1
|
Wu JJ, Zhang QN, Liao SS, Li JH, Zhang JD, Huang JZ. Healthcare providers' perceived barriers to providing breastfeeding support in Northwest rural China. Int Breastfeed J 2024; 19:22. [PMID: 38570781 PMCID: PMC10993573 DOI: 10.1186/s13006-024-00630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers' perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China. METHODS This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, "village doctors", and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed. RESULTS Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers' lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers' housing situation, mothers' mobility, and cultural barriers were discussed. CONCLUSIONS The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China's Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide.
Collapse
Affiliation(s)
- Jiao-Jiao Wu
- School of Nursing, Lanzhou University, Yanxi Road 28, Lanzhou, Gansu, China
| | - Qing-Ning Zhang
- School of Philosophy and Sociology, Lanzhou University, 222 Tianshuinan Road, Lanzhou, Gansu, China.
| | - Su-Su Liao
- Institute of Basic Medical Science, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 5 Dongdan Santiao, Beijing, China
| | - Jiang-Hong Li
- Institute for Community Research, 2 Hartford Sq. W., Ste. 210, 06106, Hartford, CT, USA
| | - Jian-Duan Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei, China
| | - Jing-Zhi Huang
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| |
Collapse
|
2
|
Factors associated with exclusive breastfeeding practice among mothers in nine community health centres in Nanning city, China: a cross-sectional study. Int Breastfeed J 2021; 16:71. [PMID: 34556129 PMCID: PMC8461910 DOI: 10.1186/s13006-021-00416-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China. METHODS The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0-5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices. RESULTS In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice. CONCLUSIONS Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged.
Collapse
|
3
|
Zhang X, Zhang M, Lin T, Zhao J, Luo Z, Hou J, Sun B, Chen L. Relationship between traditional maternal diet pattern and breastmilk composition of rural lactating women during the first month postpartum in Shigatse, Tibet. Food Sci Nutr 2021; 9:4185-4198. [PMID: 34401070 PMCID: PMC8358384 DOI: 10.1002/fsn3.2384] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 11/10/2022] Open
Abstract
Maternal nutrition can influence the composition of human breastmilk by altering the components that are sensitive to maternal diet pattern. Traditional Tibetan maternal diet pattern among native rural lactating women possesses distinct characteristics due to its unique geographical environment and dietary habits. This study investigated maternal diet pattern and human breastmilk composition of Tibetan lactating women through different lactation stages during the first month postpartum in Shigatse. The results indicated that Tibetan maternal diet profile was apparently monotonous, mainly sufficient in Zanba, buttered tea, red meat, and fatty soup, yet insufficient in white meat, eggs, leafy vegetables, and fruits, leading to imperfect maternal nutritional intakes with high-level carbohydrates and deficient proteins. Distinctions of maternal diet profiles in various degrees can be discovered upon different lactation stages, which brings multiple influences to the composition of human milk. There was significantly weak-to-medium correlation of protein contents between maternal diet intakes and human milk, while other macronutrients correlated insignificantly. Micronutrient constituents in human milk, involving functional unsaturated fatty acids and free essential amino acids, were also impacted by maternal diet intakes through different lactation stages. These results show that more systematic and profound research is requisite for the clarification and development of Tibetan maternal diet to offer more enhanced and individualized nutritional recommendations for Tibetan lactating women and infants.
Collapse
Affiliation(s)
- Xiaomei Zhang
- National Engineering Center of Dairy for Maternal and Child HealthBeijing Sanyuan Foods Co. Ltd.BeijingChina
- Beijing Engineering Research Center of DairyBeijing Technical Innovation Center of Human Milk ResearchBeijing Sanyuan Foods Co. Ltd.BeijingChina
- Beijing Advanced Innovation Center for Food Nutrition and Human HealthBeijing Technology & Business UniversityBeijingChina
| | - Minghui Zhang
- National Engineering Center of Dairy for Maternal and Child HealthBeijing Sanyuan Foods Co. Ltd.BeijingChina
- Beijing Engineering Research Center of DairyBeijing Technical Innovation Center of Human Milk ResearchBeijing Sanyuan Foods Co. Ltd.BeijingChina
| | - Tie Lin
- National Engineering Center of Dairy for Maternal and Child HealthBeijing Sanyuan Foods Co. Ltd.BeijingChina
- Beijing Engineering Research Center of DairyBeijing Technical Innovation Center of Human Milk ResearchBeijing Sanyuan Foods Co. Ltd.BeijingChina
| | - Junying Zhao
- National Engineering Center of Dairy for Maternal and Child HealthBeijing Sanyuan Foods Co. Ltd.BeijingChina
- Beijing Engineering Research Center of DairyBeijing Technical Innovation Center of Human Milk ResearchBeijing Sanyuan Foods Co. Ltd.BeijingChina
| | - Zhang Luo
- Food Science CollegeTibet Agriculture & Animal Husbandry UniversityNyingchi, TibetChina
| | - Juncai Hou
- Key Laboratory of Dairy Science, Ministry of EducationCollege of Food ScienceNortheast Agricultural UniversityHarbinChina
| | - Baoguo Sun
- Beijing Advanced Innovation Center for Food Nutrition and Human HealthBeijing Technology & Business UniversityBeijingChina
| | - Lijun Chen
- National Engineering Center of Dairy for Maternal and Child HealthBeijing Sanyuan Foods Co. Ltd.BeijingChina
- Beijing Engineering Research Center of DairyBeijing Technical Innovation Center of Human Milk ResearchBeijing Sanyuan Foods Co. Ltd.BeijingChina
| |
Collapse
|
4
|
Zhang R, Cheng L, Zhang T, Xu T, Li M, Yin W, Jiang Q, Yang Y, Hu T. Brick tea consumption is a risk factor for dental caries and dental fluorosis among 12-year-old Tibetan children in Ganzi. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:1405-1417. [PMID: 30483920 DOI: 10.1007/s10653-018-0216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Brick tea contains high concentration of fluoride. The aim of the present work was to explore whether and how the brick tea is a risk factor for dental caries and dental fluorosis among Tibetan children in Ganzi. A cross-sectional study was conducted with 368 12-year-old Tibetan children in Ganzi. Dental caries was measured by DMFT index, and dental fluorosis severity was measured by Dean's Index. Community Fluorosis Index was used to estimate public health significance of dental fluorosis. Oral health-related behaviors and awareness, dietary habits and socioeconomic status were determined by a questionnaire. Bivariate and multivariate analyses were used to determine risk factors associated with dental caries and dental fluorosis. Dental caries prevalence was 37.50%, mean DMFT was 0.84 ± 1.53, while dental fluorosis prevalence was 62.23%. Community Fluorosis Index was 1.35, indicating a medium prevalent strength of dental fluorosis. Dental fluorosis was associated with mother's regular consumption of brick tea and residence altitude, and dental caries was associated with mother's regular consumption of brick tea. Mother's regular consumption of brick tea was a risk factor for both dental fluorosis and dental caries among children. Reducing mother's brick tea consumption during pregnancy and lactation may improve oral health status of their children.
Collapse
Affiliation(s)
- Rui Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Li Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Tao Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Ting Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Meng Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Wei Yin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Qingling Jiang
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yingming Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China.
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
5
|
Association between gestational weight gain and exclusive breast-feeding for the first 6 months postpartum in Chinese women. Public Health Nutr 2019; 22:2092-2098. [PMID: 30859927 DOI: 10.1017/s1368980019000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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<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.
Collapse
|
6
|
Alzaheb RA. Factors Influencing Exclusive Breastfeeding in Tabuk, Saudi Arabia. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2017; 11:1179556517698136. [PMID: 28469519 PMCID: PMC5398646 DOI: 10.1177/1179556517698136] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/01/2017] [Indexed: 01/06/2023]
Abstract
Background: Breast milk contains all the nutrients infants need for their first 6 months of life. However, only a minority of Saudi Arabian mothers exclusively breastfeed, so the influencing factors must be examined to encourage more to do so. The study aimed to determine the prevalence of exclusive breastfeeding at 6 months and its associated factors in Tabuk, North West Saudi Arabia. Methods: A total of 589 mothers of healthy infants aged between 6 and 24 months were interviewed while attending Well-Baby Clinics within 5 primary health care centers. Interviews deployed a structured questionnaire to collect sociodemographic information and detailed data concerning breastfeeding practices. A logistic regression analysis was then performed on the data to identify the factors independently associated with exclusive breastfeeding practice for infants at 6 months. Results: Exclusive breastfeeding was practiced by 31.4% of mothers for the first 6 months of their infant’s life. The logistic regressions indicated that exclusive breastfeeding at 6 months was less likely to be practiced by working mothers, Saudi nationals, and for babies born via cesarean delivery or at low birth weights. Conversely, the mother’s awareness of the recommended exclusive breastfeeding duration was positively associated with exclusive breastfeeding. Conclusions: Programs promoting 6 months of exclusive breastfeeding should target high-risk groups. Two factors identified by this study are modifiable: working mothers and mothers’ awareness of the exclusive breastfeeding duration recommendation. Strategies to improve exclusive breastfeeding rates should therefore focus on workplace facilities and increasing awareness of the exclusive breastfeeding recommendation.
Collapse
Affiliation(s)
- Riyadh A Alzaheb
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| |
Collapse
|
7
|
Association between the Infant and Child Feeding Index (ICFI) and nutritional status of 6- to 35-month-old children in rural western China. PLoS One 2017; 12:e0171984. [PMID: 28207774 PMCID: PMC5313129 DOI: 10.1371/journal.pone.0171984] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/30/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the relationship between the quality of feeding practices and children's nutritional status in rural western China. METHODS A sample of 12,146 pairs of 6- to 35-month-old children and their mothers were recruited using stratified multistage cluster random sampling in rural western China. Quantile regression was used to analyze the relationship between the Infant and Child Feeding Index (ICFI) and children's nutritional status. RESULTS In rural western China, 24.37% of all infants and young children suffer from malnutrition. Of this total, 19.57%, 8.74% and 4.63% of infants and children are classified as stunting, underweight and wasting, respectively. After adjusting for covariates, the quantile regression results suggested that qualified ICFI (ICFI > 13.8) was associated with all length and HAZ quantiles (P<0.05) and had a greater effect on the following: poor length and HAZ, the β-estimates (length) from 0.76 cm (95% CI: 0.53 to 0.99 cm) to 0.34 cm (95% CI: 0.09 to 0.59 cm) and the β-estimates (HAZ) from 0.17 (95% CI: 0.10 to 0.24) to 0.11 (95% CI: 0.04 to 0.19). Qualified ICFI was also associated with most weight quantiles (P<0.05 except the 80th and 90th quantiles) and poor and intermediate WAZ quantiles (P<0.05 including the 10th, 20th 30th and 40th quantiles). Additionally, qualified ICFI had a greater effect on poor weight and WAZ quantiles in which the β-estimates (weight) were from 0.20 kg (95% CI: 0.14 to 0.26 kg) to 0.06 kg (95% CI: 0.00 to 0.12 kg) and the β-estimates (WAZ) were from 0.14 (95% CI: 0.08 to 0.21) to 0.05 (95% CI: 0.01 to 0.10). CONCLUSIONS Feeding practices were associated with the physical development of infants and young children, and proper feeding practices had a greater effect on poor physical development in infants and young children. For mothers in rural western China, proper guidelines and messaging on complementary feeding practices are necessary.
Collapse
|
8
|
Chen X, Xia B, Ge L. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC Pediatr 2015; 15:46. [PMID: 25895651 PMCID: PMC4422261 DOI: 10.1186/s12887-015-0364-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early transition from breastfeeding and non-nutritive sucking habits may be related to occlusofacial abnormalities as environmental factors. Previous studies have not taken into account the potential for interactions between feeding practice, non-nutritive sucking habits and occlusal traits. This study assessed the effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Peking city. METHODS This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior crossbite, posterior crossbite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple logistic regressions were applied to analyze the associations. RESULTS It was found that a short duration of breast-feeding (never or ≤ 6 months) was directly associated with posterior cross bite (OR = 3.13; 95% CI = 1.11-8.82; P = 0.031) and no maxillary space (OR = 1.63; 95% CI = 1.23-2.98; P = 0.038). In children breast-fed for ≤ 6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR = 4.21; 95% CI = 1.85-9.60; P = 0.0002). Children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of a class II canine relationship compared with those who were bottle-fed for up to 18 months. Non-nutritive sucking habits were also found to affect occlusion: A prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit associated with excessive overjet and absence of lower arch developmental space. CONCLUSION Breastfeeding duration was shown to be associated with the prevalence of posterior crossbite, no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a digit-sucking habit were more likely to develop an open bite.
Collapse
Affiliation(s)
- Xiaoxian Chen
- Department of Pediatric Dentistry, First Dental Center, Peking University School and Hospital of Stomatology, Postal address: Jia No.37 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Bin Xia
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| | - Lihong Ge
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| |
Collapse
|