Early initiation of breast-feeding in Ghana: barriers and facilitators

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.

Determinants of early initiation of breastfeeding following birth in West Africa: A multilevel analysis using data from multi-country national health surveys

BACKGROUND

Early initiation of breastfeeding (EIBF), within the first hour of birth, is crucial for promoting exclusive breastfeeding and establishing optimal nursing practices. However, global EIBF rates remain low, with even lower rates observed in Africa. Despite existing research gaps, this study aims to determine the prevalence of EIBF and identify maternal and child-related factors associated with its practice in West Africa.

METHODS

This study utilized West African Demographic and Health Survey (DHS) data from 13 countries, including 146,964 children's records. To assess model fit, likelihood test and deviance were used. Similarly, intraclass correlation coefficient, median odds ratio, and proportional change in variance were employed for random effect. A multilevel logistic regression model was used to identify individual- and community-level factors influencing EIBF due to the hierarchical nature of the data. Variables with p-values ≤0.2 in the binary model and <0.05 in the final analysis were considered significantly associated with EIBF.

RESULTS

The pooled prevalence of EIBF in West African nations was 50.60% (95% CI; 50.34-50.85%). The highest prevalence rate was observed in Serra Leone (75.33%) and the lowest prevalence was found in Senegal (33.94%). In the multilevel multiple logistic regression model, maternal education (AOR = 1.10, 95% CI, 1.03,1.16), marital status AOR = 1.07, 95% CI, 1.01,1.13), birth weight (AOR = 0.91, CI 0.86,0.96), birth orders (AOR = 1.09, CI 1.03,1.16), and (AOR = 1.11, CI 1.03,1.19), place of residence (AOR = 1.14, CI 1.07,1.21), and mode of delivery type (AOR = 0.26, CI 0.24,0.29) were significantly correlated with EIBF in West Africa.

CONCLUSIONS

The incidence of EIBF in West Africa was found to be low. The study emphasizes the need for targeted behavioral change communication programs to address timely breastfeeding initiation, specifically targeting mothers and child characteristics. Factors such as education, delivery mode, marital status, birth weight, birth order, and place of residence were significantly associated with EIBF. Special attention should be given to improving EIBF rates among women undergoing caesarean sections, infants with low birth weight, and primiparous mothers, along with structural improvements in the healthcare sector in West Africa.

‘They said, let’s teach you how you are going to care for the child at home…’: caregivers’ and healthcare worker’s perceptions and experiences of post-discharge preterm care in eastern Uganda

Background

Complications of prematurity are the leading cause of neonatal mortality, and the majority of these deaths occur in low and middle-income countries. Research in these settings has focused on improved outcomes for preterm infants in hospital settings, however, research into the continuation of preterm care in the home after discharge from a neonatal unit is limited. This study examines the experiences and perceptions of caregivers of preterm infants during the initial weeks following discharge from a neonatal unit in Uganda, and the views of healthcare workers (HCWs) on the ability of caregivers to cope.

Methods

This qualitative study used multiple data collection approaches, namely focus group discussions (FGDs), in-depth interviews (IDIs), field observations, and case studies to explore the perceptions and experiences of providing care to preterm infants post-discharge from a neonatal unit in eastern Uganda from the perspectives of caregivers and HCWs.

Results

We recruited 39 participants with a total of 35 separate sessions including 18 IDIs (12 caregivers and 6 HCWs), 3 FGDs (17 caregivers), and 4 case studies (14 separate IDIs over 5 weeks after discharge, three mothers, and one grandmother). IDIs and FGDs took place at the Mbale Regional Referral Hospital or in participants’ homes.

Key themes emerged; preparation for continuing care in the home, psychosocial challenges to providing preterm care in the home, barriers to continuing preterm care in the home, and suggestions for improvement of preterm care in the home. Caregivers had good knowledge and awareness about different aspects of preterm care. Following discharge, caregivers struggled to maintain quality care due to loss of continuous support from the neonatal team, feelings of anxiety and isolation, financial issues, and home responsibilities.

Conclusion

This study highlights multiple challenges to continuing preterm care in this Ugandan setting. Improved training and education for caregivers, especially in neonatal resuscitation, enhanced and continued support of the caregiver and infant in the home, and increased community involvement following discharge may all be key solutions. These findings are fundamental to improving care in the home for preterm infants in eastern Uganda and similar settings.

Time trends in the prevalence and determinants of age-appropriate breast feeding among children aged 0-23 months in Ghana: a pooled analysis of population-based surveys, 2003-2017

OBJECTIVE

We assessed the sociodemographic and maternal-child characteristics associated with age-appropriate breast feeding among children aged 0-23 months in Ghana.

METHODS

We pooled data on 12 743 children aged 0-23 months from three Demographic and Health Surveys (2003, 2008 and 2014) and three Multiple Indicator Cluster Surveys (2006, 2011 and 2017-2018). The outcome was age-appropriate breast feeding from birth to 23 months, with age-appropriate breast feeding defined as exclusive breast feeding at 0-5 months (ie, at less than 6 months) and breastfeeding alongside appropriate complementary feeding at 6-23 months. Potential determinants were maternal-child sociodemographic, obstetric and healthcare factors. Logistic regression was used to determine the factors associated with age-appropriate breast feeding. We accounted for the complex sampling design of the cross-sectional surveys in the analysis.

RESULTS

Most children aged 0-3 months were exclusively breastfed. Among children aged 4-5 months, the most common feeding pattern was breastfeeding alongside water and/or solid foods. Exclusive breastfeeding prevalence in children less than 6 months peaked in 2008 at 62.8% and declined to 42.9% in 2017. For 6-11 month olds, the percentage experiencing age-appropriate breast feeding has been stable over the last four surveys, ranging from 79.3% in 2008 to 81.1% in 2017. Age-appropriate breast feeding in 12-23 month olds declined from 77.8% in 2003 to 61.2% in 2017. Rural residence, younger age, non-facility births and multiple births were associated with decreased odds of exclusively breast feeding. For 6-11 month olds, age-appropriate breast feeding was less likely if the woman did not receive postnatal care. Younger age, being unmarried, high income, wanting a child later and earlier birth order were associated with decreased odds of age-appropriate breast feeding in 12-23 month olds.

CONCLUSION

Ghanaian children are now less likely to be exclusively breastfed than they were a decade ago. To succeed, breastfeeding promotion programmes should adopt approaches that address the predictors of suboptimal breast feeding at each age, as identified in this study.

Are verbatim transcripts necessary in applied qualitative research: experiences from two community-based intervention trials in Ghana

Conducting qualitative research within public health trials requires balancing timely data collection with the need to maintain data quality. Verbatim transcription of interviews is the conventional way of recording qualitative data, but is time consuming and can severely delay the availability of research findings. Expanding field notes into fair notes is a quicker alternative method, but is not usually recommended as interviewers select and interpret what they record. We used the fair note methodology in Ghana, and found that where research questions are relatively simple, and interviewers undergo sufficient training and supervision, fair notes can decrease data collection and analysis time, while still providing detailed and relevant information to the study team. Interviewers liked the method and felt it made them more reflective and analytical and improved their interview technique. The exception was focus group discussions, where the fair note approach failed to capture the interaction and richness of discussions, capturing group consensus rather than the discussions leading to this consensus.

Magnitude e características dos nascimentos termo tardio e pós-termo e complicações maternas e neonatais no Brasil, 2011

Este estudo analisou o nascimento termo tardio e pós-termo, avaliando o perfil materno, suas características e as complicações maternas e neonatais. Foram selecionados 23.610 bebês do estudo Nascer no Brasil (2011), sendo realizada uma análise descritiva da população de estudo. A associação entre o nascimento termo tardio e pós-termo e seus desfechos foi efetuada pela utilização de regressões logísticas (valor de p < 0,05). A prevalência encontrada foi de 7,4% para o termo tardio e de 2,5% para o pós-termo, tendo ambos sido mais frequentes nas regiões Norte e Nordeste, em adolescentes, mulheres negras, de baixa escolaridade, multíparas, atendidas no setor público. As gestações termo tardio tiveram maior chance de indução do parto vaginal (OR = 2,02; IC95%: 1,67-2,45), de cesariana (OR = 1,32; IC95%: 1,16-1,52), de laceração grave (OR = 3,75; IC95%: 1,36-10,36) e de uso oxigenoterapia para os recém-nascidos (OR = 1,52; IC95%: 1,02-2,26). Nas gestações pós-termo, os recém-nascidos tiveram menor chance de amamentação ao nascer (OR = 0,74; IC95%: 0,56-0,97) e durante a hospitalização (OR = 0,62; IC95%: 0,40-0,97) e maior chance de nascerem pequenos para a idade gestacional (OR = 4,01; IC95%: 2,83-5,70). Os resultados utilizando somente a ultrassonografia como medida da idade gestacional confirmaram os achados anteriores. Gestações termo tardio e pós-termo ocorrem com maior frequência nas regiões Norte e Nordeste e em mulheres com maior vulnerabilidade social, associando-se a complicações maternas e neonatais.

Determinants of Early Initiation of Breastfeeding Practices of Newborns in Bangladesh: Evidence From Bangladesh Demographic and Health Survey

Purpose

Early initiation of breastfeeding is essential for newborns after birth to reduce mortality and morbidity. Early initiation of breastfeeding awareness/activities may be a vital role in Bangladesh to minimize the infant deaths. The aim of this study is to identify factors associated with the early initiation of breastfeeding practices.

Methods

In this study, Bangladesh Demographic and Health Survey (BDHS) 2017 to 2018 data was used that will be the first analysis for early initiation of breastfeeding practices in this data set in Bangladesh. Considering the importance of early breastfeeding practices, the dependent variable was divided into 3 categories (immediately: breastfeeding for less than 20 minutes, within an hour, and after 1 hour) to find a significant association with early breastfeeding practices in Bangladesh. Bivariate analysis is used to examine the differentials to early initiation of breastfeeding according to the selected number of background variables. Multinomial logistic regression is used to determine predictive independent factors associated with the dependent variable.

Results

Using BDHS 2017 to 2018 data on 4950 observations, this study revealed that 24.6% of mothers breastfed their babies immediately after birth and 36.2% of mothers breastfed their babies within an hour. The rate of mothers who breastfeed their babies immediately after birth is lowest at the age of 20 to 25, mothers with a higher level of education, richer class, Khulna division, the first child born, Islam, and private/NGO. With a multivariate analysis of breastfeeding within an hour compared to immediate breastfeeding: richest (OR = 0.71), Barisal division (OR = 0.72), and Buddhism ( O R = 0 . 52 ) are less likely to breastfeed newborns compared to the reference category. On the other hand, primary, secondary, and higher educated mothers are more likely to breastfeed newborns compared to no educated mothers. Besides, breastfeeding newborns after 1 hour compared to immediate after birth: mothers aged 20 to 25 (OR = 1.40), richer (OR = 1.46), higher secondary (OR = 2.06), Khulna division (OR = 1.81), and private/NGO (OR = 2.51) are more likely breastfeed newborn.

Conclusion

Mother's education, wealth index, region, birth order, religion, and place of delivery have a significant impact on the early initiation of breastfeeding practices, but the rate of immediate breastfeeding is relatively lower than others. Ultimately, this information will help planners and other professionals plan strategies and interventions to provide good quality health services.

Maternal and child factors associated with early initiation of breastfeeding in Chad: evidence from nationally representative cross-sectional data

Background

Early initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad.

Methods

We used data from the children's recode file of the 2014–2015 Chad Demographic and Health Survey. A total of 3991 women ages 15–49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

We found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB.

Conclusions

Maternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.

Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi

Background

Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi.

Methods

The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy.

Results

The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers.

Conclusions

Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.

Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review

BACKGROUND

Sub-Saharan Africa carries a disproportionate burden of under-five child deaths in the world and appropriate breastfeeding practices can support efforts to reduce child mortality rates. Health facilities are important in the promotion of early and exclusive breastfeeding. The purpose of this review was to examine facility-based barriers and facilitators to early and exclusive breastfeeding in Sub-Saharan Africa.

METHODS

A systematic search was conducted on Medline, Web of Science, CINAHL, African Journals Online and African Index Medicus from database inception to April 29, 2021 and primary research studies on breastfeeding practices in health facilities in Sub-Saharan Africa were included in the review. We assessed qualitative studies with the Critical Appraisal Skills Programme Qualitative Checklist and quantitative studies using the National Heart, Lung, and Blood Institute tool. The review protocol was registered to Prospero prior to conducting the review (CRD42020167414).

RESULTS

Of the 56 included studies, relatively few described health facility infrastructure and supplies-related issues (5, 11%) while caregiver factors were frequently described (35, 74%). Facility-based breastfeeding policies and guidelines were frequently available but challenged by implementation gaps, especially at lower health service levels. Facilitators included positive caregiver and health worker attitudes, knowledge and support during the postpartum period. Current studies have focused on caregiver factors, particularly around their knowledge and attitudes, while health facility infrastructure and supplies factors appear to be growing concerns, such as overcrowding and lack of privacy during breastfeeding counselling that lowers the openness and comfort of mothers especially those HIV-positive.

CONCLUSION

There has been a dramatic rise in rates of facility births in Sub-Saharan Africa, which must be taken into account when considering the capacities of health facilities to support breastfeeding practices. As the number of facility births rise in Sub-Saharan Africa, so does the responsibility of skilled healthcare workers to provide the necessary breastfeeding support and advice to caregivers. Our review highlighted that health facility infrastructure, supplies and staffing appears to be a neglected area in breastfeeding promotion and a need to strengthen respectful maternity care in the delivery of breastfeeding counselling, particularly in supporting HIV-positive mothers within the context of Sub-Saharan Africa.

The association between paternal characteristics and exclusive breastfeeding in Ghana

Background

Studies have shown that partners play an influential role in exclusive breastfeeding practice and that they can act as either deterrents or supporters to breastfeeding. However, there are limited studies on the influence of partners’ characteristics on exclusive breastfeeding in Ghana. This study examined the association between partners’ characteristics and exclusive breastfeeding in Ghana.

Methods

This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Infants less than 6 months old (exclusively breastfed or not) with maternal and paternal characteristics were included in the study. A total of 180 participants were used for the study. A binary logistic regression was used to examine the influence of partners’ characteristics on exclusive breastfeeding.

Results

Partners’ characteristics such as education, desire for children, religion, and children ever born were associated with exclusive breastfeeding. Mothers whose partners had primary education (AOR = 0.12; CI 95%: 0.02–0.93; p = 0.04) were less likely to practice exclusive breastfeeding compared to those whose partners had no formal education. Also, mothers whose partners desired more children (AOR = 0.20; CI 95%: 0.06–0.70; p = 0.01) were less likely to practice exclusive breastfeeding compared to those whose partners desire fewer children.

Conclusion

Improving EBF requires the involvement of partners in exclusive breastfeeding campaigns/programmes. A more couple-oriented approach is required by health practitioners to educate and counsel both mothers and partners on the importance of exclusive breastfeeding in Ghana.

Consistency of the determinants of early initiation of breastfeeding in Ghana: insights from four Demographic and Health Survey datasets

BACKGROUND

Early initiation of breastfeeding (EIBF) is a key strategy in averting neonatal deaths. However, studies on the facilitators and risk factors for EIBF are rare in Ghana. We examined trends in EIBF and its major facilitators and risk factors in Ghana using data from Demographic and Health Surveys from 1998 to 2014.

METHODS

We used complete weighted data of 3194, 3639, 2909 and 5695 pairs of mothers ages 15-49 y and their children ages 0-5 y in the 1998, 2003, 2008 and 2014 surveys, respectively. We accounted for the complex sampling used in the surveys for both descriptive statistics and multiple variable risk ratio analysis.

RESULTS

The proportion of children who achieved EIBF increased by about 2.5 times from 1998 to 2003 and there was a marginal increase in the proportion of children who achieved EIBF between 2003 and 2014. Children born by caesarean section were at higher risk of being breastfed later than 1 h across all four surveys. Being born in the Upper East Region (compared with the Western Region) of Ghana facilitated EIBF in 2003 and 2008.

CONCLUSIONS

The study revealed that the current estimate of the proportion of children achieving EIBF in Ghana was 55.1%, and delivery by caesarean section and region of residence consistently predicted the practice of EIBF in Ghana.

Determining factors associated with breastfeeding and complementary feeding practices in rural Southern Benin

This study aimed at characterizing breastfeeding and complementary feeding practices in a food-insecure area of Benin and identifying factors associated with these practices. A cross-sectional study was conducted in the districts of Bopa and Houéyogbé among n = 360 mother-child pairs. Children aged 0-17 months were considered. Socioeconomic characteristics among children and mothers, Breastfeeding on demand, Breastfeeding frequency during children illness, and Positioning and Attachment of children while breastfeeding were assessed using semi-structured interviews and observations. Qualitative 24-hr recalls were administered to mothers to compute WHO recommended complementary feeding practices indicators namely minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) among 6-17 months old children (n = 232). Associations between each feeding practice and mothers' socioeconomic characteristics were tested using multivariate generalized linear models. Breastfeeding on demand and good positioning and attachment for breastfeeding rates were 59% and 66%, respectively. Only 26% of mothers used to increase breastfeeding frequency when their children were ill. The proportions of children who met MDD, MMF, and MAD were 51%, 75%, and 44%, respectively. Children living in Houéyogbé were less likely to be breastfed on demand compared with those living in Bopa; however, they had better breastfeeding frequency during illness and meal frequency. Socioeconomic factors with significant association with breastfeeding practices were children age and sex and mothers' education, ethnicity, and employment status. Complementary feeding practices were positively associated with children's age but not with other socioeconomic characteristics. Breastfeeding and complementary feeding practices were almost suboptimal or medium and still need to be improved through well designed nutrition intervention program including nutrition education.

Literacy is power: structural drivers of child malnutrition in rural Liberia

BACKGROUND

In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country's civil war and were further exacerbated by the 2014-2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations.

METHODS

Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers' experiences, as well as health workers' understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data.

RESULTS

Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition.

DISCUSSION

The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.

Determinants of early initiation of breastfeeding in Ghana: a population-based cross-sectional study using the 2014 Demographic and Health Survey data

Background

The World Health Organisation (WHO) recommends that breastfeeding should be initiated within the first hour of delivery followed by exclusive breastfeeding up to 6 months. This study examined the determinants of early initiation of breastfeeding in Ghana using data from the 2014 Ghana Demographic and Health Survey.

Methods

A sample size of 4219 was used for the study. Descriptive statistics was conducted to ascertain the proportion of children who had early initiation of breastfeeding after which binary logistic regression analysis was carried out. Results were presented using frequencies, percentages, unadjusted and adjusted odds ratios. Statistical significance was pegged at p<0.05.

Results

Children of first birth order [AOR = 0.71, CI = 0.61–0.84], those who were delivered by non-professionals [AOR = 0.51, CI = 0.30–0.88] and those whose mothers were Traditionalists [AOR = 0.65, CI = 0.46–0.92] and Mole-Dagbanis [AOR = 0.69, CI = 0.54–0.89] were less likely to go through early initiation of breastfeeding compared to those of 2–4 birth order, those who were delivered by health professionals, those whose mothers were Christians and Akan, respectively. Conversely, children born to mothers who read newspaper/magazine at least once a week were more likely to go through early initiation of breastfeeding, compared to those who never read newspaper/magazine [AOR = 1.40, CI = 1.01–1.95]. Children born to mothers who watched television less than once a week were more likely to go through early initiation of breastfeeding compared to those who watched television at least once a week [AOR = 1.40, CI = 1.01–1.95]. Finally, women from the Northern [AOR = 2.40, CI = [1.77–3.26] and Upper East regions [AOR = 2.57, CI = [1.86–3.56] practiced early initiation of breastfeeding compared to those from the Ashanti region.

Conclusions

Empowering healthcare providers to be consistent in early breastfeeding initiation advocacy and effective community engagement on the need to embrace and practice early initiation of breastfeeding can improve the situation.

Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey

Introduction

Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women.

Methods

This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women’s individual, household and community level characteristics.

Results

Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women’s non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman’s husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28–3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40–0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65–2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women’s age, education or rural-urban residence display no statistically significant relationship with EIBF.

Conclusion

Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.

Examining working mothers' experience of exclusive breastfeeding in Ghana

BACKGROUND

Although substantial evidence exists on factors that influence exclusive breastfeeding, there is a general lack of qualitative studies that examine how specific workplace factors constrain or promote exclusive breastfeeding among working mothers. The current study therefore examines working mothers' experience of exclusive breastfeeding, laying emphasis on the influence of workplace factors on working mothers' decision to exclusively breastfeed their babies.

METHODS

The study uses a qualitative research approach and a three-stage purposive sampling procedure to select 20 mothers from 10 organizations in five industries for in-depth interviews on their exclusive breastfeeding experience. Data collected from the interviews were analysed using content analysis, with two major themes emerging for discussion.

RESULTS

The results suggest that two major factors influence exclusive breastfeeding among working mothers: practice of exclusive breast feeding (knowledge and understanding of exclusive breastfeeding, and experience in exclusive breastfeeding) and workplace factors (length of maternity leave, closing time, absence of maternity policy in organizations, inadequate institutional support and family work-life balance).

CONCLUSION

The results of the study suggest that workplace factors play an equally crucial role in the decision by mothers to exclusively breastfeed their babies. Thus, in the special case of working mothers where breastfeeding prevalence is low, the findings of this study can be crucial in evolving appropriate policies to support working mothers in their effort to exclusively breastfeed their babies.

Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study

INTRODUCTION

The early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast feeding of newborns in public primary healthcare facilities (PHCs) in Northeast Nigeria, to influence the planning of programmes targeted at improving newborn care in the region.

METHOD

We used an explanatory mixed-method approach. We conducted case observation of childbirths and newborn care for the quantitative arm, and interviewed mothers and birth attendants 1 hour after childbirth for the qualitative arm. The analysis for the quantitative arm was done with SPSS V.23. For the qualitative arm, we transcribed the audio files, coded the texts and categorised them using thematic analysis.

RESULT

We observed 393 and 27 mothers for the quantitative and qualitative arms of the study, respectively. The quantitative arm shows that 39% of mothers did not breastfeed their newborns within 1 hour of birth. The qualitative arm shows that 37% of mothers did not breastfeed within 1 hour of birth. Themes that describe the barriers to early breast feeding in public PHCs are: birth attendants' unwillingness or inability to accommodate mothers' safe traditional practices, ineffective rooming-in practices, staff shortages, lack of privacy in the lying-in ward and poor implementation of visiting-hour policy in public PHCs. The pregnant women denied safe traditional birth practices like chanting, praying or reading religious books during delivery are five times more likely not to breastfeed newborns within the first hour of birth (relative risk=4.5, 95% CI 1.2-17.1) compared with pregnant women allowed these practices.

CONCLUSION

Stakeholders must increase their focus on improving breastfeeding practices in public PHCs. Instituting policies that protect mothers' privacy and finding innovative ways to accommodate and promote safe traditional practices in the intrapartum and postpartum period in PHCs will improve the early breast feeding of newborns in these PHCs.

The Global call for action on infection prevention and control

PURPOSE

Healthcare-associated infections (HAIs) constitute a major threat to patient safety and affect hundreds of millions of people worldwide. The World Health Organization in 2016 published guidelines on the core components for infection prevention and control (IPC) programme. This was in response to a global call for focused action. The purpose of this paper is to examine and promote understanding of the tenets of the IPC guidelines and highlight their implications for implementation in low-income countries.

DESIGN/METHODOLOGY/APPROACH

Drawing from personal experiences in leading the implementation of health programmes as well as a review of published and grey literature on IPC, authors discussed and proposed practical approaches to implement IPC priorities in low-income setting.

FINDINGS

Availability of locally generated evidence is paramount to guide strengthening leadership and institutionalisation of IPC programmes. Preventing infections is everybody's responsibility and should be viewed as such and accorded the required attention.

ORIGINALITY/VALUE

Drawing from recent experiences from disease outbreaks and given the heavy burden of HAIs especially in low-income settings, this paper highlights practical approaches to guide implementation of the major components of IPC.

Exclusive Breastfeeding Rates and Associated Factors in 13 "Economic Community of West African States" (ECOWAS) Countries

Exclusive breastfeeding (EBF) has important protective effects on child survival and also increases the growth and development of infants. This paper examined EBF rates and associated factors in 13 “Economic Community of West African States” (ECOWAS) countries. A weighted sample of 19,735 infants from the recent Demographic and Health Survey dataset in ECOWAS countries for the period of 2010–2018 was used. Survey logistic regression analyses that adjusted for clustering and sampling weights were used to determine the factors associated with EBF. In ECOWAS countries, EBF rates for infants 6 months or younger ranged from 13.0% in Côte d’Ivoire to 58.0% in Togo. EBF decreased significantly by 33% as the infant age (in months) increased. Multivariate analyses revealed that mothers with at least primary education, older mothers (35–49 years), and those who lived in rural areas were significantly more likely to engage in EBF. Mothers who made four or more antenatal visits (ANC) were significantly more likely to exclusively breastfeed their babies compared to those who had no ANC visits. Our study shows that EBF rates are still suboptimal in most ECOWAS countries. EBF policy interventions in ECOWAS countries should target mothers with no schooling and those who do not attend ANC. Higher rates of EBF are likely to decrease the burden of infant morbidity and mortality in ECOWAS countries due to non-exposure to contaminated water or other liquids.

Factors Associated with the Early Initiation of Breastfeeding in Economic Community of West African States (ECOWAS)

The early initiation of breastfeeding (EIBF) within one hour after birth enhanced mother–newborn bonding and protection against infectious diseases. This paper aimed to examine factors associated with EIBF in 13 Economic Community of West African States (ECOWAS). A weighted sample of 76,934 children aged 0–23 months from the recent Demographic and Health Survey dataset in the ECOWAS for the period 2010 to 2018 was pooled. Survey logistic regression analyses, adjusting for country-specific cluster and population-level weights, were used to determine the factors associated with EIBF. The overall combined rate of EIBF in ECOWAS was 43%. After adjusting for potential confounding factors, EIBF was significantly lower in Burkina Faso, Cote d’Ivoire, Guinea, Niger, Nigeria, and Senegal. Mothers who perceived their babies to be average and large at birth were significantly more likely to initiate breastfeeding within one hour of birth than those mothers who perceived their babies to be small at birth. Mothers who had a caesarean delivery (AOR = 0.28, 95%CI = 0.22–0.36), who did not attend antenatal visits (ANC) during pregnancy, and delivered by non-health professionals were more likely to delay initiation of breastfeeding beyond one hour after birth. Male children and mothers from poorer households were more likely to delay introduction of breastfeeding. Infant and young child feeding nutrition programs aimed at improving EIBF in ECOWAS need to target mothers who underutilize healthcare services, especially mothers from lower socioeconomic groups.

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.

Reasons for formula feeding among rural Bangladeshi mothers: A qualitative exploration

In Bangladesh the exclusive breastfeeding rate remains low and prelacteal, formula and bottle feeding is increasing. This study aims to explore reasons behind infant formula feeding practices from mothers, caregivers, and health care provider's perspective. This was a qualitative study carried out in four sub-districts of Sylhet and Jessore of rural Bangladesh. Data were collected through focus group discussions (12), in-depth interviews (4) and key informant interviews (12) from January to February 2014. The qualitative data collected and were analyzed using thematic content analysis. This study clearly showed the factor behind formula feeding by Bangladeshi rural women. One of the major findings was that women could not differentiate between formula and other milk. Main differences between formula and powder milk were the type of consumer where formula only was taken by infant and children less than 2 years. Other major reasons include; poor breastfeeding practices, lack of appropriate breastfeeding practices, superficial knowledge on harmful effect on infant formula; perceived insufficient breast milk production, the influence of family and society and authoritarian power of hospital staff. Rural mothers have intension to feed infant formula to their infants due to various factors including individual, social, cultural and institutional. These identified factors can contribute to policy making and develop more specific interventions targeting expected mother and their family members that can contribute to stop formula feeding and increase breastfeeding practices in rural Bangladesh.

Predictors of early initiation of breastfeeding among Zimbabwean women: secondary analysis of ZDHS 2015

Background

The World Health Organization recommends initiation of breastfeeding within the first hour of delivery. Early initiation is beneficial for both mother and baby. Previous Zimbabwe Demographic and Health Surveys (ZDHS) have shown reduction in early initiation of breast feeding from 68% (2005/06) to 58% (2015). This study sought to investigate factors associated with early initiation of breast feeding among women aged 15–49 years in Zimbabwe.

Methodology

Secondary analysis of ZDHS 2015 data was done to investigate the association between early initiation of breast feeding and maternal, provider and neonatal factors using multivariate logistic regression (n = 2192).

Results

The majority of the study sample (78%) reported having practised early initiation of breastfeeding during their most recent delivery (preceding 24 months).Children who were put on skin to skin contact (AOR = 1.51, 95% CI 1.13–2.02) and those delivered by skilled attendants (AOR = 4.36, 95% CI 1.07–17.77) had greater odds of early initiation compared to those who were not. Other factors associated with early initiation were multiparity (AOR 1.82 95% CI 1.33–2.49) and rural residence (AOR 2.10 95% 1.12–3.93). However, having an abnormal birth weight, i.e. low birth weight (AOR 0.60 95% CI 0.36–0.99) and macrosomia (AOR = 0.42, CI 0.22–0.79) as well as delivery by caesarean section (AOR 0.1195% CI 0.06–0.19) were associated with reduced odds of early initiation.

Conclusion

Early initiation of breast feeding in Zimbabwe is mainly associated with residing in the rural areas and multiparity. The 78% rate of early initiation of breastfeeding was contrary to the 58% reported in the ZDHS findings. Interventions targeting an improvement in early initiation of breastfeeding must aim at women who deliver by caesarean section, women with babies of abnormal birth weight, primi-parous women and women residing in rural areas.

Knowledge and practice of exclusive breastfeeding among mothers in the tamale metropolis of Ghana

Background

The prevalence of exclusive breastfeeding (EBF) for the first six months of life has remained low worldwide and in Ghana, despite strong evidence in support of its practice. This study was aimed at assessing the knowledge and practice of exclusive breastfeeding among mothers in the Tamale metropolis of Ghana.

Methods

In a descriptive cross-sectional study, 393 mother-infant pairs attending child welfare clinics from three health facilities in the Tamale Metropolis were surveyed. A structured item questionnaire was used to collect data on the socio-demographic Characteristics of the participants, their knowledge regarding breastfeeding and level of practice of exclusive breastfeeding (EBF). The results were presented in frequency counts, percentages and inferences were made using a contingency table and chi-square values were computed to check for the relationship between participants demographic characteristics, the Knowledge and the practice of EBF and P value was set at 0.05.

Results

The Analysis of the data was done with SPSS version 20. The study surveyed a total of 393 mothers from Tamale metropolis, of whom 27.7% reported having exclusively breastfed their infant for the first 6 months of life. The socio-demographic of the participants showed that they all had some level of education. The study revealed that 39.4% initiated breastfeeding within one hour after birth. Majority of participants had heard of EBF 277 (70.5%), about 344 (87.5%) of participants believed that EBF should be practised for 5 months in their locality. Pearson Chi-square test of the association between sociodemographic characteristics associated and EBF showed a significant association between EBF and the sex of the child, X² = 4.177, P = .041. Whiles, EBF and the Knowledge on child spacing was X² = 17.769, P < .001 and EBF and knowledge on Breast cancer reduction was also significant X² = 4.384, P = .036.

Conclusions

Although all the participants had some level of education background, a majority did not have adequate knowledge on EBF and EBF practice was low in the study community. Thus, we suggest improved education at the child welfare clinics and the media should be used as a platform to educate women adequately about importance of EBF.

A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana

Background

The paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector.

Methods

The study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector.

Results

The findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector.

Conclusion

The study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

Neonatal care practices in sub-Saharan Africa: a systematic review of quantitative and qualitative data

BACKGROUND

Recommended immediate newborn care practices include thermal care (immediate drying and wrapping, skin-to-skin contact after delivery, delayed bathing), hygienic cord care and early initiation of breastfeeding. This paper systematically reviews quantitative and qualitative data from sub-Saharan Africa on the prevalence of key immediate newborn care practices and the factors that influence them.

METHODS

Studies were identified by searching relevant databases and websites, contacting national and international academics and implementers and hand-searching reference lists of included articles. English-language published and unpublished literature reporting primary data from sub-Saharan Africa (published between January 2001 and May 2014) were included if it met the quality criteria. Quantitative prevalence data were extracted and summarized. Qualitative data were synthesized through thematic analysis, with deductive coding used to identify emergent themes within each care practice. A framework approach was used to identify prominent and divergent themes.

RESULTS

Forty-two studies were included as well as DHS data - only available for early breastfeeding practices from 33 countries. Results found variation in the prevalence of immediate newborn care practices between countries, with the exception of skin-to-skin contact after delivery which was universally low. The importance of keeping newborn babies warm was well recognized, although thermal care practices were sub-optimal. Similar factors influenced practices across countries, including delayed drying and wrapping because the birth attendant focused on the mother; bathing newborns soon after delivery to remove the dirt and blood; negative beliefs about the vernix; applying substances to the cord to make it drop off quickly; and delayed breastfeeding because of a perception of a lack of milk or because the baby needs to sleep after delivery or does not showing signs of hunger.

CONCLUSION

The majority of studies included in this review came from five countries (Ethiopia, Ghana, Malawi, Tanzania and Uganda). There is a need for more research from a wider geographical area, more research on newborn care practices at health facilities and standardization in measuring newborn care practices. The findings of this study could inform behaviour change interventions to improve the uptake of immediate newborn care practices.

Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana

Background

Exclusive breastfeeding is important for child health and growth, but its practice is low in many developing countries. This study aimed at determining the breastfeeding practices and examining the sociodemographic characteristics that influence exclusive breastfeeding among mothers attending child welfare clinic at Manhean, in the Tema East Sub-Meteropolitan area of Greater Accra region of Ghana.

Methods

This was a cross-sectional study that employed a structured questionnaire to collect data among 355 mothers of children aged 0-24 months selected through simple random sampling, attending a child welfare clinic from May to June, 2016. Breastfeeding practices were assessed based on the practices in the last 24 h prior to the study as defined by the World Health Organization.

Results

There was a universal awareness and high knowledge about exclusive breastfeeding among mothers, but prevalence among infants less than 6 months was 66.0% (n = 138/209). Mothers currently breastfeeding were 263 (74.0%); 225 (63.4%) initiated breastfeeding within the first hour after delivery and 289 (81.0%) of the mothers offered colostrum to babies after delivery. Continued breastfeeding rate at 1 year was 77.3% (n = 17/22). Only 33.7% (n = 31/92) of infants aged 6-8 months had started receiving complementary foods. For infants aged less than 24 months, 30.1% (n = 98/326) were bottle feeding. Mothers aged 20-24 (Adjusted odd ratio [AOR] 9.80; 95% confidence interval [CI] 2.11, 45.46), 25-29 (AOR 9.49; 95% CI 2.07, 43.47) and 30-34 (AOR 6.02; 95% CI 1.41, 25.65) were more likely to practice exclusive breastfeeding. Mothers who had tertiary education were less likely to practice EBF than those with no education (AOR 0.18; 95% CI 0.36, 0.85). Mothers from ethnic groups in northern Ghana were less likely to exclusively breastfeed their infants compared to those of Ghanaian (Ga) ethnicity (AOR 0.29; 95% CI 0.09, 0.96).

Conclusions

Exclusive breastfeeding and timely complementary feeding practices are suboptimal. Educational status, age and ethnicity of mothers strongly predicted maternal practice of exclusive breastfeeding. Interventions emphasizing a practical education should therefore be targeted at addressing factors that influence exclusive breastfeeding.

Prevalence of key breastfeeding indicators in 29 sub-Saharan African countries: a meta-analysis of demographic and health surveys (2010-2015)

OBJECTIVES

To carry out a meta-analysis to assess the prevalence of four key breastfeeding indicators in four subregions of 29 sub-Saharan African countries.

DESIGN, SETTINGS AND PARTICIPANTS

The 29 countries were categorised into four subregions, and using cross-sectional data from the most recent Demographic and Health Surveys (2010-2015) of these countries prevalence of each of four key breastfeeding indicators was estimated for each of the subregions by carrying out a meta-analysis. Due to the presence of significant heterogeneity among the various surveys (I2>50%), a random-effect analytic model was used, and sensitivity analysis was performed to examine the effects of outliers.

MAIN OUTCOME VARIABLES

Early initiation of breast feeding, exclusive breast feeding, predominant breast feeding and bottle feeding.

RESULTS

The overall prevalence of early initiation of breast feeding varied between a lowest of 37.84% (95% CI 24.62 to 51.05) in Central Africa to a highest of 69.31% (95% CI 67.65 to 70.97) in Southern Africa; the overall prevalence of exclusive breast feeding ranged between a lowest of 23.70% (95% CI 5.37 to 42.03) in Central Africa to a highest of 56.57% (95% CI 53.50 to 59.95) in Southern Africa; the overall prevalence of predominant breast feeding ranged between a lowest of 17.63% (95% CI 12.70 to 22.55) in East Africa and a highest of 46.37% (95% CI 37.22 to 55.52) in West Africa; while the prevalence of bottle feeding varied between a lowest of 8.17% (95% CI 5.51 to 10.84) in West Africa and a highest of 30.05% (95% CI 28.42 to 31.69) in Southern Africa.

CONCLUSIONS

West Africa and Central Africa recorded lower overall prevalence of early initiation of breast feeding and exclusive breast feeding than the WHO's recommended target of 50% by the year 2025. Intervention for improved breastfeeding practices in sub-Saharan Africa should target West and Central Africa, while intervention to minimise bottle feeding should target Southern Africa.

Predictors of exclusive breastfeeding and consumption of soft, semi-solid or solid food among infants in Boucle du Mouhoun, Burkina Faso: A cross-sectional survey

INTRODUCTION

Exclusive breastfeeding is among the most effective interventions for preventing child mortality. The objectives of this paper are to describe infant feeding knowledge and practices in Boucle du Mouhoun, Burkina Faso; to identify predictors of exclusive breastfeeding among infants <6 months, and consumption of soft, semi-solid or solid food among infants 6-11 months; to describe mothers' sources of information regarding breastfeeding.

METHODS

A cross-sectional survey (n = 2288) of a representative sample of women aged 15-49 years with at least one live birth in past year took place during June and July 2015. Crude and multivariable random-effects logistic regressions were used to identify factors predictive of exclusive breastfeeding and consumption of soft, semi-solid or solid food.

RESULTS

30% of infants <6 months were exclusively breastfed; 67% of infants age 6-11 months consumed soft, semi-solid or solid food the day and night before the interview. 2% of infants age 6-11 months had a minimum acceptable diet. There was strong evidence of a positive association between knowledge and practice of exclusive breastfeeding, nonetheless 60% of mothers who correctly identified that an infant should be exclusively breastfed for 6 months did not breastfeed their infant exclusively. Only 42% of mothers reported receiving advice on breastfeeding from a health worker, despite all mothers having contact with a health worker at least once during pregnancy or postpartum.

CONCLUSION

Given poor practices and low levels of knowledge, targeted interventions are needed to improve infant nutrition in Boucle du Mouhoun during antenatal, delivery and postnatal care. Most women now deliver in a facility in Burkina Faso; increased attention should be paid to ensuring that existing guidelines relating to support and counselling for infant feeding are adhered to. Factors such as social norms are also important and these should be investigated in more detail using qualitative methods.

Early initiation of breastfeeding: a systematic literature review of factors and barriers in South Asia

Background

Early or timely initiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition however remains low in South Asia and the factors and barriers warrant greater consideration for improved action. This review synthesises the evidence on factors and barriers to initiation of breastfeeding within 1 h of birth in South Asia encompassing Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.

Methods

Studies published between 1990 and 2013 were systematically reviewed through identification in Academic Search Complete, CINAHL, Global Health, MEDLINE and Scopus databases. Twenty-five studies meeting inclusion criteria were included for review. Structured thematic analysis based on leading frameworks was undertaken to understand factors and barriers.

Results

Factors at geographical, socioeconomic, individual, and health-specific levels, such as residence, education, occupation, income, mother’s age and newborn’s gender, and ill health of mother and newborn at delivery, affect early or timely breastfeeding initiation in South Asia. Reported barriers impact through influence on acceptability by traditional feeding practices, priests’ advice, prelacteal feeding and discarding colostrum, mother-in-law’s opinion; availability and accessibility through lack of information, low access to media and health services, and misperception, support and milk insufficiency, involvement of mothers in decision making.

Conclusions

Whilst some barriers manifest similarly across the region some factors are context-specific thus tailored interventions are imperative. Initiatives halting factors and directed towards contextual barriers are required for greater impact on newborn survival and improved nutrition in the South Asia region.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0076-7) contains supplementary material, which is available to authorized users.

Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers

Background

The practice of exclusive breastfeeding (EBF) is influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors. This study assessed knowledge, attitudes and practice of EBF among rural lactating mothers with infants aged 0–6 months. Factors associated to the practice of EBF were also investigated.

Methods

This cross-sectional study was conducted among 190 rural lactating mothers with infants aged 0–6 months seeking postnatal care at a health centre in Ghana. All data was collected using a questionnaire that contained both closed and open ended questions.

Results

About 26 % (n = 50) of the mothers were unable to correctly define EBF. The majority (92.6 %, n = 176) of the mothers said they felt good to EBF for 6 months, to breastfed on demand (99.5 %, n = 189) and did not have difficulties EBF (90 %, n = 171). Despite the generally positive attitude towards EBF, 42 % (n = 79) of the mothers did not EBF their babies. These mothers did not practice EBF because they misunderstood certain signs of the child to mean wanting to eat food or drink water, regarded breastmilk to be inadequate to meet the nutritional needs of the child and misunderstood healthcare professionals’ EBF advice. Higher maternal education was associated with higher likelihood of EBF (OR 3.5; 95 % CI 1.6, 7.7; p = 0.002). Mothers whose babies were younger than 3 months were more likely to EBF (OR 12.0; 95 % CI 4.4, 32.5; p < 0.001) than those having babies aged ≥ 3 months. Furthermore, higher knowledge of EBF was associated with the likelihood of EBF (OR 5.9; 95 % CI 2.6, 13.3; p < 0.001).

Conclusion

Mothers’ knowledge and attitudes towards EBF were favourable but practice of EBF was suboptimal. This study adds additional evidence that knowledge of EBF, child’s age and maternal level of education are important determinants of the practice of EBF. Beyond dissemination of health messages, healthcare professionals should pay more counselling attention to less educated mothers, and also older children’s caregivers.

Determinants of suboptimal breastfeeding practice in Debre Berhan town, Ethiopia: a cross sectional study

BACKGROUND

Optimal breastfeeding is inextricably linked to the achievement of Millennium Development Goals (MDGs) of eradicating extreme poverty and hunger, reducing child mortality and improving maternal health. Breastfeeding is safe, promotes sensory and cognitive development and contains antibodies that protect infants from common childhood illnesses. The objective of this study was to assess suboptimal breastfeeding and its determinants factors among mothers who have children below 23 months old in Debre Berhan, Ethiopia.

METHODS

A community based cross sectional study was conducted from 1 March 2015 until 30 March 2015. Five hundred forty eight mothers were included in the study using a two stage sampling technique. The data was collected by trained data collectors through pretested semi structured questionnaire. The collected data were cleaned, coded, entered and then analyzed using SPSS version 20 windows program. Descriptive statistics, binary and multivariable regression analysis with 95 % confidence interval was carried out and p value less than 0.05 used to determine the significant association. Late initiation of breastfeeding was defined as initiation of breastfeeding after one hour of delivery while early cessation of breastfeeding was to stop breastfeeding before 24 months of age. According to World Health Organization exclusive breastfeeding was defined as the practice of feeding breast milk only, including expressed breast milk, to infants and excluding water, other liquids, breast milk substitutes, and solid foods. Vitamin drops, minerals, oral rehydrating solution (ORS) and medicines may be given.

RESULTS

The prevalence of late initiation of breastfeeding, not exclusively breastfeeding and early cessation of breastfeeding were 17.5 % (95 % Confidence Interval [CI] 15.2 %, 19.4), 49.8 % (95 % CI 46.3, 50.5) and 12.8 % (95 % CI 11.7, 14.1) respectively. Birth at home was significantly associated with late initiation of breastfeeding (Adjusted Odds Ratio [AOR] 3.0; 95 % CI 1.5, 6.0). No advice during antenatal care was a predictor of not exclusively breastfeeding (AOR1.7; 95 % CI 1.2, 2.5). Being illiterate (AOR 3.2; 95 % CI 1.2, 8.3) and no advice during antenatal care about breastfeeding (AOR 1.9; 95 % CI 1.0. 3.4) were significantly associated with early cessation of breastfeeding.

CONCLUSION

Educational status, age, antenatal and postnatal follow up, resident and place of delivery were predictors of suboptimal breastfeeding. Integrated and targeted interventions were recommended to achieve a better outcome in minimizing the late initiation, non-exclusive and early cessation of breastfeeding.

Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity--a systematic review and meta-analysis

The purpose of this study was to review the evidence on the effect of initiation of breastfeeding early after birth and of exclusive breastfeeding during the first month in reducing neonatal mortality and morbidity. We searched Cochrane and PubMed databases for all available papers addressing our review questions and identified eleven papers. Data were extracted using a standard abstraction form. Evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Meta-analysis was done using STATA 11.0. Early initiation of breastfeeding was associated with a reduced risk of neonatal mortality. Initiating breastfeeding after the first hour doubled the risk of neonatal mortality. Exclusively breastfed neonates had a lower risk of mortality and infection-related deaths in the first month than partially breastfed neonates. Exclusively breastfed neonates also had a significantly lower risk of sepsis, diarrhea and respiratory infections compared with those partially breastfed. The pooled evidence indicates that substantial benefits in reducing neonatal mortality and morbidity can be achieved with effective promotion of early initiation of breastfeeding and exclusive breastfeeding during the first month of life.

Socio-medical determinants of timely breastfeeding initiation in Ethiopia: Evidence from the 2011 nation wide Demographic and Health Survey

BACKGROUND

Early initiation of breastfeeding is a simple and cost effective intervention to advance the health of mothers and newborns. The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend that breastfeeding should be initiated within one hour of birth. The aim of this study is to identify factors associated with timely initiation of breastfeeding among mothers in Ethiopia within one hour of birth.

METHODS

This study used data from the 2011 Ethiopia Demographic and Health Survey. A total of 11,654 households were included in the analysis from 11 administrative states of Ethiopia. Bivariate and multivariable logistic regression models with adjusted odds ratio (AOR) and 95 % confidence intervals (CI) were used to quantify predictors of early breastfeeding initiation.

RESULTS

The overall prevalence of timely breastfeeding initiation was 52 % (95 % CI: 51.09, 52.91). The prevalence was higher in urban settings (61.4 %; 95 % CI: 58.85, 63.85) than in rural areas (52.3 %; 95 % CI: 51.33, 53.28). The highest prevalence was found in Addis Ababa 71.5 % (95 % CI: 64.88, 77.12) while the lowest prevalence was 41.7 % (95 % CI: 36.62, 47.00) in Somali regional state. Multivariable logistic regression analysis showed that rural mothers had 39 % lower odds of timely breastfeeding initiation (AOR 0.61; 95 % CI: 0.50, 0.76) compared to urban mothers. Mothers who had secondary education or higher had 60 % higher odds of timely breastfeeding initiation (AOR 1.6; 95 % CI: 1.02, 2.44) than never educated mothers. Mothers who had caesarian deliveries had 61 % lower odds of timely breastfeeding initiation (AOR 0.39; 95 % CI: 0.22, 0.71) compared to vaginal deliveries. Working mothers were 23 % less likely to timely initiate breastfeeding (AOR 0.77; 95 % CI: 0.69, 0.85) compared to housewives. Female infants had a 20 % higher chance of timely breastfeeding initiation (AOR 1.2; 95 % CI: 1.05, 1.30) compared to male infants.

CONCLUSION

Early initiation of breastfeeding within the first hour after birth was not optimal  in Ethiopia. Factors such as place of residence, educational level, occupation, gender of the newborn and type of delivery should be considered in any intervention program in order to enhance timely breastfeeding initiation.

Roles and responsibilities in newborn care in four African sites

Objectives

To explore roles and responsibilities in newborn care in the intra‐ and postpartum period in Nigeria, Tanzania and Ethiopia.

Methods

Qualitative data were collected using in‐depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses.

Results

We found that birth attendants were the main decision‐makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first‐time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision‐maker in the family.

Conclusion

Interventions should move beyond a focus on the mother–child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study

We report the infant feeding experiences in the first month of life for 2,053 infants participating in "Malnutrition and Enteric Infections: Consequences for Child Health and Development" (MAL-ED). Eight sites (in Bangladesh, India, Nepal, Pakistan, Brazil, Peru, South Africa, Tanzania), each followed a cohort of children from birth (by day 17), collecting detailed information on infant feeding practices, diet and illness episodes. Mothers were queried twice weekly regarding health status, breastfeeding and the introduction (or no) of non-breast milk liquids and foods. Here, our goal is to describe the early infant feeding practices in the cohort and evaluate factors associated with termination of exclusive breastfeeding in the first month of life. With data from enrollment to a visit at 28-33 days of life, we characterized exclusive, predominant or partial breastfeeding (using a median of 6-9 visits per child across the sites). Only 6 of 2,053 infants were never breastfed. By one month, the prevalences of exclusive breastfeeding were < 60% in 6 of 8 sites, and of partial breastfeeding (or no) were > 20% in 6 of 8 sites. Logistic regression revealed that prelacteal feeding (given to 4-63% of infants) increased the likelihood of partial breastfeeding (Odds Ratio (OR): 1.48 (95% confidence interval (CI): 1.04, 2.10), as did the withholding of colostrum (2-16% of infants) (OR: 1.63:1.01, 2.62), and being a first-time mother (OR: 1.38:1.10, 1.75). Our results reveal diversity across these sites, but an overall trend of early transition away from exclusive breastfeeding in the first month of life. Interventions which introduce or reinforce the WHO/UNICEF Ten Steps for Successful Breastfeeding are needed in these sites to improve breastfeeding initiation, to reinforce exclusive breastfeeding and delay introduction of non-breast milk foods and/or liquids.

Designing for action: adapting and implementing a community-based newborn care package to affect national change in Uganda

Background

There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind.

Objective

This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake.

Design

We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed.

Results

An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing.

Conclusions

Designing interventions for national scale-up requires strategies and planning from the outset. Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities. This approach has the potential to rapidly translate research into policy, but care must be taken not to exceed available evidence while seizing the policy opportunity.

Determinants of suboptimal breastfeeding practices in Nigeria: evidence from the 2008 demographic and health survey

BACKGROUND

In Nigeria, suboptimal breastfeeding practices are contributing to the burden of childhood diseases and mortality. This study identified the determinants of key suboptimal breastfeeding practices among children 0-23 months in Nigeria.

METHOD

Data on 10,225 children under-24 months were obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). Socio-economic, health service and individual factors associated with key breastfeeding indicators (early initiation of breastfeeding, exclusive breastfeeding, predominant breastfeeding and bottle feeding) were investigated using multiple logistic regression analyses.

RESULTS

Among infants 0-5 months of age, 14% [95% confidence Interval (CI): 13%, 15%] were exclusively breastfed and 48% [95% CI: 46, 50%] were predominantly breastfed. Among children aged 0-23 months, 38% [95% CI 36, 39%] were breastfed within the first hour of birth, and 15% [95% CI: 14, 17%] were bottle-fed. Early initiation of breastfeeding was associated with higher maternal education, frequent antenatal care (ANC) visits and birth interval but deliveries at a health facility with caesarean section was associated with delayed initiation of breastfeeding. Educated mothers, older mothers and mothers from wealthier households exclusively breastfeed their babies. The risk for bottle feeding was higher among educated mothers and fathers, and women from wealthier households including mothers who made frequent ANC visits.

CONCLUSION

Socio-economic and health service factors were associated with suboptimal breastfeeding practices in Nigeria. To improve the current breastfeeding practices, breastfeeding initiatives should target all mothers - particularly low SES mothers - including, national and sub-national health policies that ensure improved access to maternal health services, and improvements to baby friendly hospital and community initiatives for mothers.

Early infant feeding practices in three African countries: the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors

Background

Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. We report its impact on early infant feeding practices from the PROMISE-EBF trial.

Methods

PROMISE-EBF was a cluster randomised behaviour change intervention trial of exclusive breastfeeding (EBF) promotion by peer counsellors in Burkina Faso, Uganda and South Africa implemented during 2006-2008 among 2579 mother-infant pairs. Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits. Early infant feeding practices: use of prelacteal feeds (any foods or drinks other than breast milk given within the first 3 days), expressing and discarding colostrum, and timing of initiation of breastfeeding are presented by trial arm in each country. Prevalence ratios (PR) with 95% confidence intervals (95%CI) are given.

Results

The proportion of women who gave prelacteal feeds in the intervention and control arms were, respectively: 11% and 36%, PR 0.3 (95% CI 0.2, 0.6) in Burkina Faso, 13% and 44%, PR 0.3 (95% CI 0.2, 0.5) in Uganda and 30% and 33%, PR 0.9 (95% CI 0.6, 1.3) in South Africa. While the majority gave colostrum, the proportion of those who expressed and discarded it in the intervention and control arms were: 8% and 12%, PR 0.7 (95% CI 0.3, 1.6) in Burkina Faso, 3% and 10%, PR 0.3 (95% CI 0.1, 0.6) in Uganda and 17% and 16%, PR 1.1 (95% CI 0.6, 2.1) in South Africa. Only a minority in Burkina Faso (<4%) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms, whilst in Uganda the proportion of early initiation of breastfeeding in the intervention and control arms were: 55% and 41%, PR 0.8 (95% CI 0.7, 0.9).

Conclusions

The PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in the intervention arm in Uganda. Late breastfeeding initiation continues to be a challenge. No clear behaviour change was seen in South Africa.

Trial registration

NCT00397150.

Electronic supplementary material

The online version of this article (doi:10.1186/1746-4358-9-19) contains supplementary material, which is available to authorized users.

Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change

BACKGROUND

Hypothermia contributes to neonatal morbidity and mortality in low-income countries, yet little is known about thermal care practices in rural African settings. We assessed adoption and community acceptability of recommended thermal care practices in rural Tanzania.

METHODS

A multi-method qualitative study, enhanced with survey data. For the qualitative component we triangulated birth narrative interviews with focus group discussions with mothers and traditional birth attendants. Results were then contrasted to related quantitative data. Qualitative analyses sought to identify themes linked to a) immediately drying and wrapping of the baby; b) bathing practices, including delaying for at least 6 hours and using warm water; c) day to day care such as covering the baby's head, covering the baby; and d) keeping the baby skin-to-skin. Quantitative data (n = 22,243 women) on the thermal care practices relayed by mothers who had delivered in the last year are reported accordingly.

RESULTS

42% of babies were dried and 27% wrapped within five minutes of birth mainly due to an awareness that this reduced cold. The main reason for delayed wrapping and drying was not attending to the baby until the placenta was delivered. 45% of babies born at a health facility and 19% born at home were bathed six or more hours after birth. The main reason for delayed bathing was health worker advice. The main reason for early bathing believed that the baby is dirty, particularly if the baby had an obvious vernix as this was believed to be sperm. On the other hand, keeping the baby warm and covered day-to-day was considered normal practice. Skin-to-skin care was not a normalised practice, and some respondents wondered if it might be harmful to fragile newborns.

CONCLUSION

Most thermal care behaviours needed improving. Many sub-optimal practices had cultural and symbolic origins. Drying the baby on birth was least symbolically imbued, although resisted by prioritizing of the mothers. Both practical interventions, for instance, having more than one attendant to help both mother and baby, and culturally anchored sensitization are recommended.

Reliability of demographic and socioeconomic variables in predicting early initiation of breastfeeding: a replication analysis using the Kenya Demographic and Health Survey data

OBJECTIVES

Examine the reliability of sociodemographic variables in predicting initiation of breastfeeding within an hour of birth (EarlyBF), using data from 1998, 2003 and 2008-2009.

STUDY DESIGN

A replication analysis using the Kenya Demographic and Health Survey (KDHS) data collected in 1998, 2003 and 2008-2009. The candidate predictor variables were child's gender, home or health facility place of birth, vaginal or caesarean mode of birth, urban or rural setting, province of residence, Wealth Index and maternal education, occupation, literacy and media exposure.

SETTING

Kenya.

PARTICIPANTS

6375 dyads of mothers aged 15-49 and their children aged 0-23 months (2125 dyads in each of the survey years).

RESULTS

Mode of birth and province were statistically significant predictors of EarlyBF in 1998, 2003 and 2008-2009. Children delivered through caesarean section were non-EarlyBF in 1998 (OR 2.63, 95% CI 1.72 to 4.04), 2003 (OR 3.36, 95% CI 1.83 to 6.16) and 2008 (OR 3.51, 95% CI 2.17 to 5.69). The same was true of those living in the Western province in 1998 (OR 2.67, 95% CI 1.61 to 4.43), 2003 (OR 4.92, 95% CI 3.01 to 8.04) and 2008 (OR 6.07, 95% CI 3.54 to 10.39).

CONCLUSIONS

The 1998 KDHS data do not provide the basis for reliable prediction of EarlyBF, with reliability conceptualised as replicability of findings using highly similar data sets from 2003 and 2008-2009. Most of the demographic and socioeconomic variables were unreliable predictors of EarlyBF. We speculate that activities in parts or all of Kenya changed the analysis context in the period between 1998 and 2008-2009, and these changes were of a sufficient magnitude to affect the relationships under investigation. The degree to which this is a general problem in child health research is not known, calling for further research to investigate this methodological issue with other health end points and other data.

Can breastfeeding promote child health equity? A comprehensive analysis of breastfeeding patterns across the developing world and what we can learn from them

BACKGROUND

In 2010 more than 7.7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries, and recent estimates have attributed hundreds of thousands of these deaths to suboptimal breastfeeding.

METHODS

This study estimated prevalence of suboptimal breastfeeding for 137 developing countries from 1990 to 2010. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These prevalence estimates were disaggregated by wealth quintile and linked with child mortality rates to assess how improved rates of breastfeeding may affect child health inequalities.

RESULTS

In 2010, the prevalence of exclusive breastfeeding ranged from 3.5% in Djibouti to 77.3% in Rwanda. The proportion of child Disability Adjusted Life Years (DALYs) attributable to suboptimal breastfeeding is 7.6% at the global level and as high as 20.2% in Swaziland. Suboptimal breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within most countries, breastfeeding prevalence rates do not vary considerably across wealth quintiles.

CONCLUSIONS

Breastfeeding is an effective child health intervention that does not require extensive health system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries.

Knowledge, attitude, and practices regarding early start of breastfeeding among pregnant, lactating women and healthcare workers in El-Minia University Hospital

BACKGROUND

Breastfeeding within the first hour of life is a potential mechanism for health promotion and is considered to be an indicator of excellence of breastfeeding. This study was conducted to evaluate the knowledge, attitude, and practice regarding early breastfeeding initiation within the first hour of life in both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital, Minia, Egypt.

SUBJECTS AND METHODS

A study was conducted on four groups of participants from both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital, each of them consisting of 30 individuals, using a questionnaire to assess the knowledge, attitude, and practice regarding early breastfeeding initiation for each group.

RESULTS

Sixty percent of women delivered by spontaneous vaginal delivery and 16.7% of those delivered by cesarean section initiated breastfeeding within 30 minutes to 1 hour after birth. Forty percent of lactating women delivered by spontaneous vaginal delivery, 83.3% of lactating women delivered by cesarean section, and 36.7% of healthcare workers used prelacteal feed instead of early breastfeeding initiation. The most important factors affecting the breastfeeding initiation were maternal illness followed by immediate skin-to-skin contact.

CONCLUSIONS

Although the majority of women participating in this study exhibited knowledge about early breastfeeding initiation, actual application of this practice was clearly deficient. In order to improve the rates of breastfeeding initiation within the first hour of life we should enhance vaginal delivery and prenatal classes and implement Baby-Friendly Hospital Initiative policies in both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital.

Infant nutrition in the first seven days of life in rural northern Ghana

BACKGROUND

Good nutrition is essential for increasing survival rates of infants. This study explored infant feeding practices in a resource-poor setting and assessed implications for future interventions focused on improving newborn health.

METHODS

The study took place in the Kassena-Nankana District of the Upper East Region of northern Ghana. In-depth interviews were conducted with 35 women with newborn infants, 8 traditional birth attendants and local healers, and 16 community leaders. An additional 18 focus group discussions were conducted with household heads, compound heads and grandmothers. All interviews and discussions were audio taped, transcribed verbatim and analyzed using NVivo 9.0.

RESULTS

Community members are knowledgeable about the importance of breastfeeding, and most women with newborn infants do attempt to breastfeed. However, data suggest that traditional practices related to breastfeeding and infant nutrition continue, despite knowledge of clinical guidelines. Such traditional practices include feeding newborn infants water, gripe water, local herbs, or traditionally meaningful foods such as water mixed with the flour of guinea corn (yara'na). In this region in Ghana, there are significant cultural traditions associated with breastfeeding. For example, colostrum from first-time mothers is often tested for bitterness by putting ants in it - a process that leads to a delay in initiating breastfeeding. Our data also indicate that grandmothers - typically the mother-in-laws - wield enormous power in these communities, and their desires significantly influence breastfeeding initiation, exclusivity, and maintenance.

CONCLUSION

Prelacteal feeding is still common in rural Ghana despite demonstrating high knowledge of appropriate feeding practices. Future interventions that focus on grandmothers and religious leaders are likely to prove valuable in changing community attitudes, beliefs, and practices with regard to infant nutrition.

Opportunities for improving, adapting and introducing emollient therapy and improved newborn skin care practices in Africa

Infections and complications from prematurity cause a majority of global neonatal deaths. Recent evidence has demonstrated the life-saving ability of topical emollient therapy in resource-poor settings. With the potential to reduce infection and neonatal mortality by 41 and 26%, respectively, emollient therapy is a promising option for improving newborn care. While application of oil to the newborn is nearly universal in South Asia, little is known about this behavior in Africa. This article draws on literature regarding neonatal skin care in Africa to describe behaviors, motivations and potential for introducing topical emollients. Oil massage does not appear to be universal. When oil massage occurs, substances of unknown toxicity and possibly damaging massage practices are used; thus, there is scope for introduction of improved therapeutic practices. Overall, more research is needed to develop the evidence base of current neonatal skin care behaviors in Africa, and to determine emollient therapy effectiveness there.

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

OBJECTIVE

To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region.

STUDY DESIGN

Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h.

RESULT

Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 1  h after birth.

CONCLUSION

Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.

A large cross-sectional community-based study of newborn care practices in southern Tanzania

Despite recent improvements in child survival in sub-Saharan Africa, neonatal mortality rates remain largely unchanged. This study aimed to determine the frequency of delivery and newborn-care practices in southern Tanzania, where neonatal mortality is higher than the national average. All households in five districts of Southern Tanzania were approached to participate. Of 213,220 female residents aged 13–49 years, 92% participated. Cross-sectional, retrospective data on childbirth and newborn care practices were collected from 22,243 female respondents who had delivered a live baby in the preceding year. Health facility deliveries accounted for 41% of births, with nearly all non-facility deliveries occurring at home (57% of deliveries). Skilled attendants assisted 40% of births. Over half of women reported drying the baby and over a third reported wrapping the baby within 5 minutes of delivery. The majority of mothers delivering at home reported that they had made preparations for delivery, including buying soap (84%) and preparing a cloth for drying the child (85%). Although 95% of these women reported that the cord was cut with a clean razor blade, only half reported that it was tied with a clean thread. Furthermore, out of all respondents 10% reported that their baby was dipped in cold water immediately after delivery, around two-thirds reported bathing their babies within 6 hours of delivery, and 28% reported putting something on the cord to help it dry. Skin-to-skin contact between mother and baby after delivery was rarely practiced. Although 83% of women breastfed within 24 hours of delivery, only 18% did so within an hour. Fewer than half of women exclusively breastfed in the three days after delivery. The findings suggest a need to promote and facilitate health facility deliveries, hygienic delivery practices for home births, delayed bathing and immediate and exclusive breastfeeding in Southern Tanzania to improve newborn health.