Exclusive breastfeeding in southern Brazil: prevalence and associated factors

Breastfeeding among South Sudanese refugees in protracted settlements in Adjumani district, Uganda: facilitators and barriers

BACKGROUND

Evidence suggests that forced migration and refugee status may adversely impact mothers' breastfeeding choices. Furthermore, suboptimal breastfeeding practices have been reported among vulnerable populations including those living in refugee settlements. Therefore, this study investigated the barriers and facilitators of breastfeeding in protracted settlements in Adjumani district, in the West Nile region in Uganda.

METHODS

This study was conducted among refugees living in protracted settlements located in Uganda in July 2019. Participants, originally from South Sudan, included mothers (n = 63) and fathers (n = 32) of children less than 24 months of age. Agojo, Ayilo-I, and Nyumanzi were randomly selected among the 17 refugee settlements in Adjumani. Participants formed a total of six focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. Each FGD consisted of 15-16 participants. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo, v. 12.

RESULTS

Facilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers noted that breastfeeding protected children from diseases and breastfed children grew well. Fathers, the community, and organizations provided material support for breastfeeding mothers. Four themes were identified as barriers to breastfeeding: physical, socioeconomic, knowledge, and psychosocial. Mothers and fathers described physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers reported that working or educated mothers may use other milk to feed their infant. Some mothers and fathers believed infants under six months needed more than breastmilk. Fathers described psychosocial barriers such as mothers' fear of pain during breastfeeding and maternal mental health issues.

CONCLUSION

Interventions and policies that aim to improve breastfeeding in protracted settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations.

Determinants of exclusive breastfeeding practices among mothers in Ethiopia

BACKGROUND

Exclusive breastfeeding (EBF) is the most cost-effective intervention to reduce infant morbidity and mortality worldwide. It is crucial since human milk contains nutrients, living cells, and defensive factors which enable infants to have better immunity, physical and mental development. Therefore, this study aimed at identifying the predictors of exclusive breastfeeding practices among mothers in Ethiopia using Ethiopian Demographic and Health Survey (EDHS) 2016 data.

METHODS

EDHS 2016 data were used for the analysis. A total of 1,066 mothers were included in the analysis. The binary logistic regression model was used to identify the determinants of EBF practice among mothers. The result presented using adjusted odd ratio (AOR) with a 95% confidence interval.

RESULTS

The prevalence of EBF was 58% of infants under age 6 months. Mothers age 25-34 (AOR = 1.74; 95% CI 1.31-2.32), child age 4-5 months (AOR = 0.74; 95% CI 0.66-0.84), married marital status (AOR = 1.26; 95% CI 1.06-1.50), mothers attained secondary education or higher (AOR = 2.00; 95% CI 1.54-2.58), husband attained secondary education or higher (AOR = 1.70; 1.39-2.13), richer wealth index (AOR = 0.35; 95% CI 0.18-0.69), accessed to the media (AOR = 1.77; 95% CI 1.38-2.27), number of living children 3-4 (AOR = 0.49; 95% CI 0.25-0.95), health facility (AOR = 1.87; 95% CI 1.09-3.20), rural residence (AOR = 0.66; 95% CI 0.49-0.89) and mothers living in Afar (AOR = 100.2; 95% CI 15.68-640.61), Somali (AOR = 52.65; 95% CI 8.48-326.77), SNNPR (AOR = 6.94; 95% CI 1.05-45.79), Harari (AOR = 61.94; 95% CI 9.75-393.44), Addis Ababa (AOR = 13.07; 95% CI 2.06-82.99), and Dire Dawa (AOR = 28.91; 95% CI 4.38-190.86) were associated with EBF practice.

CONCLUSIONS

The practice of exclusive breastfeeding remains low in Ethiopia. Therefore, the stakeholders should be taken into consideration those determinant factors identified in this study in policies and programmes to increase EBF practice among mothers. Moreover, designing and implementing specific strategies to enhance the rate of exclusive breastfeeding practices through community-based education is recommended.

Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional study

BACKGROUND

Children need good nutrition to develop proper immune mechanisms and psychosocial maturity, but malnutrition can affect their ability to realize this. Apart from the national demographic and health survey, which is carried out every 5 years, there have not been enough documented studies on child breastfeeding and weaning practices of caregivers in the Volta Region. We, therefore, examined child breastfeeding and weaning practices of mothers in the Volta Region of Ghana.

METHODS

A sub-national survey method was adopted and a semi-structured questionnaire was used to collect data from 396 mothers and their children. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and logistic regression were employed in analysing the data. We defined exclusive breastfeeding as given only breast milk to an infant from a mother or a wet nurse for six months of life except drops or syrups consisting of vitamins, minerals, supplements, or medicines on medical advice, and prolonged breastfeeding as breastfeeding up to 24 months of age.

RESULTS

The prevalence of exclusive breastfeeding (EBF) was 43.7%. Mothers constituting 61.1% started breastfeeding within an hour of giving birth. In addition to breast milk, 5.1% gave fluids to their children on the first day of birth. About 66.4% started complementary feeding at 6 months, 22.0% breastfed for 24 months or beyond, while 40.4% fed their children on-demand. Child's age (AOR: 0.23, 95% CI:0.12-0.43, p<0.0001), prolonged breastfeeding (AOR: 0.41, 95%CI: 0.12-0.87, p = 0.001), mother's religion (AOR: 3.92, 95%CI: 1.23-12.61, p = 0.021), feeding practices counselled on (AOR: 1.72, 95%CI: 1.96-3.09, p = 0.023), mother ever heard about EBF (AOR: 0.43, 95%CI: 1.45-2.41, p = 0.039), child being fed from the bottle with a nipple (AOR: 1.53, 95%CI: 1.94-2.48, p = 0.003), and age at which complementary feeding was started (AOR: 17.43, 95%CI: 3.47-87.55, p = 0.008) were statistically associated with EBF.

CONCLUSION

Breastfeeding education has been ongoing for decades, yet there are still gaps in the breastfeeding practices of mothers. To accelerate progress towards attainment of the sustainable development goal 3 of ensuring healthy lives and promoting well-being for all at all ages by the year 2030, we recommend innovative policies that include extensive public education to improve upon the breastfeeding and weaning practices of mothers.

Evaluation of breastfeeding self-effectiveness and its associated factors in puerperal women assisted at a public health system in Brazil

Abstract Objectives: evaluate breastfeeding self-efficacy and its associated factors in puerperal women assisted at a public health system in Brazil. Methods: it is a cross-sectional analytical study, with convenience sampling and two instruments: sociodemographic, personal and clinical, and Breastfeeding Self-Efficacy Scale (BSES-SF), applied to puerperal women in a puerperal outpatient clinic at two public maternity hospitals in Goiânia/GO, from September to November 2019. Inclusion criteria: mothers in puerperal period, age above 18 years, children born at term and on exclusive breastfeeding. Exclusion criteria: report depression and premature wean. Results: 128puerperal women were interviewed. The average age was 26.7 (± 5.9) years old. The levels of self-efficacy were high (95.3%) and no puerperal had a low level. The variables with statistical significance were: experience in breastfeeding (p= 0.0312), not having received information on breastfeeding during pregnancy (p=0.0292), did not receive other milk at the maternity (p=0.0380), did not feel pain while breastfeeding (p=0.0242), being able to breastfeed on demand (p=0.0124), presence of breast engorgement (p=0.0207), presenting protruding nipples (p=0.0427). Conclusions: clinical and personal aspects were identified as risk factors for early weaning. This can provide information for the training ofprofessionals and structuring the interventions in health services, with a view in preventing these risks.

Determinants of exclusive breastfeeding practice in Bangladesh: Evidence from nationally representative survey data

BACKGROUND

Exclusive breastfeeding (EBF) means that an infant should be breastfed only for the first six months of life to achieve optimal child development and to prevent infant morbidity and mortality. The aim of this analysis was to determine the individual-, household-, and community-level factors associated with EBF practice in Bangladesh.

METHODS

A total of 1,440 women-child pairs data were analysed extracted from 2011 and 2014 Bangladesh Demographic and Health Survey. Multilevel logistic regression models were used separately for individual-, household-, and community level factors to identify the different level of factors associated with EBF practice.

RESULTS

Around 61% women in Bangladesh practiced EBF with significant variation across several individual-, household-, and community-level factors. At the individual level, higher odds of EBF practice was found among mothers' received higher number of antenatal care and lower age of child. Mothers' higher education and engagement in formal jobs were found negatively associated with EBF practice. At the community level, higher odds of EBF was found among women live in Barishal, Dhaka, and Rajshahi divisions, and resided in the community with moderate level of female education, higher level of fertility, and higher use of antenatal and delivery care.

CONCLUSIONS

One in every three children in Bangladesh do not breastfeed exclusively which needs special attention for the policymakers. In this case, educated women engaged in income generating activities and women did not use antenatal care should be given priority. At the community level, priority should be given for the women's resides in the community with lower level of antenatal and delivery healthcare services use.

Exclusive breastfeeding cessation and associated factors among employed mothers in Dukem town, Central Ethiopia

BACKGROUND

Employed women tend to exclusively breastfeed less than non-employed women. Early returning to work has been major reason why employed women stop exclusive breastfeeding. The aim of this study was to investigate exclusive breastfeeding (EBF) cessation and associated factors among employed mothers in Dukem town, Central Ethiopia.

METHODS

A cross-sectional study was conducted from February to March 2015 using total sample of 313 randomly selected permanently employed women. Information regarding participants' work-related factors, health service and sociodemographic factors were collected by face to face interview using structured questionnaire. Data were checked for completeness, entered and analyzed by SPSS version 20. Binary logistic regression was done to identify factors associated with exclusive breastfeeding cessation. The strength of association was measured using odds ratio with 95% confidence intervals.

RESULTS

Prevalence of exclusive breastfeeding cessation was 75.7% (95% CI 71.0, 80.5%). Having a short duration of maternity leave (AOR 9.3; 95% CI 3.8, 23), being a full time employee (AOR 3.5; 95% CI 1.7, 11), being private organization employee (AOR=2.1, 95% CI(1, 4.3)), lack of flexible work time (AOR 3.0; 95% CI 1.2, 7.5), not pumping breast milk (AOR 4.3; 95% CI 1.7, 11), lack of a lactation break (AOR 6.7; 95% CI 3,14.5) and work place far away from her child (AOR 3.1; 95% CI 3.1, 6.3), were significantly associated with cessation of EBF among employed mothers.

CONCLUSION

Prevalence of exclusive breastfeeding cessation was much higher than the international and national expectation. The concerned governmental bodies should consider improving the legislation of the 3 months postpartum maternity leave to reduce employed mother's exclusive breastfeeding cessation.

HABITS AND ATTITUDES OF MOTHERS OF INFANTS IN RELATION TO BREASTFEEDING AND ARTIFICIAL FEEDING IN 11 BRAZILIAN CITIES

Objective:

To analyze the relationship between habits and attitudes of mothers and the types of milk offered to their children in their first two years of life.

Methods:

Retrospective study including 773 interviews of mothers from 11 Brazilian cities with children under 2 years of age. Interviews were conducted in 11 cities of Brazil. The following factors were analyzed: breastfeeding method planned during pregnancy and the method actually applied after birth; type(s) of milk(s) used on the day of the interview and earlier; age at which the child was introduced to whole milk; and source of advice used to choose a certain type of milk.

Results:

Breast milk was offered to 81.7% of infants during their first six months of life, to 52.2% of infants during their second semester (p<0.001) and to 32.9% of infants during their second year of life (p<0.001). In contrast, cow’s milk consumption increased from 31.1 to 83.8% (p<0.001) and 98.7% (p=0.05), respectively, for these three age groups. Infant (15.0%) and follow-on (also known as toddler’s) (2.3%) formulas were used by a much smaller number of infants than whole cow’s milk. Most mothers were not prescribed whole cow’s milk. Pediatricians were the health care professionals who most often recommended infant formulas.

Conclusions:

Rates of breastfeeding in Brazil remain below recommended levels. Brazilian mothers often decide to feed their infants with whole cow’s milk on their own initiative. The use of infant formulas after weaning is still too low.

Exclusive breastfeeding status of children aged between 6 and 24 months in the nomadic population of Hadaleala district, Afar Region, northeast Ethiopia

Background

Exclusive breastfeeding (EBF) during infancy is fundamental, however it is not fully practiced in the nomadic population of Ethiopia. In Ethiopia, there is still a lack of information on the implementation of the EBF, especially among the nomadic population. This study was conducted to assess the EBF status of children during their first 6 months of life, who are now aged between 6 and 24 months, in the nomadic population of Afar region. The study also aimed to identify factors affecting exclusive breastfeeding.

Methods

A community based cross-sectional study was conducted from April to May, 2015 to assess EBF of children aged between 6 and 24 months during the first 6 months of life. Exclusive breastfeeding is defined as consuming only breast milk (including expressed breast milk) during the first 6 months and no other liquids and solid foods except medications, and non exclusive breastfeeding is taking liquids and solid foods in addition to breast milk. The cluster sampling technique was used to select the study participants. Data were collected from 254 households using a structured questionnaire.

Results

One hundred eighty eight of the children were fed breast milk exclusively for the first 6 months of age; the rate of EBF in the study area was 74% (95% CI 70, 78%). One hundred fifty four (60.6%) of the children received breast milk within 1 h immediately after birth and 207 (81.5%) of the children maintained breastfeeding at the time of the survey. Exclusive breastfeeding was statistically associated with mothers aged above 35 years (AOR 8.3, 95% CI 1.7, 40.3), commencing to breastfeed in first hour (AOR 3.5, 95% CI 1.8, 6.9), and parents who didn’t migrate or move to a more comfortable area (AOR 4.6, 95% CI 1.5, 14.4).

Conclusion

Exclusive breastfeeding was not fully practiced in the study area. Therefore, promotion of infant and young children feeding (IYCF) is needed in the area to strengthen EBF practices. Moreover, child feeding practices should be integrated with the existing health system and attention should be given to the nomadic mothers.

Pacifier use and interruption of exclusive breastfeeding: Systematic review and meta-analysis

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.

Práticas educativas segundo os “Dez passos para o sucesso do aleitamento materno” em um Banco de Leite Humano

Resumo Este artigo objetivou avaliar práticas educativas segundo os “Dez Passos para o Sucesso do Aleitamento Materno” em Banco de Leite Humano. Estudo retrospectivo com informações sociodemográficas e gestacionais maternas e referentes ao bebê, obtidas de protocolo de atendimento de nutrizes (2009-2012). Tais dados foram associados aos passos relacionados a práticas educativas dentre os “Dez Passos”. Realizou-se análise descritiva, teste qui-quadrado e regressão de Poisson. Foram avaliadas 12.283 mães, com mediana de 29 (12-54) anos de idade. As orientações recebidas sobre amamentação no pré-natal (passo 3) prevaleceram entre mães de 30-39 anos e o contato pele/pele (passo 4) entre as orientadas. O treinamento sobre amamentação (passo 5) predominou entre aquelas que amamentaram exclusivamente. Notou-se maior prevalência de amamentação exclusiva (passo 6) e sob livre demanda (passo 8) e uso de bicos artificiais (passo 9) entre os lactentes de mães orientadas. Os achados apontam importante papel do profissional da saúde no treinamento mãe/filho sobre aleitamento materno e incentivo ao contato pele/pele, amamentação exclusiva e sob livre demanda. As orientações ofertadas necessitam aprimoramento a fim de reduzir o uso de bicos artificiais e potencializar a amamentação exclusiva.

Prevalence and associated factors for early interruption of exclusive breastfeeding: meta-analysis on Brazilian epidemiological studies

Abstract Objectives: to summarize Brazilian studies that analyzed the risk factors for Exclusive Breastfeeding (EBF) interruption before the child's six months of life. Methods: systematic review and meta-analysis indexed articles from Bireme, Scielo and Pubmed databases published in the period of January 2000 to December 2015. Results: 22 articles were included in the meta-analysis. The factors related to newborns were observed, such as birth weight (OR= 1.17; CI 95%: 1.05-1.29), female gender (OR= 1,09; CI 95%: 1.04-1.13) and the use of pacifier (OR= 2.29; CI 95%: 1.68-2.91) were the main factors responsible for the increase in the occurrence of EBF interruption. The factors were related to the mother, maternal age below twenty years old (OR= 1.22; CI 95%: 1.12-1.33) low schooling level (OR=1.28; CI 95%: 1.11-1.45), primiparity (OR= 1.17; CI 95%: 1.02-1.32) maternal employment during the postpartum period (OR= 1.26; CI 95%: 1.11-1.41), and low family income (OR= 1.22; CI 95%: 1.08-1.37) contributed significantly to the EBF interruption . Conclusions: the meta-analysis of Brazilian epidemiological studies demonstrated evidences to conclude that below the age of twenty, low schooling, primiparity, maternal employment in the postpartum period and low family income are associated to the interruption of exclusive breastfeeding until 6 months of age. Children with low birth weight, female gender and used a pacifier had greater vulnerability to not be exclusively breastfed. In conclusion, most of these factors can be modified through appropriate public policies throughout the adequate prenatal period to promote exclusive breastfeeding.

Excessive maternal weight and practice of exclusive breastfeeding among women of low socioeconomic status

ABSTRACT Objective: To investigate the impact of excessive maternal weight on the early discontinuation of exclusive breastfeeding Methods: This is a longitudinal study including mother-infant dyads of low socioeconomic status receiving prenatal care in Health Care Centers in Porto Alegre, Rio Grande do Sul, Brazil. A structured questionnaire was administered to women in the last trimester of pregnancy, including weight measurements. Another interview was conducted six months after delivery, and data on infant feeding practices were collected and maternal height was measured. Maternal nutritional status was assessed using body mass index values according to gestational age. Discontinuation of exclusive breastfeeding before 4 months was considered a low duration rate Results: A total of 619 mother-infant dyads were evaluated. The prevalence of maternal overweight in the third trimester of pregnancy was 51%. The median duration of exclusive breastfeeding was 2.0 months. After adjustment for possible confounding factors, no association between maternal overweight and early discontinuation of exclusive breastfeeding was identified. Maternal smoking was identified as a risk factor (1.23, 95%CI=1.13-1.35) for early discontinuation of exclusive breastfeeding Conclusion: Excessive maternal weight was not confirmed as a risk factor for early discontinuation of exclusive breastfeeding. However, women who reported being smokers had a higher risk of early discontinuation of exclusive breastfeeding than those who did not smoke. This indicates the need for public health interventions to promote smoking cessation during pregnancy and in the postpartum period because of the deleterious effects of this habit on maternal and infant health.

Factors influencing exclusive breastfeeding among Iranian mothers: A longitudinal population-based study

Background: Exclusive breastfeeding (EBF) contributes to the health and survival of the newborns. Many factors influence the EBF behavior. This study aimed to identify the determinant factors in order to improve the practice of EBF among Iranian mothers. Methods: A longitudinal study was carried out in 1445 mothers with newborns in Qazvin city, Iran (September 2015-March 2016). Demographic variables as well as the constructs of theory of planned behavior (TBP) were measured by questionnaires. Bivariate analysis using Pearson and Spearman correlation tests with analysis of variance were used to investigate the associations among the variables. Both hierarchal multiple regression and logistic regression were applied to identify potential determinative factors for the EBF. Results: Nearly, 80% (CI: 77.97-82.63%) of the participants had the intention of EBF. All TPB constructs, moral norms, and self-identity were significantly correlated with each other (r: 0.09- 0.40, P < 0.01). Some demographic variables such as age, income, employment and primiparity were also correlated with the EBF (r: 0.11-0.15, P < 0.05). The constructs of the TPB were able to predict the EBF behavior, which account for 49% of the variance in the predicting factors (df = 8, F = 7.70). The self-identity and moral norms accounted for an additional 15% of the variance (df = 10, F = 3.16). Younger mothers with lower socio-economic status were at higher risk of EBF cessation. The intention has a greater impact on the initiation of EBF than perceived behavioral control (PBC) but not for the maintenance of EBF (OR, 2.88 [CI: 2.38-3.48] & 1.13 [CI:1.03- 1.23] vs. OR, 1.27 [CI:1.15-1.39] & 2.66 [CI: 2.02-3.49]). Conclusion: The interventions to promote knowledge, attitude and behavioral control towards the EBF should be considered especially in the young mothers with low socio-economic status.

Determinants of exclusive breastfeeding practices among mothers in azezo district, northwest Ethiopia

Background

Exclusive breastfeeding (EBF) is a very important, long lasting and cost effective intervention to help reduce the morbidity and mortality of infants. However, a large proportion of infants are not exclusively breastfed as recommended by the World Health Organization. The study aim was to assess the exclusive breastfeeding practices and identify determinants among mothers in Azezo District, Ethiopia.

Methods

A community based cross-sectional study was conducted among 346 mothers with infants aged between 0–6 months. Data were collected using a pretested, interviewer administered questionnaire. Descriptive statistics and logistic regression analysis were used to describe the study objectives and identify the determinants of EBF in the previous 24 h. Associations between the study and outcome variables were described using odds ratios and 95 % confidence intervals (CI).

Results

Any breastfeeding and exclusive breastfeeding in the previous 24 h were 99 and 79 %, respectively. The mean number of exclusive breastfeeds in the 24 h period was 6.5. Exclusive breastfeeding rates were highest among mothers aged ≥ 30 years (Adjusted odds ratio [AOR] 1.75; 95 % CI 1.14, 3.42). Infants whose mothers were unemployed were more likely to be exclusively breastfed than infants whose mothers were employed (AOR 1.62; 95 % CI 1.03, 2.95). Mothers earning ≤ 1000 birr (US $47.62) monthly were 77 % less likely to practice EBF (AOR 0.23; 95 % CI 0.13, 0.44). Mothers who delivered at the healthcare facility practised more exclusive breastfeeding than those who delivered at home (AOR 2.18; 95 % CI 1.22, 4.35). Mothers who received antenatal and postnatal care had better rates of EBF (AOR 2.24; 95 % CI 1.18, 5.76 and AOR 1.62; 95 % CI 1.09, 3.21) and mothers not practicing prelacteal feeding were more likely to exclusively breastfeed compared with mothers practicing prelacteal feeding (AOR 2.16; 95 % CI 1.16, 4.06).

Conclusions

Any breastfeeding and exclusive breastfeeding rates in the previous 24 h are relatively high in the study area compared with previous studies. Maternal factors (age, education, income, employment, antenatal care, prelacteal feeding), infants’ age, delivery place and information access were independent predictors to EBF in previous 24 h. Improving the mother’s knowledge, income, information access, nutritional counselling, quality of antenatal and postnatal care service, place of delivery and avoiding prelacteal feeding practices are important to improving the exclusive breastfeeding rate in the previous 24 h.

Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review

OBJECTIVE

To identify factors associated with exclusive breastfeeding in the first six months of life in Brazil.

METHODS

Systematic review of epidemiological studies conducted in Brazil with exclusive breastfeeding as outcome. Medline and LILACS databases were used. After the selection of articles, a hierarchical theoretical model was proposed according to the proximity of the variable to the outcome.

RESULTS

Of the 67 articles identified, we selected 20 cross-sectional studies and seven cohort studies, conducted between 1998 and 2010, comprising 77,866 children. We identified 36 factors associated with exclusive breastfeeding, being more often associated the distal factors: place of residence, maternal age and education, and the proximal factors: maternal labor, age of the child, use of a pacifier, and financing of primary health care.

CONCLUSIONS

The theoretical model developed may contribute to future research, and factors associated with exclusive breastfeeding may subsidize public policies on health and nutrition.

Exclusive Breastfeeding Practice and Its Associated Factors among Mothers of Infants Less Than Six Months of Age in Debre Tabor Town, Northwest Ethiopia: A Cross-Sectional Study

Background. Exclusive breastfeeding for the first six months of life is recommended by the World Health Organization and United Nations Children’s Fund. However, the prevalence of exclusive breastfeeding is very low in many developing countries including Ethiopia.Objectives. The study was aimed at assessing the prevalence of exclusive breastfeeding practice and its associated factors among infants aged six months in Debre Tabor town.Methods. Community based cross-sectional study was conducted. Simple random sampling technique was employed in the selection of participants. Data were collected using pretested and structured questionnaire through face-to-face interview. Odds ratios with their 95% CI were computed and variables havingpvalue less than 0.05 in the multivariable logistic regression were considered as significantly associated with the dependent variable.Result. Of 470 mother-infant pair’s samples, 453 were included in the final analysis. The overall age appropriate rate of EBF practice was found to be 70.8%. Having an infant aged 2-3 months [AOR = 2.3 (95% CI: 1.12, 6.42)], giving birth in the health facility [AOR = 3.8 (95% CI: 2.18, 7.32)], being a house wife in occupation [AOR = 2.4 (95% CI (1.22, 6.92)], receiving counseling/advice on infant feeding [AOR = 2.1 (95% CI: 1.61, 5.41)], and colostrums feeding [AOR = 1.5 (95% CI: 1.28, 7.98)] were found to be significantly associated with EBF practice.Conclusion and Recommendations. A small proportion of infants are exclusively breastfed during the first 6 months. Promoting institutional delivery, revising the leave after birth, advice and counseling pregnant mothers about EBF, and enabling every mother to encourage colostrum feeding were recommended in order to increase the proportion of women practicing exclusive breastfeeding.

[Breastfeeding indicators produced at time of vaccination in four Primary Care Centres in southern Santiago, Chile]

OBJECTIVES

To compare official breastfeeding (BF) data with those obtained by interviews conducted during regular vaccination visits.

SUBJECTS AND METHOD

A pilot descriptive study with convenience sampling was conducted by interviewing guardians of children attending vaccination in four Primary Care Centres in south Santiago. BF prevalence indicators were calculated and stratified by age and education of mothers. A comparison was made between the results and the official ones reported by each Centre. Chi-squared (X2) was calculated to evaluate differences (P<.05) RESULTS: A total of 1990 cases were analysed, in which exclusive BF prevalence was 43.4%, 34.2% and 8.8%, at 2, 4, and 6 months, respectively. At the sixth month, official data (41%) was significantly higher (P<.001). Mothers with less than 12 years of schooling have a lower prevalence of exclusive BF at the 4th month than those with higher education (28.4% vs. 37.8%, respectively, P<.05).

CONCLUSIONS

Even considering the small size of the sample studied, exclusive BF prevalence obtained is surprisingly lower than official reported data. That difference might be explained by: (a) children brought to vaccinations are roughly two fold the number brought to well-child clinics and, (b) potential bias in official data obtained by staff in charge of promotion and education on BF practices, which could distort the results. Further studies are needed to improve the methodology for collecting and analysis BF data.

Prevalence and predictors of exclusive breastfeeding for the first six months of life among women in Halaba special woreda, Southern Nations, Nationalities and Peoples' Region/SNNPR/, Ethiopia: a community based cross-sectional study

BACKGROUND

Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, with no addition of any liquid or solids apart from drops or syrups consisting of vitamins, mineral supplements or medicine, and nothing else. Several studies have shown that exclusive breastfeeding for the first six months plays a great role in preventing morbidity and mortality. In Ethiopia, for example, mortality rates of infant and children younger than five years are high. Understanding the prevalence and predictors that influence exclusive breastfeeding in this is crucial to promoting the practice.

OBJECTIVES

To assess the prevalence and predictors of exclusive breastfeeding with in the first six months of life among women in Halaby special woreda, SNNPR (Southern Nations, Nationalities and Peoples' Region) Ethiopia.

METHODS

A community-based cross sectional study was conducted between November 2013 and January 2014 among women with infants aged less than 6 months and the sample size was 422 in Halaba special woreda, SNNPR (Southern Nations, Nationalities and Peoples' Region) Ethiopia. A random sampling technique was used in sampling the study subjects. Structured questionnaire was developed and adopted from EDHS 2011 and WHO standard and that all the variables to be assessed were incorporated. Data was entered and analyzed through using Epi Info 7 for Dos version 3.5.1 and Statistical Package for the Social Sciences (SPSS) software for windows version 20 respectively.

RESULTS

The prevalence of exclusive breastfeeding was (70.5 %) and awareness of exclusive breastfeeding was (92.4 %). Antenatal follow up (AOR/Adjusted odds ratio = 1.9; 95 % CI, 1.05-3.6), postnatal follow up (AOR/Adjusted odds ratio = 2.2; 95 % CI, 1.25-3.87), initiation of breast feeding immediately within one hour (AOR/Adjusted odds ratio =3.8; 95 % CI, 2.4-6.2), attended formal school (AOR Adjusted odds ratio/=1.9;95 % CI,1.1-3.4), advice about exclusive breastfeeding (AOR Adjusted odds ratio/=6.3;95 % CI,1.3-30.9); and awareness about exclusive breastfeeding (AOR Adjusted odds ratio/= 8.2; 95 % CI 3.34-20), have significant association with exclusive breastfeeding.

CONCLUSIONS

Strategies that target improving awareness among women at health facility and community level help to improve exclusive breastfeeding. In addition, promotion of EBF for working mothers through working environment recommended.

Clarifying nipple confusion

Nipple confusion, an infant's difficulty with or preference for one feeding mechanism over another after exposure to artificial nipple(s), has been widely debated. This is in part due to conflicting statements, one by the American Academy of Pediatrics in 2005 suggesting that infants should be given a pacifier to protect against Sudden Infant Death Syndrome, and the other by the World Health Organization in 2009 stating that breastfeeding infants should never be given artificial nipples. Despite the limited and inconsistent evidence, nipple confusion is widely believed by practitioners. Therefore, there is a unique opportunity to examine the evidence surrounding nipple confusion by assessing the research that supports/refutes that bottle feeding/pacifier use impedes breastfeeding efficacy/success/duration. This review examined 14 articles supporting and refuting nipple confusion. These articles were reviewed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Based on our review, we have found emerging evidence to suggest the presence of nipple confusion only as it relates to bottle usage and found very little evidence to support nipple confusion with regards to pacifier use. The primary difficulty in conclusively studying nipple confusion is establishing causality, namely determining whether bottles'/pacifiers' nipples are causing infants to refuse the breast or whether they are simply markers of other maternal/infant characteristics. Future research should focus on prospectively examining the causality of nipple confusion.

Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review

Breastfeeding is the most advantageous feeding option for infants, and epidemiological studies provide evidence for its promotion. The objective of this review was to comprehensively delineate the barriers and facilitators of exclusive breastfeeding of infants aged 0-6 months old by mothers in developing countries. A search of CINAHL, MEDLINE and PsycINFO was carried out to retrieve studies from January 2001 to January 2014. Using our inclusion criteria, we selected studies that described barriers and facilitators of exclusive breastfeeding. Qualitative and quantitative studies were considered. Twenty-five studies involving 11 025 participants from 19 countries were included. Barriers and facilitators of exclusive/full breastfeeding were identified, analysed tabulated and summarised in this review. Maternal employment was the most frequently cited barrier to exclusive breastfeeding. Maternal perceptions of insufficient breast milk supply was pervasive among studies while medical barriers related to illness of mothers and/or infants as well as breast problems, rather than health care providers. Socio-cultural factors such as maternal and significant other's beliefs about infant nutrition also often constitute strong barriers to exclusive breastfeeding. Despite these barriers, mothers in developing countries often possess certain personal characteristics and develop strategic plans to enhance their success at breastfeeding. Health care providers should be informed about the determinants of exclusive breastfeeding and provide practical anticipatory guidance targeted at overcoming these barriers. In so doing, health care providers in developing countries can contribute to improving maternal and child health outcomes.

The comparison of parents' educational level on the breastfeeding status between turkman and non-turkman ethnic groups in the north of iran

BACKGROUND

Mother's milk plays an important role in infant's health, and World Health Organization (WHO) recommends infants should be breastfed for 2 years or up.

AIM

The main objective of this study was to evaluate the breastfeeding status based on parents' educational level with comparison between Turkman and non-Turkman ethnic groups in the North of Iran in 2010.

SUBJECTS AND METHODS

This is a descriptive, cross-sectional study, which was carried out on 6519 subjects (3897 = non-Turkman and 2622 = Turkman) in urban and rural areas. Data have been collected through interviewing with primary school children's mothers. The schools and students were selected using multi-cluster random sampling methods. Breastfeeding was defined based on WHO predominant definition.

RESULTS

Of all mothers, 5.8% (377/6519) breastfed for 6 months, 34.8% (2265/6519) for 7-18 months, 57.4% (3745/6519) for 18-24 months and 2% (132/6519) didn't breastfeed their infants. Breastfeeding prevalence at 19-24 months in Turkman ethnic group (64.7%; 1696/2622) was significantly more than in non-Turkman ethnic group (52.6%; 2049/3897) (P < 0.01) besides early weaning prevalence (at 6 months) in Turkman group was significantly less than in non-Turkman group (4.7%; 123/2622 vs. 6.5%; 254/3897) (P < 0.01). Odds ratio for weaning before 6 months in non-Turkman mothers were 0.563 (0.365-0.786, confidence interval [CI] 95%) in 1-12 years schooling and 0.665 (0.486-0.910, CI: 95%) in uneducated groups compared to college educated. This ratio in Turkman fathers was 3.413 (1.726-6.746, CI: 95%) in 1-12 years schooling compared with college educated.

CONCLUSION

The duration of breastfeeding was longer among Turkman compared with non-Turkman mothers, and longer duration of breastfeeding was associated with higher educational level in the Turkman but not in the non-Turkman mothers.

Postpartum Treatment With Immunoglobulin Does Not Prevent Relapses of Multiple Sclerosis in the Mother

Multiple sclerosis (MS) is a chronic, neurological, immune-mediated disease that can worsen in the postpartum period. There is no consensus on the use of immunoglobulin for prevention of disease relapses after delivery. We have shown that the controversial beneficial effect of immunoglobulin given immediately after birth could not be observed in patients with MS.

Duration of exclusive breastfeeding in a Brazilian population: new determinants in a cohort study

Background

Determinants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. The present study aimed to identify factors associated with discontinuation of EBF in a municipality in northeastern Brazil, including variables that have received little or no attention in previous literature.

Methods

This cohort study involved 1,344 mother-child pairs selected from maternity hospitals in Feira de Santana, Bahia, Brazil. Subjects were followed up for 6 months through monthly home visits, and discontinuation of EBF was recorded. Possible determinants were tested using Cox’s four-level hierarchical survival model, taking into consideration the temporal proximity of the predisposing factors to interruption of EBF. Median duration of EBF was estimated using Kaplan-Meier’s survival curve.

Results

Median duration of EBF was 89 days. Out of the 19 variables tested, 9 showed an association with EBF cessation; of these, two had never been evaluated in Brazilian studies, namely, mother partner’s appreciation for breastfeeding (hazard ratio [HR] 0.62; 95% confidence interval [95% CI] 0.48-0.79) and limiting the number of nighttime feeds at the breast (HR 1.58; 95% CI 1.11-2.23). Another two variables that had been previously evaluated, but had never been described as determinants of discontinuation of EBF showed association: presence of cracked nipples (HR 2.54; 95% CI 2.06-3.13) and prenatal care provided by public services (HR 1.34; 95% CI 1.17-1.55). Other variables showing associations with the outcome were: guidance on breastfeeding received at the hospital (HR 0.80; 95% CI 0.68-0.92), birth in a Baby-Friendly Hospital (HR 0.85; 95% CI 0.73-0.99), less than or equal to 8 years of maternal schooling (HR 1.34, 95% CI 1.17-1.53), mother working outside the home (HR 1.73; 95% CI 1.53-1.95), and use of a pacifier (HR 1.40; 95% CI 1.14-1.71).

Conclusions

The study confirmed that the factors associated with EBF duration are multiple, variable, and dependent on the population being evaluated. Characteristics that had never been previously evaluated or described, at least in Brazilian studies, behaved as determinants of EBF in the present study, and thus allow to expand the existing list of factors determining this practice.

[Breastfeeding-Friendly Primary Care Unit Initiative and the relationship with exclusive breastfeeding]

OBJECTIVE

To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-Friendly Primary Care Unit Initiative.

METHODS

Cross-sectional study, whose data source were research on feeding behaviors in the first year of life conducted in the vaccination campaigns of 2003 and 2006, at the municipality of Barra Mansa, RJ, Southeastern Brazil. For the purposes of this study, infants under six months old, accounting for a total of 589 children in 2003 and 707 children in 2006, were selected. To verify the relationship between being followed-up by Breastfeeding-Friendly Primary Care Unit Initiative units and exclusive breastfeeding practice, only data from the 2006 inquiry was used. Variables that in the bivariate analysis were associated (p-value ≤ 0.20) with the outcome (exclusive breastfeeding practice) were selected for multivariate analysis. Prevalence ratios (PR) of exclusive breastfeeding were obtained by Poisson Regression with robust variance through a hierarchical model. The final model included the variables that reached p-value ≤ 0.05.

RESULTS

The prevalence of exclusive breastfeeding increased from 30.2% in 2003 to 46.7% in 2006. Multivariate analysis showed that mother's low education level reduced exclusive breastfeeding practice by 20.0% (PR = 0.798; 95%CI 0.684;0.931), cesarean delivery by 16.0% (PR = 0.838; 95%CI 0.719;0.976), and pacifier use by 41.0% (PR = 0.589; 95%CI 0.495;0.701). In the multiple analysis, each day of the infant's life reduced exclusive breastfeeding prevalence by 1.0% (PR = 0.992; 95%CI 0.991;0.994). Being followed-up by Breastfeeding-Friendly Primary Care Initiative units increased exclusive breastfeeding by 19.0% (PR = 1.193; 95%CI 1.020;1.395).

CONCLUSIONS

Breastfeeding-Friendly Primary Care Unit Initiative contributed to the practice of exclusive breastfeeding and to the advice for pregnant women and nursing mothers when implemented in the primary health care network.

Degree of compliance with the ten steps of the Breastfeeding Friendly Primary Care Initiative and its association with the prevalence of exclusive breastfeeding

OBJECTIVE

To analyze the association between the degree of compliance with the ten steps of the Breastfeeding-Friendly Primary Care Initiative (BFPCI) and the prevalence of exclusive breastfeeding (EBF) in infants younger than six months in the city of Rio de Janeiro.

METHODS

This was a cross-sectional study conducted in a representative sample of 56 primary health care units of this municipality. The assessment of compliance with the ten steps of the BFPCI was carried out by interviewing health care professionals, pregnant women, and mothers; the generated performance scores were classified into tertiles. To obtain the outcome, i.e., the EBF, a data collection questionnaire was applied to mothers of children younger than six months who were followed up at these units in November of 2007. Prevalence ratios were obtained for the EBF using Poisson regression with robust variance.

RESULTS

The prevalence of EBF was 47.6%. In the multivariate analysis, the upper tertile of performance showed a 34% higher prevalence of EBF (PR=1.34, 95% CI: 1.24 to 1.44) and the second tertile was 17% higher (PR=1.17, 95% CI: 1.08 to 1.27) than the first tertile. Mothers who did not work outside home had a 75% higher prevalence of EBF (PR=1.75, 95% CI: 1.53 to 2.01); assistance in a basic health unit, as opposed to a family health unit, implied a 10% higher prevalence (PR=1.10, 95% CI: 1.03 to 1.19). The prevalence of EBF decreased 1% for each day of the infant's life (PR=0.993, 95% CI: 0.992 to 0.993).

CONCLUSION

Given the contribution of BFPCI to the practice of EBF, a greater investment in the expansion and sustainability of this initiative is recommended, as well as its association with other strategies to promote, protect, and support breastfeeding.

Exclusive breastfeeding duration and determinants among Brazilian children under two years of age

OBJECTIVE: The present study described the duration and identified the determinants of exclusive breastfeeding. METHODS: The study used data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher 2006 (National Demographic and Health Survey on Women and Children 2006). Data were collected using questionnaires administered by trained professionals and refer to a subsample of 1,704 children aged less than 24 months. The estimated durations of exclusive breastfeeding are presented according to socioeconomic, demographic and epidemiological variables. Kaplan Meier estimator curves were used to produce valid estimates of breastfeeding duration and the Cox's proportional hazards model was fitted to identify risks. RESULTS: The median estimated duration of exclusive breastfeeding was 60 days. The final Cox model consisted of mother's age <20 years (hazard ratio=1.53, 95% confidence interval=1.11-1.48), use of pacifier (hazard ratio=1.53, 95% confidence interval=1.37-1.71), not residing in the country's southeast region (hazard ratio=1.22, 95% confidence interval=1.07-1.40) and socioeconomic status (hazard ratio=1.28, 95% confidence interval=1.06-1.55). CONCLUSION: The Kaplan Meier estimator corrected the underestimated duration of breastfeeding in the country when calculated by the current status methodology. Despite the national efforts done in the last decades to promote breastfeeding, the results indicate that the duration of exclusive breastfeeding is still half of that recommended for this dietary practice to promote health. Ways to revert this situation would be ongoing educational activities involving the educational and health systems, associated with advertising campaigns on television and radio mainly targeting young mothers with low education level and low income, identified as those at high risk of weaning their children early.

Overcoming barriers to breastfeeding continuation and exclusivity

PURPOSE OF REVIEW

To review recent research that delineates predictors of breastfeeding duration and exclusivity.

RECENT FINDINGS

Many mothers find it difficult to meet personal goals and follow expert recommendations for continued and exclusive breastfeeding despite increased rates of initiation. Recent studies have revealed varied sociodemographic, biomedical, and psychosocial determinants of breastfeeding duration and exclusivity.

SUMMARY

In order to help mothers meet personal goals and expert recommendations for breastfeeding, pediatricians should educate themselves regarding predictors of and barriers to successful breastfeeding. Once these predictors and barriers have been identified, targeted anticipatory guidance can be provided to help mothers achieve breastfeeding success.