Factors associated with breastfeeding duration: a prospective cohort study in Sichuan Province, China

Breastfeeding status and determinants of current breastfeeding of Syrian refugee children in Turkey

BACKGROUND

Turkey hosts the highest number of refugees in the World including 65% of Syrian refugees who reside in Turkey. Mothers and children were the most negatively affected among the Syrian refugees who had to migrate from their countries as a result of the civil war in Syria. One of the most important issues in terms of child health is breastfeeding. Breastfeeding in migrants should be promoted worldwide to mitigate infant mortality and diseases. The aim of this study is to examine the association between breastfeeding status in Syrian refugee children under two years and socio-demographic characteristics of Syrian refugee mothers with further analysis of Turkey Demographic and Health Survey-Syrian Migrant-2018 (TDHS-SM-2018) data.  METHODS: The data source is the TDHS-SM-2018. Data for the last-born children with a gestational duration greater than 32 weeks from the mothers' singleton pregnancy, aged less than two years old and living with the mother were included (unweighted n = 744). The dependent variable was the breastfeeding status (breastfeeding in the last 24 h during the study period) in children under two years. Complex sample logistic regression evaluated the associations.

RESULTS

The percentage of breastfeeding in children under the age of two years was found to be 62.4%, and the total median breastfeeding duration was 14.6 months. Univariate analysis showed that the earlier mothers immigrated to Turkey, the higher the current breastfeeding rate. Breastfeeding rates were found to be higher among people living in the South and East regions (65.2% and 65.1% respectively). Multivariable binary complex sample logistic regression revealed that breastfeeding status at the study period was associated with long preceding birth interval; delivery in a public hospital; absence of prelacteal feeding; being non-pregnant; and the region and age of the child. No relationship for current breastfeeding was found with maternal activities, maternal life satisfaction, financial satisfaction, and educational status.

CONCLUSION

Current breastfeeding in our sample was more likely among mothers with a longer birth interval who avoided prelacteal feeding. The Baby-Friendly approach and family planning services should be integrated into refugee health centers.

Relationship between Maternal Postpartum Intention to Breastfeed and Actual Breastfeeding Duration - Four Provinces, China, 2015-2017

What is already known about this topic?

Several studies have reported that maternal antenatal intention to breastfeed is a strong predictor of actual breastfeeding duration. However, little research has investigated whether maternal postpartum intention also extends breastfeeding duration.

What is added by this report?

Maternal postpartum intention to breastfeed was a protective factor for extending actual breastfeeding duration after controlling potential confounders.

What are the implications for public health practice?

It is crucial to address and promote intrinsic and extrinsic factors that influence a mother's intention to breastfeed after delivery, thereby extending the actual breastfeeding duration.

Continuing breastfeeding for at least two years after birth in rural Vietnam: prevalence and psychosocial characteristics

Background

The World Health Organization recommends breastfeeding for at least two years (24 months or more) after birth. In Vietnam, 22% of women continue breastfeeding for at least two years. The aim of this study was to determine the sociodemographic and psychosocial characteristics of mother-baby dyads associated with breastfeeding for 24 months or more in a rural setting in Vietnam.

Methods

A secondary analysis was conducted on existing data obtained from a prospective study in Ha Nam, Vietnam. Women were recruited when they were pregnant and were followed up until 36 months after giving birth. The data were collected between 2009 and 2011. The associations between sociodemographic and psychosocial characteristics and continued breastfeeding for 24 months or more were examined using a multivariable logistic regression model.

Results

Overall, 363 women provided complete data which were included in the analyses. Among those, 20.9% breastfed for 24 months or more. Women who were 31 years old or older were more likely to breastfeed for 24 months or more than women who were 20 years old or younger (adjusted odds ratio, AOR, 9.54 [95% CI 2.25, 40.47]). Women who gave birth to girls were less likely to breastfeed for 24 or more months than women who had boys (AOR 0.44; 95% CI 0.25, 0.80).

Conclusions

This study provides evidence that may be useful for policy-makers to help improve breastfeeding practices for all children in Vietnam by targeting policy towards younger women and women with girls to promote continued breastfeeding for at least 24 months.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00427-8.

Factors associated with duration of breastfeeding in Bangladesh: evidence from Bangladesh demographic and health survey 2014

BACKGROUND

Breastfeeding for optimum duration is one of the most effective ways to reduce infant morbidity and mortality and confirms expected growth and development of children. The aim of this study was to determine the effect of socio-demographic and anthropometric determinants on duration of breastfeeding (DB) among mothers in Bangladesh.

METHODS

The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 3541 married non-pregnant and currently non-breastfeeding Bangladeshi mothers in reproductive age who had at least one child aged 6-36 months were included in this study. Independent sample t-test and one-way analysis of variance (ANOVA) were used to find the significance difference in DB between two and more than two groups respectively. Multiple linear regression model was utilized to determine the effect of socio-economic, demographic, anthropometric and health related variables on DB.

RESULTS

This study revealed that the mean and median of DB among Bangladeshi mothers were 18.91 (95% CI: 18.65-19.17) and 19.00 months respectively. Independent sample t-test and ANOVA showed that DB among Bangladeshi mothers was significantly influenced by (i) ANC visits, (ii) religion, (iii) mode of delivery, (iv) place of delivery, (v) parents' education, (vi) geographical location, (vii) mothers' occupation and (viii) household wealth quintile. Multiple regression analysis demonstrated that mothers' age, total number of children, mothers' age at first birth, ANC visits, mothers' occupation and geographical location were important predictors of DB.

CONCLUSIONS

Healthcare providers and decision makers can consider these findings to make plan for counseling of mothers and family members to promote optimum DB practice in first 2 years of baby's life.

Impact of gestational diabetes mellitus on the duration of breastfeeding in primiparous women: an observational cohort study

Background

The impact of gestational diabetes mellitus (GDM) on the duration of breastfeeding varies between shortening and no impact. Breastfeeding seems to reduce both maternal and offspring risk for type 2 diabetes and offspring risk for overweight or obesity later in life. The aim of our study was to evaluate in primiparous women whether GDM had an influence on the duration of breastfeeding, and further, to evaluate the factors that influenced on the duration of breastfeeding.

Methods

The study cohort (N = 1089) consisted of all primiparous women with a Finnish background excluding women with pre-existing diabetes mellitus who lived in the city of Vantaa, Finland, gave birth to a singleton living child between 2009 and 2015, and with valid data on breastfeeding available. The diagnosis of GDM was based on a standard 75 g 2-h oral glucose tolerance test. Data were obtained from Finnish national registers and from the medical records of the city of Vantaa.

Results

No differences were observed in the duration of breastfeeding between women diagnosed with GDM and without GDM, 7.5 (Standard Deviation [SD] 3.7) months versus 7.9 (SD 3.5) months (p = 0.17). Women diagnosed with GDM breastfed boys for a longer duration than girls (maternal age, pre-pregnancy body mass index, marital status, educational attainment, duration of pregnancy, and smoking habits adjusted p = 0.042). Women who breastfed < 6 months were younger, were more likely smokers, had shorter education, and higher pre-pregnancy body mass index than women who breastfed over 6 months (p <  0.001 for linearity).

Conclusions

In primiparous women GDM did not influence breastfeeding duration. The positive health effects of breastfeeding should be emphasized especially in young, overweight and less educated women in order to minimize the risk of obesity and type 2 diabetes for themselves and their offspring.

WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial

Background

Exclusive breastfeeding for the first 6 months of life is the optimal way to feed infants. However, recent studies suggest that exclusive breastfeeding rates in China remain low and are well below the recommended target. There has been evidence that a lack of awareness of, or exposure to, breastfeeding information is associated with poor breastfeeding practices. WeChat, the most widely used social networking platform in China, has shown some potential to promote health behaviours. We thus hypothesised that a breastfeeding intervention program delivered via WeChat would achieve at least a 10% increase in exclusive breastfeeding prevalence at 6 months compared to the control group.

Methods

A two-arm, parallel, multicentre randomised controlled trial of 1000 pregnant women will be conducted at four maternity hospitals of Chengdu, China. Eligible women who consent to participate in the trial will be recruited at 28–30 weeks of gestation, and randomly allocated to either the intervention group (participants receive breastfeeding-related information from WeChat) or the control group (participants receive non-breastfeeding information from WeChat) using a central randomisation system on a 1:1 ratio at each participating site. The primary outcomes are exclusive breastfeeding rate and full breastfeeding rate at 6 months postpartum. All randomised participants will be included in the outcome analyses with missing data being imputed based on the best-case and worst-case scenarios. Multilevel mixed regression models will be used in the primary analyses to assess the effectiveness of intervention program on the breastfeeding rates.

Discussion

This trial uses the most widely used social media program as a means of delivering messages to mothers to increase exclusive breastfeeding in China. Increasing exclusive breastfeeding will contribute to meeting the health and environmental goals of the Sustainable Development Guidelines.

Trial registration ClinicalTrials.gov, NCT04499404. Registered 5 August 2020—Retrospectively registered, https://clinicaltrials.gov/show/NCT04499404

Breastfeeding in China: A Review of Changes in the Past Decade

This review summarizes breastfeeding rates in China reported during the decade 2007-2018, a decade on from our previous review published in 2007. Compared with the studies undertaken before 2007 in China, recent studies are more likely to report breastfeeding rates using longer periods of observation, enabling rates to be summarized to six and 12 months postpartum in this review. There appears to have been a modest increase in breastfeeding in China. The mean duration of "any breastfeeding" was 10 months (9 to 11 months in the majority of cities), an increase compared with the previous review in which the mean of "any breastfeeding" duration was 8 months (7 to 9 months in the majority of cities). Using data from cohort studies, the proportion of infants being breastfed at 4 months increased from 78% in the earlier decade to 83% more recently. A second baby is usually breastfed for longer than the first, considering both "any" and "exclusive breastfeeding". China is a huge country and there is considerable diversity in culture, level of economic development, education and breastfeeding rates in different areas of China, but our review suggests that there has been some improvement in the "any breastfeeding" rate in the most recent decade.

The Patterns and Social Determinants of Breastfeeding in 12 Selected Regions in China: A Population-Based Cross-Sectional Study

BACKGROUND

With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.

RESEARCH AIM

We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.

METHODS

The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.

RESULTS

The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0-5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).

CONCLUSIONS

The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort

The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22‐year follow‐up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort‐II). First generation breastfeeding data were collected at 3 months and 4‐year‐old follow‐ups. In the 93Cohort‐II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live‐born infant, and 1,222 children were assessed. Fifty‐four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.

A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort

BACKGROUND

The first few weeks after childbirth are critical, as women may encounter lactation problems and postpartum depression during this period. However, it is still unclear whether early breastfeeding behaviours are related to the symptoms of postnatal depression (PND) in Chinese populations. Therefore, the current study aimed to investigate the association between symptoms of PND and infant feeding practices based on a large-scale Chinese cohort.

METHODS

A prospective study of the community-based cohort was conducted from January 2015 to December 2016. Infant feeding outcomes, including exclusive/partial breastfeeding and formula feeding, were assessed according to the WHO guidelines. Symptoms of PND were assessed by the Edinburgh Postnatal Depression Scale at 4 weeks postpartum. Multivariate generalized estimating equation models were applied to investigate the associations between depressive symptoms and infant feeding behaviours.

RESULTS

A total of 956 mother-infant pairs were included. Fifty-six mothers presented screen-positive symptoms of PND with a cut-off ≥10. The percentage of early breastfeeding initiation was 75.8%, while the average duration of exclusive breastfeeding was 3.90 ± 2.33 months. Postnatal depressive symptoms were associated with a shorter breastfeeding duration (8.02 vs. 6.32 months, P < 0.05) and earlier formula introduction (4.98 vs. 3.60 months, P < 0.05). After adjustments were made for covariates, postnatal depressive symptoms were associated with an increased risk of the discontinuation of exclusive and partial breastfeeding (β = - 0.049, P = 0.047 and β = - 0.082, P = 0.006, respectively). Compared to mothers without symptoms of PND, mothers with depressive symptoms were more likely to supplement formula for their infants in the first year of life (β =0.074, P = 0.016). These associations were still significant in the sensitivity analyses, using an EPDS cut-off of ≥13.

CONCLUSIONS

Our findings indicate that depressive symptoms at 4 weeks postpartum are associated with the cessation of exclusive and partial breastfeeding duration and the introduction of formula in the 12 months of delivery. Early psychosocial assessment and social support should be offered to mothers in the early postpartum period to indirectly prevent adverse breastfeeding outcomes.

Physical Activity During Pregnancy is Associated with Improved Breastfeeding Outcomes: A Prospective Cohort Study

Physical activity is important for health, but little is known about associations between physical activity during pregnancy and breastfeeding. The aim of this study was to investigate any association between antenatal physical activity and breastfeeding duration. A prospective cohort of 2030 Vietnamese women, recruited between 24 and 28 week-gestation was followed up to twelve months postpartum. Physical activity was determined using the pregnancy physical activity questionnaire at baseline interview. Data was available for 1715 participants at 12 months, a 15.5% attrition rate. At 12 months 71.8% of mothers were still breastfeeding. A total of 20.9% women met physical activity targets and those mothers undertaking higher levels of physical activity had a lower risk of breastfeeding cessation by twelve months [hazard ratios HR = 0.59 (95% CI 0.47–0.74), p < 0.001, and HR = 0.74 (0.60–0.92), p = 0.006; respectively] when compared to the lowest tertile. Similarly, women with increased levels of physical activity have higher rates of breastfeeding at twelve months, compared to the lowest level [odds ratio OR = 1.71 (95% CI 1.29–2.25) and 1.38 (1.06–1.79)]. Higher levels of physical activity by pregnant women are associated with improved breastfeeding outcomes.

Association between gestational weight gain and exclusive breast-feeding for the first 6 months postpartum in Chinese women

OBJECTIVE

The association between gestational weight gain (GWG) and exclusive breast-feeding (EBF) practices remains unclear. The present study evaluated the association between GWG and EBF in the first 6 months postpartum among primiparas in rural China.

DESIGN

The study population was drawn from a previous randomized controlled trial, and the relevant data were obtained from an electronic, population-based perinatal system and a monitoring system for child health care. GWG was categorized according to the guidelines of the Institute of Medicine.

SETTING

Five rural counties in Hebei Province, China.ParticipantsA total of 8449 primiparas.

RESULTS

Of the women, 58·7 % breast-fed exclusively for the first 6 months postpartum. Overweight women who gained either more or less weight than the recommended GWG tended to experience failure of EBF (OR=0·49; 95 % CI 0·34, 0·70; P&lt;0·001 and OR=0·79; 95 % CI 0·63, 0·99; P=0·048, respectively). The same results were also observed among obese women; the OR for lower and greater weight gain were 0·28 (95 % CI 0·08, 0·94; P=0·04) and 0·55 (95 % CI 0·32, 0·95; P=0·03), respectively.

CONCLUSIONS

GWG that is below or above the Institute of Medicine recommendations is associated with EBF behaviour for the first 6 months postpartum in overweight and obese primiparas in rural China.

Modifiable Individual Factors Associated with Breastfeeding: A Cohort Study in China

Breast milk is an ideal first food for infants in the initial months of life. This study aimed to identify modifiable individual factors in breastfeeding during the first six months of life in Hunan. This birth cohort study was conducted in three communities in Changsha, Hunan province. Data were collected through maternal health manuals and self-administered questionnaires during the follow-up period. To find risk factors and calculate odds ratios, generalized estimating equation models were applied. The final study included 951 mother-infant pairs. The prevalence of exclusive breastfeeding and any breastfeeding in this study was below the World Health Organization's breastfeeding goals. Infant age, passive smoking after delivery, minor postnatal depression, and feeding-bottles were shown to act negatively on both exclusive breastfeeding and any breastfeeding. In addition, cesarean delivery and delayed breastfeeding initiation had adverse effects on exclusive breastfeeding. Multiparas were less likely to continue any breastfeeding during the first few months. This study highlights the importance of screening probable maternal depression during primary care service and reducing secondhand smoke and feeding-bottle use. The results also suggest that healthcare professionals should provide more assistance and education to multiparas and mothers with cesarean delivery or delayed breastfeeding initiation.

Initial difficulties with breastfeeding technique and the impact on duration of exclusive breastfeeding

Abstract Objectives: the present study aimed to evaluate the influence of initial difficulties in breastfeeding on duration of exclusive breastfeeding. Methods: a prospective study with follow up of nursing mothers and their babies in the first six months of age. The studied population was randomly selected among the Brazilian public health system (SUS, Portuguese acronym) users in three hospitals. The breastfeeding observation protocol was used to collect initial data, which also included socio-demographic, prenatal assistance, delivery care, the postpartum period and the newborn variables. After hospital discharge, data were collected by phone. The multiple regression model was used for statistical analysis. Results: 175 mother-baby binomials were followed. Problems with breasts during the postpartum hospital stay (p= 0.030; OR=2.38; CI95%=1.02-5.48), maternal work outside home (p=0.027; OR=2.12; CI95%=1.03-4.31) and low maternal schooling level (p=0.017; OR=2.13; CI95%=1.10-4.06) were shown to be associated with the early interruption of exclusive breastfeeding before the child has completed 6 months of age. A family income lower than one minimum wage was a protective factor (p=0.048; OR=0.42; CI95%=0.17-0.97). Conclusions: socioeconomic aspects and difficulties in breastfeeding associated with problems with the puerperal breasts stood out as factors which restrict the duration of exclusive breastfeeding.

Family-Centered Breastfeeding Education to Promote Primiparas' Exclusive Breastfeeding in China

BACKGROUND

Few breastfeeding education programs focus on primiparas and the importance of family members on exclusive breastfeeding in China. Research aim: This study aimed to explore the influence of a family-centered breastfeeding education program in promoting exclusive breastfeeding up to 6 months postpartum and to improve women's attitude and knowledge, family members' knowledge, and family support.

METHODS

This was a two-group quasi-experimental design with multiple comparisons. Participants ( N = 59) were randomized to either the intervention ( n = 29) or the control ( n = 30) group. The intervention group received two prenatal breastfeeding education lectures that included important family members, three home visits, eight telephone calls, text or video/audio support, and quality online resources during lactation. The control group received in-hospital care and follow-up by community nurses after discharge.

RESULTS

Compared with the control group, the intervention group was more likely to exclusively breastfeed in the first 6 months, odds ratio = 0.44, 95% confidence interval [0.20, 0.98]. The mean knowledge level of the intervention group improved more across time ( p < .05) and was higher than the control group ( p < .05). Perceived family support within the intervention group was significantly higher than the control group from 1 to 6 months ( p < .05).

CONCLUSION

The breastfeeding education program is an effective strategy to promote exclusive breastfeeding in China.

A Time-varying Covariate Approach for Survival Analysis of Paediatric Outcomes

BACKGROUND

Conventional survival analysis is commonly applied in the analysis of time-to-event data in paediatric studies, where the exposure variables of interest are often treated as time-fixed. However, the values of these exposure variables can vary over time and time-fixed analysis may introduce time-dependent bias.

METHODS

Time-dependent bias is illustrated graphically considering two scenarios in longitudinal study settings for paediatric time-to-event outcomes. As an illustrative example, the time-varying covariate approach was applied to survival analysis of breast-feeding data (n = 695) collected in China between 2010 and 2011, with an emphasis on the effects of covariates 'solid foods introduction' and 'maternal return to work' on breast-feeding duration up to 12 months postpartum.

RESULTS

Time-varying exposures could occur before or after the occurrence of an event of interest so that time-fixed analysis can lead to biased and imprecise parameter estimates. In the illustrative example, the reduced risk of 'solid foods introduction' (hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.50, 0.75) on breast-feeding cessation and an absence of an association with 'maternal return to work' (HR 0.99, 95% CI 0.73, 1.36) from the time-fixed analysis reversed (HR 1.50, 95% CI 1.17, 1.93) and became significant (HR 1.45, 95% CI 1.06, 2.00), respectively, based on the time-varying covariate model.

CONCLUSIONS

The time-varying covariate approach is preferable for survival analysis of time-to-event data in the presence of time-varying exposures.

Prevalence of Breastfeeding: Findings from the First Health Service Household Interview in Hunan Province, China

Background: With the development of economy and urbanization, methods of child-feeding have significantly changed in China over the past three decades. However, little is known about breastfeeding in China since 2009. This study aims to update information on the prevalence of breastfeeding in China. Methods: Data were obtained from the first Health Service Household Interview Survey of Hunan Province, China. Of 24,282 respondents, 1659 were aged five years or younger. We ran multivariable logistic regression to examine the impact of urban/rural setting, gender, age and household income per capita on the use of breastfeeding. Results: A total of 79.4% of children aged 5 years or younger had been breastfed at some point and 44.9% been breastfed exclusively in the first 6 months of life. After controlling for setting urban/rural setting, gender and child age, children from households with average family income were more likely to be breastfed than those from households with the lowest family income (adjusted odds ratio: 2.28). Children from households with higher and the highest family income were less likely to be exclusively breastfed in the first 6 months of life compared to those from households with the lowest family income (adjusted odds ratio: 0.51 and 0.68, respectively). Conclusions: It is encouraging that the prevalence of exclusive breastfeeding for infants in the first 6 months of life in Hunan Province, China is approaching the goal of 50% proposed by the World Health Organization (WHO). Nevertheless, more efforts are needed to further promote exclusive breastfeeding in the first 6 months after birth.

Factors associated with Early Initiation of Breastfeeding in Western Nepal

The initiation of breastfeeding within one hour of birth has numerous nutritional and immunological benefits and has been found to reduce neonatal mortality. This community-based prospective cohort study aimed to report the rate of, and factors associated with, early initiation of breastfeeding in Western Nepal. The rate of early initiation of breastfeeding was reported, and associations between early initiation and independent variables were tested by Chi-square test, followed by multiple logistic regression. Of the 735 mother-infant pairs, a total of 310 (42.2%) reported early initiation. Mothers who were assisted by traditional attendants during childbirth, delivered by caesarean section, from ethnically disadvantaged families and had delivered low birth weight infants, were less likely to initiate breastfeeding early whereas the mothers who were from the poorest families and did not introduce prelacteal feeds to their infants were more likely to initiate breastfeeding within the first hour. Skills-training to support breastfeeding as part of the training of skilled birth attendants and other health workers is likely to promote recommended infant feeding practices.

Timing and Determinants of the Introduction of Complementary Foods in Kuwait: Results of a Prospective Cohort Study

BACKGROUND

The early introduction of complementary foods is common in Middle Eastern countries but little is known about the determinants of this practice in this region.

OBJECTIVES

This prospective cohort study conducted from October 2007 to October 2008 investigated the determinants of the very early (before 17 weeks) introduction of complementary foods in Kuwait and compared rates of this practice against rates reported in the mid-1990s.

METHODS

A total of 373 women were recruited from maternity hospitals in Kuwait City and followed to 26 weeks postpartum. Data on complementary feeding practices were available from 303 women. Multivariate logistic regression was used to estimate the association of very early introduction of complementary foods with infant sex and maternal characteristics including age, years of education, employment intentions at 6 months postpartum, parity, prepregnancy body mass index, and prepregnancy smoking status.

RESULTS

All infants had received complementary foods by 26 weeks of age, with 30.4% receiving complementary foods before 17 weeks of age. Women born in other Arabic countries were less likely to introduce complementary foods before 17 weeks (adjusted odds ratio [adj OR] = 0.40; 95% confidence interval [CI], 0.22-0.73) than women born in Kuwait. Women who were exclusively formula feeding at 6 weeks postpartum were less likely to introduce complementary foods before 17 weeks (adj OR = 0.40; 95% CI, 0.23-0.71) than women who were still breastfeeding.

CONCLUSION

Compared to the mid-1990s, fewer infants in Kuwait were receiving complementary foods before 17 weeks. Nevertheless, all infants had received complementary foods by 6 months of age.

Antenatal Depressive Symptoms and Breastfeeding: A Prospective Cohort Study

INTRODUCTION

Globally many women suffer from depression during pregnancy. This study investigated the impact of antenatal depressive symptoms on the duration of breastfeeding up to 6 months among women in Sabah, Malaysia.

SUBJECTS AND METHODS

A prospective cohort study of 2,072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36-38 weeks of gestation and followed up at 1, 3, and 6 months postpartum. Depressive symptoms were assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale (EPDS). Cox regression analyses were performed to determine the relationship between antenatal EPDS scores and cessation of breastfeeding before 6 months postpartum.

RESULTS

In total, 1,078 (52%) women with complete information on breastfeeding duration were included in the final sample. Approximately 99% of mothers were breastfeeding at discharge, and 87% of them continued to breastfeed at 6 months postpartum. Women with an antenatal EPDS score of 8 or above were twice more likely to stop breastfeeding before 6 months (adjusted hazards ratio=1.95; 95% confidence interval, 1.26, 3.01) than those who scored less than 4 on the EPDS.

CONCLUSIONS

Depressive symptoms during pregnancy appeared to be associated with early breastfeeding cessation for mothers residing in Sabah.

Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff

In China the exclusive breastfeeding rate remains low and infant formula is widely used. This study aimed to elicit and compare mothers' and hospital staff perceptions of the reasons that shaped mothers' decision to formula feed. In-depth interviews with 50 mothers, and four focus group discussions with 33 hospital staff, were conducted in Hangzhou and Shenzhen in November 2014. Responses given by the mothers and hospital staff showed a number of commonalities. The perception of "insufficient breast milk" was cited by the majority of women (n = 37, 74%) as the reason for formula feeding. Mothers' confidence in breastfeeding appears to be further reduced by maternal mothers or mothers-in-law's and "confinement ladies" misconceptions about infant feeding. Inadequate breastfeeding facilities and limited flexibility at their workplace was another common reason given for switching to formula feeding. A substantial proportion of mothers (n = 27, 54%) lacked an understanding of the health benefits of breastfeeding. Antenatal education on breastfeeding benefits for expectant mothers and their families is recommended. Moreover, mothers should be provided with breastfeeding support while in hospital and be encouraged to seek professional assistance to deal with breastfeeding problems after discharge. Employers should also make work environments more breastfeeding-friendly.