linked to the high incidences of undernutrition among infant and young children in most developing countries, including Tanzania. Mycotoxin risk is an additional concern, given the documented presence of aflatoxin and fumonisin in food systems of Africa, especially maize and groundnut. In preparation for a trial of mycotoxin mitigation, we conducted focus group discussions and recipe trials to explore complementary foods and feeding practices in Kongwa, a rural district of central Tanzania. Sixty mothers of infants from 6 to 18 months of age in five villages across the district were purposefully sampled. During focus group discussions, mothers reported to mostly feed their children with cereal and groundnut‐based foods as thin or thick porridges. The most common porridge preparations contained cereal (mostly, maize) ranging from 66.7% to 80.0% by weight and groundnuts from 7.7% to 33.3%. The ratio of cereal to groundnut ranged from 3:1 to 4:1. For the recipe trial sessions, mothers chose similar ingredients reported during discussions to prepare complementary foods. The reliance on maize and groundnuts in complementary foods predisposes the children to undernutrition and exposure to aflatoxins and fumonisins. These formative research results suggest multiple intervention points to improve complementary feeding and reduce mycotoxin exposure in this population, including education messages package on feeding practices, mycotoxin control practices and complementary food formulation.

Pooled Prevalence and Determinants of Prelacteal Feeding Practice in Eastern Africa Evidence from Demographic and Health Survey Data: A Multilevel Study

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.

Maternal and infant antiretroviral therapy adherence among women living with HIV in rural South Africa: a cluster randomised trial of the role of male partner participation on adherence and PMTCT uptake

‘Mother-to-child transmission of HIV’ can occur during the period of pregnancy, childbirth, or breastfeeding. ‘Prevention of mother-to-child transmission of HIV’ (PMTCT) in Mpumalanga Province, South Africa, is especially vital as the prevalence of HIV is 28.2% in women aged 15–49. PMTCT interventions resulted in a drop of MTCT rates in Mpumalanga from ∼2% in 2015 to 1.3% in 2016. This randomised controlled trial in Mpumalanga examined the potential impact of a lay healthcare worker administered intervention, ‘Protect Your Family’, on maternal and infant adherence, and to assess the relative influence of male partner involvement on infant and maternal adherence. This cluster randomised controlled trial used a two-phase and two-condition (experimental or control) study design where participants (n = 1399) did assessments both during pregnancy and post-postpartum. Only women participated in Phase 1, and both female and male partners participated in Phase 2. Results indicated that male involvement was associated with self-reported maternal or infant antiretroviral therapy (ART) adherence, but the intervention was not associated with ART adherence. Self-reported adherence was associated with depression, age, and partner HIV status. The study results provide support for the involvement of men in the antenatal clinic setting during pregnancy. Results also support further research on the meaning and assessment of male involvement and clarification of the constructs underlying the concept in the sub-Saharan African context. Outcomes provide support for male involvement and treatment of depression as adjuncts to improve uptake of both maternal and infant medication as part of the PMTCT protocol.

Do Health Workers Play a Role in Exclusive Breastfeeding among Working Mothers in Industrial Area?

The culture of breastfeeding has been inherited for a long time in Indonesia. Changes in lifestyle have caused an increase in the number of working mothers. Results of the Basic Health Research in 2018 reported exclusive breastfeeding coverage was decreased as much as 17% between 2013 and 2018. The purpose of this study was to determine association of health workers support and other factors on exclusive breastfeeding practice among working mothers in industrial area.

METHODS

A cross-sectional study was conducted in April-June 2018 in industrial area at Cibinong, Bogor, Indonesia. As many as 126 working mothers who had babies aged 7-24 mo were selected using a purposive sampling technique.

RESULTS

Only 37.3% of working mothers breastfed their babies exclusively. The support of health workers was the most dominant factor associated with exclusive breastfeeding {(p=0.001; OR: 6.210 (1.184-6.257)}. Husband's support {(p=0.014; OR: 5.228 (1.306-10.234} were also associated with exclusive breastfeeding. Working mothers who obtained support from health workers were 6.210 times more likely to breastfeed exclusively as compared to mothers who did not receive support from health workers.

CONCLUSIONS

Actual and direct support from husband and health workers from the period of pregnancy to lactation is important for the success of exclusive breastfeeding among working mothers.

Factors predicting six-month exclusive breastfeeding among mothers in Ho Chi Minh City, Vietnam

Purpose

Exclusive breastfeeding (EBF) rates continue to be low in Vietnam. This study aimed to determine the factors predicting 6-month EBF among mothers in Ho Chi Minh City, Vietnam.

Design/methodology/approach

A cross-sectional study was conducted with 259 mothers of infants aged between six to nine months at well-baby clinics in Ho Chi Minh City. The questionnaires used for data collection included personal background questionnaire, perceived benefits of breastfeeding scale, breastfeeding self-efficacy scale-short form, perceived barriers to breastfeeding scale and the family support of breastfeeding scale. Descriptive statistics, bivariate and multiple logistic regression were used for data analysis.

Findings

About 32% of the Vietnamese mothers practiced 6-month EBF. By increasing one unit of perceived benefits of breastfeeding, perceived self-efficacy in breastfeeding and family support, the mothers' likelihood to give 6-month EBF would increase 19% (AOR = 1.19, 95% CI = 1.08, 1.31), 12% (AOR = 1.12, 95% CI = 1.04, 1.19) and 10% (AOR = 1.10, 95% CI = 1.04, 1.16), while previous breastfeeding experience, maternal age and maternal education could not significantly contribute to the 6-month EBF.

Originality/value

This is the first study in Vietnam using a nursing model, the health promotion model, as a framework to identify factors predicting 6-month EBF. An effective program for promoting EBF could be developed by manipulating and tailoring the predicting factors to fit the Vietnamese mothers' needs through a mother class, lactation clinic or individual approach.

Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

BACKGROUND

Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first 6 months among mothers on antiretroviral therapy in the Eastern Cape, South Africa.

METHODS

This was a cross-sectional study conducted between January to May 2018, on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice.

RESULTS

The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. E Exclusive breastfeeding's prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.08-2.56) and those with grade 12 or less level of education (AOR 2.76, 95% CI 1.02-7.49) had a higher likelihood of practising EBF for 6 months since birth while mothers who consumed alcohol (AOR 0.54, 95% CI 0.34-0.85) were less likely to practice EBF for 6 months.

CONCLUSIONS

The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.

Longitudinal interrelationship between HIV viral suppression, maternal weight change, breastfeeding, and length in HIV-exposed and uninfected infants participating in the Kabeho study in Kigali, Rwanda

PURPOSE

The health of infants that are HIV-exposed and -uninfected (HEU) is a major public health concern as HIV becomes a chronic condition. We investigate the interrelationship between maternal viral suppression, maternal weight status, breastfeeding, and infants that are HEU.

METHODS

The Kabeho study followed 502 HEU infants in Kigali, Rwanda, for 24 months from 2013 to 2014. We use a structural equation modeling approach to investigate the dynamic relationships between viral suppression, maternal weight change, breastfeeding, and infant length-for-age z-score (LAZ) as defined by the WHO.

RESULTS

Older mothers are more likely to be virally suppressed and to breastfeed. Viral suppression and the mother being on antiretroviral treatment for longer were related to lower infant LAZ at three months. A more positive maternal weight change was related to higher infant LAZ at the end of each period. At 12 months, a higher infant LAZ was related to increased probability of continued breastfeeding. At 18 months, continued breastfeeding was related to lower LAZ, and food shortages were related to higher LAZ.

CONCLUSION

There is a complex interrelationship between viral suppression, maternal weight change, breastfeeding, and infant LAZ. These relationships demonstrate the link between maternal and infant health in the context of HIV.

Predictors of maternal attachment among breastfeeding mothers in Jordan

Aim

This study aims to investigate the difference in maternal attachment in different scenarios, that is among mothers who breastfed their infants and mothers who combined breastfeeding with other types of feeding and determine the predictors of maternal attachment in breastfeeding mothers.

Design

A survey was used to collect data from 222 mothers from Jordan University of Science and Technology in Jordan.

Method

Who used breastfeeding or mixed methods and had healthy infants aged from 3 to 12 months and who did not have postpartum complications. The survey was conducted in three healthcare centres in Irbid city, Jordan.

Results

Mothers only breastfeed their infants did not differ in their attachment compared with those who used mixed feeding methods (using breastfeeding with formula feeding). Many factors showed significant impact on maternal attachment, which includes the mother's education, if they have assistance in caring for their infant, marital relationship quality, the infant's gender and the planning for pregnancy.

Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study

Exclusive breastfeeding has many health benefits for the baby and the mother. This study explored the reasons for the early introduction of supplementary feeding before six months, and the issues faced by parturient women in practicing exclusive breast feeding (EBF) for their HIV-exposed infants in the Eastern Cape, South Africa. Narratives from 319 parturient women with HIV (aged 18 years and above) were collected at three hospitals in the Eastern Cape through semi-structured interviews over a period of five months. Qualitative data were analysed using thematic content analysis. The maternal perception of HIV transmission from breast milk influenced the decision for the immediate introduction of formula feeding. Breast sores, lumps, surgery and perceived insufficiency of milk influenced the decision of mothers to initiate formula feeding within the first two months. However, mothers who initiated complementary feeding after two months were driven by factors common among newborns (refusal of breast milk, baby crying inconsolably and fear of losing weight) and social factors (economic or financial hardships and work-related challenges). Additionally, advice from family members weighed heavily in the decision to switch to complementary feeding, contrary to the healthcare providers' recommendations. Early complementary feeding for HIV-exposed infants is influenced by maternal perceptions of breast milk transmission, breast and infant factors and socio-economic and cultural practices in the region. Thus, behavioural interventions tailored towards promoting exclusive breastfeeding practices in this population, starting from the pre-natal and continuing during the post-partum period, should also target the immediate family members. National policy should focus on creating an EBF-friendly environment at the workplace for women.

Insights on exclusive breastfeeding norms in Kinshasa: findings from a qualitative study

Background

For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first 6 months of life. However, according to the nationally-representative 2013–2014 Demographic and Health Survey, under 50% of babies in the Democratic Republic of Congo are exclusively breastfed. Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breastmilk during the first 3 days of life. This analysis aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s (FTM’s) social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa.

Methods

The qualitative analysis was based on a vignette presented during 14 focus group discussions, with a purposively selected sample (n = 162) of FTMs age 15–24, and the male partners, mothers and mothers-in-law of FTMs age 15–24 in three health zones in Kinshasa in 2017. Thematic content analysis was performed to identify concepts and patterns in the participants’ discussions.

Results

Overall, community norms were not supportive of exclusive breastfeeding. The main barriers to exclusive breastfeeding were the belief held by most FTMs that exclusive breastfeeding was an uncommon practice; the desire to avoid negative sanctions such as name-calling and mockery for refusal to give babies water in the first 6 months of life; the desire to please key members of their social networks, specifically their mothers and friends, by doing what these influencers expected or preferred them to do; FTMs’ own lack of experience with infant feeding; and trust placed in their mothers and friends.

Conclusion

Social norms can be maintained by the belief about what others do, perceived expectations about what individuals ought to do, the negative sanctions they can face and their preference to conform to social expectations. Thus, addressing cultural beliefs and targeting sensitization efforts to key influencers that provide support to FTMs are needed to promote exclusive breastfeeding in Kinshasa. In doing so, strategies should address the barriers to exclusive breastfeeding including related misconceptions, and improve FTMs’ self-efficacy to overcome the influence of others.

A mixed-methods systematic review on barriers to exclusive breastfeeding

INTRODUCTION

The World Health Organization recommends exclusive breastfeeding for every newborn during the first 6 months of life, yet women come across various challenges to continuing it.

AIM

This systematic review was intended to identify barriers to exclusive breastfeeding among mothers.

METHODS

MEDLINE, Cumulative Index to Nursing and Allied health literature, ProQuest, Web of Science and Scopus databases were searched from January 1990 to October 2017. The systematic review included quantitative, qualitative and mixed-methods studies to identify barriers to exclusive breastfeeding among mothers of reproductive age with an infant aged between 0 and 12 months. All studies were screened based on titles, abstracts and full text by two reviewers independently. The methodological quality of included studies was assessed using appropriate tools. Of the 9737 eligible records, 44 studies were included for analysis. Classification of barriers to exclusive breastfeeding was adopted from the conceptual framework of factors affecting breastfeeding practices given by Hector and colleagues.

RESULTS

In total 32 barriers were grouped under individual, group and society level factors. Meta-analysis indicated that mothers who smoked had 2.49 times more odds of not exclusively breastfeeding than non-smoking mothers and mothers who had undergone caesarean section had 1.69 times more risk of cessation of exclusive breastfeeding than mothers who have had a vaginal childbirth.

CONCLUSION

The systematic review revealed a complex interplay of various barriers related to exclusive breastfeeding. It is recommended that context-specific strategies should be designed in accordance with barriers existing in a region or country.

Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review

Background

Exclusive breastfeeding (EBF) is recommended for the first six months of age by the World Health Organization. Mothers’ good knowledge and positive attitude play key roles in the process of exclusive breastfeeding practices. In this study, we report on a systematic review of the literature that aimed to examine the status of mothers’ knowledge, attitude, and practices related to exclusive breastfeeding in East Africa, so as to provide clues on what can be done to improve exclusive breastfeeding.

Methods

A systematic review of peer-reviewed literature was performed. The search for literature was conducted utilizing six electronic databases, Pub med, Web of Science, Google Scholar, Embase, Science Direct, and Cochrane library, for studies published in English from January 2000 to June 2019 and conducted in East Africa. Studies focused on mothers’ knowledge, attitudes, or practices related to exclusive breastfeeding. All papers were reviewed using a predesigned data extraction form.

Results

Sixteen studies were included in the review. This review indicates that almost 96.2% of mothers had ever heard about EBF, 84.4% were aware of EBF, and 49.2% knew that the duration of EBF was the first six months only. In addition, 42.1% of mothers disagreed and 24.0% strongly disagreed that giving breast milk for a newborn immediately and within an hour is important, and 47.9% disagreed that discarding the colostrum is important. However, 42.0% of mothers preferred to feed their babies for the first six months breast milk alone. In contrast, 55.9% of them had practiced exclusive breastfeeding for at least six months.

Conclusions

Exclusively breastfeeding among our sample is suboptimal, compared to the current WHO recommendations. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counseling, to improve maternal attitudes and knowledge toward breastfeeding practices.

Exclusive Breast Feeding and Its Associated Factors Among Mothers of <12 Months Old Child in Harar Town, Eastern Ethiopia: A Cross-Sectional Study

Background

Exclusive breast-feeding is the practice of feeding breast milk during the first 6 months and no other liquids and solid foods except medications. Despite its demonstrated benefits, exclusive breast-feeding practice in many countries including Ethiopia is lower than the international recommendation. However, studies about exclusive breast-feeding in the study area are limited. Therefore, this study aimed to fill this gap.

Methods and Materials

Community-based cross-sectional study was employed. A cluster sampling method was used to select 577 women who had a child aged <12 months. Data were collected using a pretested interviewer-administered questionnaire. Epi-Data version 3.1 and SPSS version 21 were used for data entry and analysis. Bivariate and multivariate logistic regressions were used to analyze the association between the dependent and independent variables.

Results

A total of 577 study participants have participated in the study which gives 97.8% response. Exclusive breast-feeding practice among the mothers was 45.8%. Women in the age group of 26-40 were 2 times more likely to breast-feed than women in the age group of 18-25 at (AOR = 1.980 [95% CI = 1.098, 3.570]). Women who have information about exclusive breast-feeding were two times more likely to breast feed than those who have no information at (AOR = 1.952 [95% CI = 1.130, 3.373]). Those women who initiated breast-feeding early were 12 times more likely to breastfeed than those women who did not initiate early at (AOR = 12.336 [95% CI = 1.331, 14.316]).

Conclusion

The overall exclusive breast-feeding practice among the women was found to be less. Age, information on breast-feeding and early initiation of breast-feeding were found as important predictors of exclusive breast-feeding. Improving access to information on recommended infant feeding is vital, and encouraging exclusive breast-feeding among mothers through proper counseling and mother-friendly work environment is advisable.

Social and Bio-Medical Predictors of Exclusive Breastfeeding Among Nursing Mothers in Lagos and Taraba States, Nigeria

PURPOSE

Although exclusive breastfeeding (EBF) is known to have positive consequences for mothers and infants, EBF rate in Nigeria is <25%. This study investigated if social factors were stronger predictors of EBF than bio-medical factors in the metropolitan areas of Lagos and Taraba States. Social factors included mother's education, infant sex, place of birth, and nature of mother's employment, while bio-medical factors included nature of birth (whether vaginal or caesarean section), problems with breast/nipple, breast milk insufficiency, and mother's age.

DESIGN AND METHODS

The study adopted a cross-sectional survey design and mixed method of data collection. From the two states, 500 mothers with babies between 7 and 12 months of age completed a structured questionnaire. Twenty respondents from each state were interviewed using an in-depth interview guide.

RESULTS

Education (β = 1.743; p < 0.001), infant sex (β = -0.454; p < 0.05), and place of delivery (β = -1.552; p < 0.001) were significant social predictors. Breast milk insufficiency (β = -1.851; p < 0.001) and mother's age (β = 0.064; p < 0.001) were significant bio-medical predictors. When all the eight factors were considered, only two of the three social factors, namely, education and infants' sex, remained significant, while three bio-medical factors, namely, breast milk insufficiency, mother's age, and nature of delivery, were significant.

CONCLUSIONS

Social and bio-medical factors co-determine the practice of EBF and must not be considered dichotomous.

PRACTICAL IMPLICATIONS

Interventions to encourage EBF among Nigerian mothers must focus on education regarding its benefits and correction of misconceptions that breast milk alone is insufficient as an infant's diet.

Main Barriers to Optimal Breastfeeding Practices in Armenia: A Qualitative Study

BACKGROUND

In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4-5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices.

RESEARCH AIM

To identify the main barriers to optimal breastfeeding practices in Armenia.

METHODS

We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches.

RESULTS

We identified two main categories of barriers to optimal breastfeeding-systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers-mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers.

CONCLUSION

Optimal breastfeeding is crucial for the best start to an infant's life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.

Prenatal infant feeding intentions and actual feeding practices during the first six months postpartum in rural Rwanda: a qualitative, longitudinal cohort study

Background

Exclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0–1 month to 81% among those aged 4–5 months. Little is known about what influences mothers’ breastfeeding practices. This study aimed to gain insights into expectant mothers’ prenatal feeding intentions, the underlying reasons, actual practices after birth, and factors facilitating or impeding EBF for the first 6 months of a child’s life in Muhanga District, Rwanda.

Methods

This qualitative longitudinal study, conducted between December 2016 and October 2017 as part of a larger study, recruited a purposive sample of 39 pregnant women attending prenatal consultations during their last trimester in two rural health centers. Women were interviewed during pregnancy, within the first week after birth and at 4 and 6 months postpartum to explore intentions, actual practices, critical transition points, and facilitating or impeding factors. Interviews were recorded, transcribed verbatim, and analyzed thematically.

Results

Of the 39 participants, 38 intended to breastfeed within the first hour after birth, and 32 intended to breastfeed exclusively for the first 6 months. In practice, 34 initiated breastfeeding within the first hour, and 12 breastfed exclusively for 6 months. Impeding factors include perceived breastmilk insufficiency, pressure from family members, past experiences, mothers’ concerns over their infants’ health, mothers’ heavy workload, poverty and food insecurity. Factors facilitating early initiation and EBF include mothers’ awareness of EBF’s advantages, confidence in their breastfeeding ability, and support from health professionals and family members.

Conclusion

Despite participants’ intentions about breastfeeding, there was a gap between intentions and actual practices. An interplay of barriers at individual, group and societal levels impeded women from EBF for the first 6 months. EBF promotion interventions should consider supporting and equipping breastfeeding mothers with skills to deal with perceived breastmilk insufficiency and to recognize the true signs of baby hunger cues. Furthermore, important influential family and community members should be targeted to support mothers to breastfeed. Interventions that consider addressing the issue of poverty-driven food insecurity should not be overlooked either.

Breastfeeding Support Offered at Delivery is Associated with Higher Prevalence of Exclusive Breastfeeding at 6 Weeks Postpartum Among HIV Exposed Infants: A Cross-Sectional Analysis

Objective HIV-exposed uninfected infants are almost twice as likely to die compared to infants born to HIV-uninfected women. HIV-exposed uninfected children whose mothers are on ART and who are breastfed have the lowest risk of dying by 24 months of age. Interventions to improve breastfeeding among HIV-infected mothers are needed. We aimed to assess the association between support/counseling provided by healthcare workers following delivery and the rate of exclusive breastfeeding (EBF) at 6-week postpartum. Methods This is a secondary analysis of data collected as part of a trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services. Between April 2013 and August 2014, newly diagnosed HIV-infected women, ≤ 32 weeks pregnant, registering for antenatal care (ANC), in 89 clinics in Kinshasa, Democratic Republic of Congo, were recruited and followed through 6 weeks postpartum. At 6-week, participants were asked if they had given anything other than breastmilk to their infant in the 24 h preceding the interview (No = EBF) and whether a nurse or a doctor talked to them about breastfeeding after they gave birth (YES = received breastfeeding support/counseling). Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) measuring the strength of the association between EBF and receiving breastfeeding support/counseling by a healthcare provider following delivery. Results Of 433 women enrolled, 328 attended a 6-week postpartum visit including 320 (97%) with complete information on EBF. Of those 320, 202 (63%) reported giving nothing other than breastmilk to their infant in the previous 24 h; 252 (79%) reported that a healthcare provider came to talk to them about breastfeeding following delivery. Mothers who reported receiveing breastfeeding support/counseling from a healthcare provider were more likely to exclusively breastfeed compared to those who did not (69% vs. 38%, OR 3.74; 95% CI 2.14-6.54). Adjustment for baseline sociodemographic characteristics did not change the association substantially, (adjusted OR 3.72; 95% CI 2.06-6.71). Conclusion for Practice Receipt of breastfeeding support/counseling from a healthcare provider after delivery among HIV-infected mothers in care at 6-weeks postpartum in Kinshasa almost quadrupled the odds of EBF.

It takes a village: An empirical analysis of how husbands, mothers-in-law, health workers, and mothers influence breastfeeding practices in Uttar Pradesh, India

Evidence on strategies to improve infant and young child feeding in India, a country that carries the world's largest burden of undernutrition, is limited. In the context of a programme evaluation in two districts in Uttar Pradesh, we sought to understand the multiple influences on breastfeeding practices and to model potential programme influence on improving breastfeeding. A cross‐sectional survey was conducted among 1,838 recently delivered women, 1,194 husbands, and 1,353 mothers/mothers‐in‐law. We used bivariate and multivariable logistic regression models to examine the association between key determinants (maternal, household, community, and health services) and breastfeeding outcomes [early initiation of breastfeeding (EIBF)], prelacteal feed, and exclusive breastfeeding (EBF). We used population attributable risk analysis to estimate potential improvement in breastfeeding practices. Breastfeeding practices were suboptimal: EIBF (26.3%), EBF (54%), and prelacteal feeding (33%). EIBF was positively associated with maternal knowledge, counselling during pregnancy/delivery, and vaginal delivery at a health facility. Prelacteal feeds were less likely to be given when mothers had higher knowledge, beliefs and self‐efficacy, delivered at health facility, and mothers/mothers‐in‐law had attended school. EBF was positively associated with maternal knowledge, beliefs and self‐efficacy, parity, and socio‐economic status. High maternal stress and domestic violence contributed to lower EBF. Under optimal programme implementation, we estimate EIBF can be improved by 25%, prelacteal feeding can be reduced by 25%, and EBF can be increased by 23%. A multifactorial approach, including maternal‐, health service‐, family‐, and community‐level interventions has the potential to lead to significant improvements in breastfeeding practices in Uttar Pradesh.

Changes in rates of early exclusive breast feeding in South Africa from 2010 to 2013: data from three national surveys before and during implementation of a change in national breastfeeding policy

OBJECTIVE

Between 1998 and 2009 reported exclusive breastfeeding (EBF) rates in South African infants, aged 0-6 months, ranged from 6.2% to 25.7%. In 2011, the National Minister of Health shifted policy to promote 'exclusive' breast feeding for all women in South Africa irrespective of HIV status (Tshwane Declaration of Support for Breastfeeding in South Africa). This analysis examines early EBF prior to and through implementation of the declaration.

SETTING

Data from the three South Africa national, cross-sectional, facility-based surveys, conducted in 2010, 2011-12 and 2012-13, were analysed. Primary health facilities (n=580) were randomly selected after a stratified multistage probability proportional-to-size sampling to provide valid national and provincial estimates.

PARTICIPANTS

A national sample of all infants attending their 6 weeks vaccination at selected facilities. The number of caregiver-infant pairs enrolled were 10 182, 10 106 and 9120 in 2010, 2011-12, and 2012-13, respectively.

PRIMARY OUTCOME MEASURE

Exclusive breast feeding as measured using structured 24 hours recall plus prior 7 days (8 days inclusive prior to day interview) and WHO definition.

RESULTS

The adjusted OR comparing EBF prevalence in 2011-12 and 2012-13 with 2010 were 2.08 and 5.51, respectively. Mothers with generally higher socioeconomic status, HIV-positive, unplanned pregnancy, primipara, postcaesarean delivery, resided in certain provinces and women who did not receive breastfeeding counselling had significantly lower odds of EBF.

CONCLUSION

With what seemed to be an intransigently low EBF rate since 1998, South Africa saw an increase in early EBF for infants aged 4-8 weeks from 2010 to 2013, coinciding with a major national breastfeeding policy change. These increases were seen across all provinces and subgroups, suggesting a population-wide effect, rather than an increase in certain subgroups or locations. While these increases in EBF were significant, the 59.1% prevalence is still below desired levels of early EBF. Further improvements in EBF programmes are needed.

Factors associated with the early termination of exclusive breastfeeding among mother-infant dyads in Samara-Logia, Northeastern Ethiopia

Background

The World Health Organization recommends that mothers should exclusively breastfeed their infants until 6 months of age due to the benefits for the mother and the child. There is documented evidence on exclusive breastfeeding from Ethiopia, but not specifically from Samara-Logia city administration. This study aimed to assess the factors associated with early termination of exclusive breastfeeding among mother-infant dyads in Samara-Logia, Ethiopia.

Methods

A cross-sectional study was conducted in March 2018. Data were collected on 484 randomly selected mother-infant dyads. The Kaplan Meier curve with the log-rank test was used to compare the survival difference. Cox regression models were used to identify the predictors of early termination of exclusive breastfeeding.

Results

The cumulative proportion of survival probability of exclusive breastfeeding to 6 months was 64.5%, with the median duration of 6 months. Mothers having partners with formal education [Adjusted hazard ratio (AHR): 0.58; 95% confidence interval (CI): 0.39, 0.85], receiving counseling on exclusive breastfeeding at antenatal check-up [AHR: 0.62; 95% CI: 0.43, 0.91], giving birth in a health institution [AHR: 0.50; 95% CI: 0.28, 0.88], initiating breastfeeding within the first hour [AHR: 0.41; 95% CI: 0.24, 0.68], and perceiving breast milk adequate for the first 6 months [AHR: 0.17; 95% CI: 0.12, 0.25] were associated with lower hazard of discontinuing exclusive breastfeeding before 6 months.

Conclusion

This study showed that the cumulative proportion of survival probability on exclusive breastfeeding was low in Samara-Logia city administration. Educating husbands to support their partners, strengthening infant feeding counseling, promoting institutional delivery, educating women about the benefit of early initiation of breastfeeding, and expanding urban health extension program are important to improve the duration of exclusive breastfeeding in Ethiopia.

Exclusive breastfeeding practices and associated factors among lactating mothers of infants aged 6-24 months in the Kumasi Metropolis, Ghana

OBJECTIVE

In spite of the benefits associated with exclusive breastfeeding practice (EBP), the practice remains low in Ghana. This study investigates prevalence and factors associated with EBP among lactating mothers of infants aged 6-24 months in Metropolitan Kumasi. Cross-sectional hospital-based data were collected at 5 health facilities from 160 randomly sampled lactating mothers. Multivariate logistic regressions were performed to determine factors associated with EBP.

RESULTS

The prevalence of EBP was 50.6%. The study revealed that mothers aged 30-49 years (AOR = 1.948; 95% CI [1.146-3.310]), with normal delivery (AOR = 1.824; 95% CI [0.863-2.467]) and those who were unemployed (AOR = 1.202; 95% CI [0.557-2.593]) and without sore nipple (AOR = 1.890; 95% CI [1.534-3.484]) were significantly more likely to practise exclusive breastfeeding. The study further found that respondents with 3-4 deliveries were 0. 492 times significantly less likely to practise exclusive breastfeeding (AOR = 0.492; 95% CI [0.274-0.886]). The study has established the primacy of socio-demographic and health-related factors such as mothers' age, employment status, number of deliveries (parity), mode of delivery and sore nipples in explaining EBP among lactating mothers. We recommend that policy on exclusive breastfeeding should consider multiple socio-demographic and health-related factors, especially, those associated with EBP.

Exclusive breastfeeding among Saudi mothers: Exposing the substantial gap between knowledge and practice

Background:

Rates of exclusive breastfeeding are exceedingly low in the Arabic world. This study aims to estimate the local prevalence of, and knowledge about, exclusive breastfeeding in Saudi Arabia.

Method:

This is a cross-sectional survey of mothers of infants aged 6–12 months who attended Taif-based “well-baby clinic.” A structured questionnaire was developed to explore predictors of, and participants’ knowledge about, exclusive breastfeeding.

Results:

Participants in the study were 202 mothers. The rate for initiation of breastfeeding in the first hour after childbirth was 13.9%. The prevalence of exclusive breastfeeding was 16.3%. Knowledge level was great among participating mothers as 65.3% of mothers scored over 75% of the total knowledge score and 95% got more than half of the questions right. Only having 3–6 children (P = 0.023) and 1-year interpregnancy interval (P = 0.005) were associated with the positive likelihood of exclusive breastfeeding. Baby age (P = 0.0218), birth in a private facility (P = 0.00843), and university education (P = 0.0131) were associated with better knowledge.

Discussion and Conclusion:

Rates of exclusive breastfeeding practice are low in Saudi Arabia despite adequate knowledge about its benefits and necessity.

Effects of Early Initiation of Breastfeeding on Exclusive Breastfeeding Practices of Mothers in Rural Haiti

INTRODUCTION

Rates and relationships of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) of mothers in rural Haiti were examined. Prelacteal and complementary feedings were identified.

METHODS

With a cross-sectional descriptive design, survey data from mothers (N = 195) were collected at three intervals after birth. Data were analyzed for indicators of EIBF, EBF, and complementary feedings.

RESULTS

Overall, 148 (75.9%) mothers reported EIBF, and 75 (38.5%) reported EBF. EIBF was associated with EBF, with an adjusted relative risk 1.35 (95% confidence interval = [0.84, 2.18]). Several nutritive and nonnutritive substances interrupted EBF during the first 6 months of life.

DISCUSSION

Haiti has an under-five mortality rate of 67.0/1,000 live births, exceeding the mean of 46.5/1,000 live births for developing regions. Both EIBF and EBF are associated with decreased neonatal and early infant mortality. Country-specific data are needed to inform and develop breastfeeding initiatives and community-level campaigns to improve the prevalence of EIBF and EBF in Haiti.

A qualitative exploration of the sociocultural determinants of exclusive breastfeeding practices among rural mothers, North West Nigeria

Background

Suboptimal breastfeeding is responsible for 96% of deaths among children under 12 months of age in developing countries. However, the exclusive breastfeeding rate in Nigeria from birth to 6 months is just 23%. The study explored the sociocultural factors that influence exclusive breastfeeding among rural mothers.

Methods

The social constructionism-interpretivist epistemological approach underpinned this qualitative study. Semi-structured interviews were conducted with 20 mothers aged 18–39 years, purposefully sampled from two Local Government Areas in Katsina State, Nigeria. Thematic content approach was utilised for analysis.

Results

Three major themes were developed from the analysis: (1) Breastfeeding initiation – the determinants of how soon a mother initiated breastfeeding included traditional new-born care practices, the birth attendant and place of delivery. (2) Exclusive breastfeeding - motivation to sustain exclusive breastfeeding was influenced by the conflict between the obligation to perform traditional rites, the mother’s awareness and family support. (3) Decision-making about infant feeding – the husband, grandmother, traditional birth attendant and the health workers all influenced participants’ decisions around infant feeding. Despite awareness of the benefits of exclusive breastfeeding among most mothers interviewed, they expressed concerns that they may not win their family’s support if their views were contrary to those held by other family members.

Conclusion

While mothers have limited powers to make decisions, the key role that grandmothers and husbands have in decisions about breastfeeding demonstrates the need to engage the support of partners and relatives through community-driven policies and integrated interventions that address social and cultural barriers throughout the prenatal and postnatal period.

Determinants of none-exclusive breast feeding practice among HIV positive women at selected Health Institutions in Ethiopia: case control study

OBJECTIVE

Exclusive breast feeding (EBF) has been practiced all over the world as the best way of cost effective feeding practice, particularly in the developing countries. This practice is associated with a lower risk of human immunodeficiency virus transmission than mixed feeding. 'Studies focusing on determinants of EBF among women living with HIV are limited. Hence, the current study is aimed at identifying those determinants.

RESULT

This study showed that being employed (AOR = 4.363, 95% CI 2.324 to 8.191), home delivery (AOR = 0.029, 95% CI 0.004 to 0.235) and secondary education (AOR = 10.351, 95% CI 1.297 to 82.628) are significantly associated with non-EBF. In this study none EBF practice was significantly associated with women who are employed, delivered at home and educational status.

A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

BACKGROUND

The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding.

METHODS

Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson's five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis.

RESULTS

From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma.

CONCLUSION

The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF.

Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers

BACKGROUND

Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival.

OBJECTIVE

We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding.

METHODS

We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically.

RESULTS

Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores.

CONCLUSION

Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.

Facilitators and Barriers to Breastfeeding and Exclusive Breastfeeding in Kilimanjaro Region, Tanzania: A Qualitative Study

Background

Breastfeeding is the best way to feed infants. It is a simple intervention to improve child health and development. Despite its advantages, there is a low global rate of exclusive breastfeeding (EBF) and, in Kilimanjaro region, Tanzania, EBF is rarely practiced. The aim of this paper is to explore social and cultural factors that might influence the practice of breastfeeding and exclusive breastfeeding in Kilimanjaro region.

Methods

A qualitative design was used. Three districts in Kilimanjaro region, namely, Same, Moshi Municipal Council, and Rombo, were selected. In each district three focus group discussions (FGDs) were conducted with mothers with infants aged 0-12 months.

Results

A total of 78 mothers participated in the focus group discussions. A majority of the mothers were positive towards breastfeeding. They believed that it prevents child sickness, creates happiness, and is good for family economy. Despite the positive attitudes, the mothers revealed many perceptions that interfered with breastfeeding and exclusive breastfeeding. These included the following: breast milk is very light and has bad odor, breastfeeding may affect mothers appearance, chango (abdominal pain) has to be treated, there is fear of the evil eye when breastfeeding in public places, breast milk may become unclean, and there is a need of pauses in breastfeeding after the child has burped on the breast.

Conclusion

There are beliefs that promote the practice of breastfeeding in this setting; these local beliefs could be used to develop breastfeeding messages to improve breastfeeding practices. However, there is also a need to address beliefs that interfere with the practice of exclusive breastfeeding in this setting.

Exclusive Breastfeeding Rates and Factors Associated with Exclusive Breastfeeding Practices in Northern Tanzania: Measurement using Two Different Methodologies-24 Hours Recall and Recall Since Birth

BACKGROUND

Exclusive breastfeeding (EBF) has many benefits to the child from mental to physical growth and development; however, methods of measuring EBF have raised a number of policy and programmatic questions. This study assesses EBF rates and factors associated with EBF practices in Northern Tanzania using two different methodologies, namely, the 24-hours recall and recall-since-birth.

METHODS

A cohort study was conducted from October 2013 to December 2015 among mother-infants' pairs. Mothers with child delivery information (N=430) were followed and included in the analyses. We enrolled pregnant women who were in their third trimesters and interviewed them with the help of questionnaires at enrollment, delivery, 7 days and thereafter monthly up to nine months after delivery. At each visit after delivery, information on breastfeeding using the two methods (24 hours recall and recall-since-birth) was collected.

RESULTS

The prevalence of EBF dropped from one month to six months when using both the 24 hours recall and the recall since birth methods, but at different rates. At six months, 24.2% of the mothers practiced EBF when measured with the recall since birth method, compared to 38.8% when measured with the 24 hour recall. Predictors of EBF were also different. When using the recall since birth method, women who had received counseling on infant feeding had increased odds of practicing EBF compared to those who did not receive counseling, [AOR=2.3; 95% CI (1.2, 3.7)]. When using 24 hours recall, women who were unemployed had increased odds of practicing EBF compared to those who were employed [AOR=1.5;95% CI(1.1,2.5)], and women aged 35 - 49 years had decreased odds of practicing EBF compared to younger women[AOR=0.28; 95 % CI(0.1,0.7)].

CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS

The two methods for EBF give substantially different results, both in the prevalence of EBF and factors associated with EBF. The higher EBF obtained with 24 hours recall represents an overestimation and thereby an overly positive picture of the situation.

Higher likelihood of 6-months exclusive breastfeeding among HIV infected than uninfected mothers: a household survey in Kenya

BACKGROUND

Exclusive breastfeeding (EBF) (breast milk feeding without additional food or drink, except medicine) is associated with deceased risk of postnatal transmission of HIV from mother to child.

METHODS

This analysis used data from a household survey in Western Kenya in 2011. Participants were mothers with HIV and uninfected mothers, aged ≥14 years who gave birth in the prior year (ever breastfed) within the Kenya Medical Research Institute/US Centers for Disease Control and Prevention (KEMRI/CDC) Health and Demographic Surveillance System. Data on breastfeeding counseling and knowledge and practices regarding breastfeeding were collected. Rates and correlates of EBF were determined using multivariable logistic regression.

RESULTS

Of 652 mothers enrolled in the study, 435 were included in this analysis. Median age was 28 years among 154 mothers with HIV and 25 years among 281 uninfected mothers. Mothers with HIV were more likely than uninfected mothers to report breastfeeding counseling at a health facility (88.9% vs. 51.6%, respectively, p <  0.001) and EBF for 6-months (64.9% versus 34.5%, p <  0.001). Premastication (pre-chewing of food by adults prior to feeding to children) was less prevalent among mothers with HIV (3.9% vs. 13.2% p = 0.001) who were also more knowledgeable about potential risk of HIV transmission through premastication (83.1% vs 71.2% p = 0.005). Mothers with HIV who EBF for six months were 3.68-fold more likely to report counseling on EBF (aOR 3.68; 95% CI: 1.00,13.70). Uninfected mothers with polygamous marriage, any antenatal care visit, unskilled delivery and delayed breastfeeding initiation (> 1 h) were less likely to practice EBF for six months 62% (aOR 0.38; 95%CI: 0.20,0.94), 72% (aOR 0.28; 95%CI: 0.10,1.00), 54% (aOR 0.46; 95% CI: 0.22,1.00) and 46% (aOR 0.54; 95%CI: 0.30,1.00) respectively.

CONCLUSIONS

Mothers with HIV were more likely to report breastfeeding counseling at a health facility, EBF for six months and less likely to practice premastication than uninfected mothers. Lessons learned from breastfeeding counseling in mothers with HIV could be used to improve awareness and change breastfeeding practices for all mothers.