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Roberts LF, Harding JE, Crowther CA, Watson E, Wang Z, Lin L. Early Feeding for the Prevention of Neonatal Hypoglycaemia: A Systematic Review and Meta-Analysis. Neonatology 2024; 121:141-156. [PMID: 38194933 PMCID: PMC10987277 DOI: 10.1159/000535503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Poor feeding, among other factors, predisposes neonates to hypoglycaemia. Early feeding is widely recommended to prevent hypoglycaemia in those at risk, but the effectiveness of this is uncertain. This review aimed to summarise and analyse the evidence on the effectiveness of early feeding for prevention of neonatal hypoglycaemia. METHODS Four databases and three clinical trial registries were searched from inception to May 24, 2023. Published and unpublished randomised controlled trials (RCTs), quasi-RCTs, cluster randomised trials, non-randomised studies of interventions, and observational studies with comparison groups were considered for inclusion with no language or publication date restrictions. We included studies of neonates who were fed early (within 60 min of birth or study defined) versus delayed. Study quality was assessed using the Cochrane Risk of Bias 1 tool or Effective Public Health Practice Project Quality Assessment tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RevMan 5.4.1 or R was used to synthesise results in random-effects meta-analyses. This review was registered prospectively with PROSPERO (CRD42022378904). RESULTS A total of 175,392 participants were included across 19 studies, of which two were RCTs, 14 cohort studies, two cross-sectional studies, and one a case-control study. Most studies (13/19) were conducted in low- or lower-middle-income countries. Early feeding may be associated with reduced neonatal hypoglycaemia (four cohort studies, 744 infants, odds ratio [OR] 0.19 (95% CI: 0.10-0.35), p < 0.00001, I2 = 44%) and slightly reduced duration of initial hospital stay (one cohort study, 1,673 infants, mean difference: -0.20 days [95% CI: -0.31 to -0.09], p = 0.0003), but the evidence is very uncertain. One RCT found early feeding had little or no effect on the risk of neonatal mortality, but three cohort studies found early feeding may be associated with reduced risk (136,468 infants, OR 0.51 [95% CI: 0.37-0.72]; low certainty evidence; p <0.0001; I2 = 54%). CONCLUSION We found that early feeding may reduce the incidence of neonatal hypoglycaemia, but the evidence is very uncertain. Given its many other benefits, early feeding should continue to be recommended. This review was primarily funded by the Aotearoa Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.
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Affiliation(s)
- Lily F Roberts
- Liggins Institute, University of Auckland, Auckland, New Zealand,
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Estelle Watson
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Zeke Wang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Dhawan D, Pinnamaneni R, Viswanath K. Association between mass media exposure and infant and young child feeding practices in India: a cross-sectional study. Sci Rep 2023; 13:19353. [PMID: 37935737 PMCID: PMC10630397 DOI: 10.1038/s41598-023-46734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/04/2023] [Indexed: 11/09/2023] Open
Abstract
The first two years of life is a critical window for good nutrition. Promoting infant and young child feeding (IYCF) practices in the first two years can help improve child survival and promote healthy growth and development. Assessment of IYCF practices is important, especially in developing countries like India where optimal IYCF practices can potentially prevent 12% of all deaths under 5 years of age, to promote awareness and intervene appropriately. The objective of our study is to generate evidence for the association between different types of mass media and appropriate IYCF practices in India, including optimal breastfeeding and appropriate complementary feeding practices. A positive association between them can point to intervention at scale. We analyzed data from India's National Family Health Survey 5 (NFHS-5), 2019-2021. Multivariable logistic regression was used to examine the association of appropriate IYCF practices with mass media exposure. After controlling for demographics and socioeconomic status, the analyses showed that, overall, women who had exposure to television followed by newspaper and movies, had higher odds of adopting the recommended IYCF practices. The results also showed that the association of media exposure varied for different IYCF practices by geography. For instance, in the rural areas, television exposure was positively associated with all the IYCF practices, but in the urban areas, television exposure was positively associated with only early initiation of breastfeeding [OR 1.25; (95% CI 1.1-1.42)]. The study strengthens our understanding that an appropriate selection of mass media channels for intervention programs can promote IYCF practices at scale. Appropriately selecting the type of mass media to create awareness about different IYCF practices, in specific urban-rural settings, could help customize intervention programs to successfully influence IYCF behaviors.
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Affiliation(s)
- Dhriti Dhawan
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW 601, Boston, MA, 02215-5450, USA.
| | | | - K Viswanath
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW 601, Boston, MA, 02215-5450, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Thorne-Lyman AL, Lama TP, Heidkamp RA, Munos MK, Manandhar P, Khatry SK, Bryce E, LeClerq SC, Katz J. How does social desirability bias influence survey-based estimates of the use of antenatal care in rural Nepal? A validation study. BMJ Open 2023; 13:e071511. [PMID: 37495390 PMCID: PMC10373690 DOI: 10.1136/bmjopen-2022-071511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVES Social desirability bias is often speculated to influence survey responses but seldom studied in healthcare. The objective was to explore whether social desirability scores (SDS) or the presence of interview observers is associated with inaccurate recall and overestimation of antenatal care (ANC) services. DESIGN Longitudinal validation study comparing recalled receipt of ANC services and nutrition components of ANC against direct observations of care. An adapted short form Marlowe-Crowne questionnaire was used to generate an SDS, and the presence of interview observers was treated as a separate exposure. We assessed accuracy and overestimation of recalled receipt of ANC services against observed receipt using log-binomial regression, adjusting for age, education, first-pregnancy and socioeconomic status. SETTING Rural Southern Nepal with recruitment from five government health posts. PARTICIPANTS 401 pregnant women. RESULTS Social desirability scores did not significantly predict accuracy or overestimation of most types of ANC care except counselling on nausea. Higher SDS was associated with more accurate recall (adjusted RR, aRR 1.08 (95% CI 1.03, 1.12)) and less overestimation (aRR 0.85 (0.80, 0.91)). The presence of mothers-in-law or husbands during interviews was associated with greater overestimation of the number of ANC visits received by more than three visits (aRR 2.07 (1.11, 3.84)) and (aRR 4.19 (2.17, 8.10)), respectively. Those interviewed with friends present tended to overestimate the receipt of counselling on nausea, avoiding alcohol and not smoking. CONCLUSION The presence of observers can lead to overestimation of the receipt of ANC care and support the conduct of interviews in private settings despite challenges of doing so in village contexts. Findings that the SDS did not predict the accuracy of most types of ANC care might reflect a reality that such questions may not be sensitive from a social-norms perspective. Additional local adaptation of SDS is recommended.
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Affiliation(s)
- Andrew L Thorne-Lyman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tsering P Lama
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
| | - Rebecca A Heidkamp
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Porcia Manandhar
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
| | - Emily Bryce
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Jhpiego, Baltimore, MD, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Stipelman CH, Stoddard GJ, Bennion J, Young PC, Brown LL. Real-Time Breastfeeding Documentation: Timing of Breastfeeding Initiation and Outpatient Duration. Acad Pediatr 2023; 23:351-358. [PMID: 35863738 PMCID: PMC10516406 DOI: 10.1016/j.acap.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration. METHODS In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery. RESULTS In adjusted models, initiating breastfeeding during each hour from age >1 to ≤6 h and during ages >6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery. CONCLUSIONS Delaying breastfeeding initiation to >1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.
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Affiliation(s)
- Carole H Stipelman
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City; Sugar House Health Center, Department of Pediatrics (CH Stipelman), University of Utah School of Medicine, Salt Lake City; University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City.
| | - Gregory J Stoddard
- Department of Internal Medicine (GJ Stoddard), University of Utah School of Medicine, Salt Lake City
| | - Jeff Bennion
- University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City
| | - Paul C Young
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
| | - Laura L Brown
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
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Dadzie B, Bayor F, Doat AR, Kappiah JB, Akayuure CA, Lamptey AA, Yakong VN, Kampo S. Investigating factors that influence the practice of exclusive breastfeeding among mothers in an urban general hospital in Ghana: a cross-sectional study. BMC Womens Health 2023; 23:24. [PMID: 36650492 PMCID: PMC9847114 DOI: 10.1186/s12905-023-02164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Ghana, only 52% of mothers exclusively breastfeed their babies and the rate of increase has been steadily slow across all geographical areas of Ghana. The purpose of this study was to determine the various factors that influence exclusive breastfeeding (EBF) among mothers who visited the child welfare clinic at the Tema General Hospital, Accra, Ghana. METHODOLOGY This descriptive cross-sectional study was carried out at the Child Welfare Clinic of the Tema General Hospital, Accra, Ghana. A random sampling technique was used to recruit mothers with children between the ages of 6 months and 24 months attending the Child Welfare Clinic. Mothers were interviewed with the aid of a structured questionnaire. RESULTS Out of the 222 of mothers interviewed, 68.8% of them exclusively breastfed their infants up to 6 months. Mothers who have good knowledge were more than 3 times (AOR = 3.484, 95% CI 1.200, 10.122, P = 0.022) likely to breastfeed their children exclusively. Those who had positive attitudes towards EBF were about 4 times (COR: 4.018, 95% = 1.444, 11.181, P = 0.008) more likely to exclusively breastfeed than those who had poor attitudes towards EBF. Also, mothers whose spouses complained about EBF were about 3 times (AOR: 2.655, 95% CI 0.620, 11.365, P = 0.018) at increased odds of not exclusively breastfeeding their babies. CONCLUSIONS High rate of EBF among mothers who visited the child welfare clinic was found. The mothers' level of knowledge and attitude towards EBF significantly influenced the 6 months of EBF. Spouses also showed a high influence on whether or not mothers should exclusively breastfeed their babies.
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Affiliation(s)
- Baaba Dadzie
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Fidelis Bayor
- Department of Physiology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Abdul-Razak Doat
- Department of Nursing, School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Jamilatu B Kappiah
- Department of Nursing, School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Collins Adombire Akayuure
- Department of Nursing, School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Aubrey A Lamptey
- Department of Pediatric Critical Care, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis TN, Accra, Ghana
| | - Vida Nyagre Yakong
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Sylvanus Kampo
- Department of Nursing, School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana.
- Department of Anaesthesia and Intensive Care, School of Medicine and Dentistry, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana.
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Sako S, Gilano G, Tekabe B, Abebe S. Determinants of early initiation of breast feeding among mothers of children aged less than 24 months in Ethiopia: A community-based cross-sectional study. BMJ Open 2022; 12:e062905. [PMID: 36302572 PMCID: PMC9621175 DOI: 10.1136/bmjopen-2022-062905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to assess the prevalence of early initiation of breast feeding (EIBF) and associated factors among mothers having children less than 2 years of age in Ethiopia. DESIGN Community-based cross-sectional study. SETTING In this analysis, data from 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) was used. The survey included all the nine regional states and two city administrations of Ethiopia. PARTICIPANTS We extracted data of 2054 mothers who had last-born children and those mothers who ever breast fed or still breast feeding their children during the survey from the 2019 EMDHS datasets. MAIN OUTCOME MEASURES We performed a two-stage multilevel mixed-effects logistic regression to identify individual and community-level determinants of EIBF. In the final model, variables with a p-value less than 5% and an adjusted OR with a 95% CI were reported as statistically significant variables with EIBF. RESULT The prevalence of EIBF among mothers having children aged 0-23 months was 73.56% (95% CI: 71.65% to 75.47%). Women who delivered at a health facility (adjusted OR (AOR)=1.98; 95% CI: 1.39 to 2.79) and have children with birth order second-fourth (AOR=1.76; 95% CI: 1.24 to 2.49) were more likely to initiate early breast feeding than their counterparts. On the other hand, women who gave birth by caesarean section (AOR=0.21; 95% CI: 0.13 to 0.33), had multiple births (AOR=0.35; 95% CI: 0.13 to 0.92) and had postnatal check-up (AOR=0.62; 95% CI: 0.44 to 0.91) were less likely to practise EIBF as compared with their counterparts. Region of residence of women was also significantly associated with EIBF. CONCLUSION In this study, the overall prevalence of EIBF was good. Place of delivery, mode of delivery, postnatal check-up, type of birth, birth order and region were factors significantly associated with EIBF. Therefore, government and stakeholders need to show commitment to improve access and utilisation of basic maternal health services to increase the practice of EIBF.
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Affiliation(s)
- Sewunet Sako
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Girma Gilano
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Be'emnet Tekabe
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Sintayehu Abebe
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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L-Thorne-Lyman A, Lama TP, Heidkamp RA, Manandhar P, Subedi S, Munos MK, Bryce E, Khatry SK, LeClerq SC, Katz J. Cognitive testing of questions about antenatal care and nutrition interventions in southern Nepal. Soc Sci Med 2022; 311:115318. [PMID: 36099684 PMCID: PMC9554791 DOI: 10.1016/j.socscimed.2022.115318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
Large scale surveys such as the Demographic and Health Surveys (DHS) are used to measure the coverage and quality of antenatal care (ANC)-related services. Studies have increasingly validated questions from these surveys, though few have explored respondent comprehension or associated thought processes. This study aimed to use cognitive testing and validation approaches to understand how survey respondents understand questions related to ANC-related nutrition services. The study was nested within a larger validation study in southern Nepal. Pregnant women's receipt of ANC related services was directly observed at five health posts followed by a recall interview at 6 months postpartum. A week later, a survey module was re-administered to 30 women containing 15 questions about receipt of ANC care and specifically nutrition-related services. Detailed probing was used to identify cognitive challenges related to comprehension, retrieval, judgement, and response. Respondents accurately recalled the four specific ANC visits recommended by the government of Nepal but those with more visits struggled to estimate the total number of ANC visits they had made. A number of terms including "antenatal care, "nutrition" and "breastfeeding" were challenging for many respondents to understand. Visits to private providers including for ultrasounds were inconsistently included in ANC visit counts suggesting that question wording could better specify the type of care. Many respondents over-estimated the number of iron folic acid (IFA) supplements taken during pregnancy, and recall was challenging. Calculations were based on estimating the number of months between first ANC visit to delivery, and only sometimes factored in missed tablets. Opportunities exist to improve questions to facilitate better comprehension by respondents through a combination of using local terms and explanations, reordering some questions, and adapting questions to better match respondents' approaches to estimating numeric responses.
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Affiliation(s)
- Andrew L-Thorne-Lyman
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Tsering Pema Lama
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
| | - Rebecca A Heidkamp
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Porcia Manandhar
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Seema Subedi
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Melinda K Munos
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Emily Bryce
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Subarna K Khatry
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
| | - Steven C LeClerq
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
| | - Joanne Katz
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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Strobel NA, Adams C, McAullay DR, Edmond KM. Mother's Own Milk Compared With Formula Milk for Feeding Preterm or Low Birth Weight Infants: Systematic Review and Meta-analysis. Pediatrics 2022; 150:188643. [PMID: 35921674 DOI: 10.1542/peds.2022-057092d] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the effect of feeding preterm or low birth weight infants with infant formula compared with mother's own milk on mortality, morbidity, growth, neurodevelopment, and disability. METHODS We searched Medline (Ovid), Embase (Ovid), and Cochrane Central Register of Controlled Studies to October 1, 2021. RESULTS Forty-two studies enrolling 89 638 infants fulfilled the inclusion criteria. We did not find evidence of an effect on mortality (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.91-1.76), infection (OR 1.52, 95% CI 0.98-2.37), cognitive neurodevelopment (standardized mean difference -1.30, 95% CI -3.53 to 0.93), or on growth parameters. Formula milk feeding increased the risk of necrotizing enterocolitis (OR 2.99, 95% CI 1.75-5.11). The Grading of Recommendations Assessment, Development, and Evaluation certainty of evidence was low for mortality and necrotizing enterocolitis, and very low for neurodevelopment and growth outcomes. CONCLUSIONS In preterm and low birth weight infants, low to very low-certainty evidence indicates that feeding with infant formula compared with mother's own milk has little effect on all-cause mortality, infection, growth, or neurodevelopment, and a higher risk of developing necrotizing enterocolitis.
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Borg B, Gribble K, Courtney‐Haag K, Parajuli KR, Mihrshahi S. Association between early initiation of breastfeeding and reduced risk of respiratory infection: Implications for nonseparation of infant and mother in the COVID‐19 context. MATERNAL & CHILD NUTRITION 2022; 18:e13328. [PMID: 35137545 PMCID: PMC9115244 DOI: 10.1111/mcn.13328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Bindi Borg
- School of Public Health University of Sydney Sydney New South Wales Australia
| | - Karleen Gribble
- School of Nursing and Midwifery Western Sydney University Penrith New South Wales Australia
| | | | | | - Seema Mihrshahi
- School of Public Health University of Sydney Sydney New South Wales Australia
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Bolarinwa OA, Ahinkorah BO, Arthur-Holmes F, Aboagye RG, Kwabena Ameyaw E, Budu E, Seidu AA, Ighodalo UL, Yaya S. Sex inequality in early initiation of breastfeeding in 24 sub-Saharan African countries: A multi-country analysis of Demographic and Health Surveys. PLoS One 2022; 17:e0267703. [PMID: 35587942 PMCID: PMC9119560 DOI: 10.1371/journal.pone.0267703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The Sustainable Development Goal (SDG) 3 aims at reducing neonatal and under-5 mortality to below 12 per 1000 and 25 per 1000 live births, respectively, globally by 2030. Studies have found that initiation of breastfeeding within one hour of birth and continuous breastfeeding for over 12 months can positively impact neonatal and infant health. However, there is evidence that the sex of a child may influence the breastfeeding practices of a mother. Thus, we examined sex inequality in early breastfeeding initiation in sub-Saharan Africa.
Materials and methods
Data from Demographic and Health Surveys conducted in 24 sub-Saharan African countries between January 2010 and December 2019 were pooled and analysed. A total of 137,677 women of reproductive age (15–49 years) were considered in this study. Bivariate and multivariable regression analyses were performed, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) with statistical significance at a p-value less than 0.05.
Results
The highest inequality in early initiation of breastfeeding was reported in Togo with a difference of 5.21% between the female and male children, while the lowest inequality was reported in Guinea with 0.48% difference between the female and male children. A higher odds of breastfeeding within 1 hour was observed among female children [cOR = 1.05; 95%(CI = 1.02–1.09)] compared to male children, and this persisted after controlling for the confounders included in this study [aOR = 1.05; 95%(CI = 1.02–1.08)].
Conclusion
We found higher odds for early breastfeeding initiation of female children compared to male children in sub-Saharan Africa. To reduce breastfeeding initiation inequalities, programmes that educate and encourage early initiation of breastfeeding irrespective of the child sex should be promoted among mothers.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - Uzairue Leonard Ighodalo
- Department of Medical Laboratory Science, Faculty of Basic Medical Science, Federal University, Oye Ekiti, Ekiti State, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Determinants of neonatal, post-neonatal and child mortality in Afghanistan using frailty models. Pediatr Res 2022; 91:991-1000. [PMID: 33879851 DOI: 10.1038/s41390-021-01527-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Afghanistan has one of the highest under-five mortality rates in South Asia, 70.4 per 1000 live births. Determinants need to be identified to reduce this rate. Knowledge of the existence of familial and community frailty will also assist in the reduction of under-five mortality. METHODS The 2015 Afghanistan Demographic Health Survey, including 32,712 live births, was analysed. Under-five mortality was disaggregated into neonatal, post-neonatal and child mortality and piecewise traditional Cox proportional hazard, variance-corrected and frailty models were developed. All the models identified determinants and the two frailty models examined the existence of familial and community frailty for each age group. RESULTS There was statistically significant evidence of community frailty. Breastfeeding status was a highly significant determinant under univariable and multivariable analysis for neonatal and post-neonatal mortality. Post-neonates of employed mothers also experienced increased mortality, particularly those whose mother worked in agriculture where the hazard ratio was 2.77 (95% CI 2.10, 3.65). Birth order 5+ was associated with increased mortality for all three age groups. CONCLUSION The Afghanistan Ministry of Public Health should identify frail communities. Support, such as daycare facilities, should be provided and early initiation of breastfeeding and breastfeeding throughout the post-neonatal period should also be encouraged. IMPACT The study identified determinants of neonatal, post-neonatal and child mortality. The study also established the presence of community frailty with respect to under-five mortality in Afghanistan. The study shows that the association of not breastfeeding and mortality is more acute in the early neonatal age group and it extends into the post-neonatal age group. The study identified the association of high birth order and mortality in the neonatal, post-neonatal and child age groups in Afghanistan. Policies should be implemented that encourage early initiation of breastfeeding to continue throughout the post-neonatal period and support for vulnerable families should be provided.
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Sultana F, Sheba IT. Factors Associated With Pre-Lacteal Feeding Practices Among Mothers Having Children Aged 0-36 Months in Bangladesh: Evidence From Bangladesh Demographic and Health Survey 2017-18. Glob Pediatr Health 2022; 9:2333794X221079550. [PMID: 35237714 PMCID: PMC8882935 DOI: 10.1177/2333794x221079550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Despite being a known barrier to optimal breast-feeding indicators, the practice
of Pre-lacteal Feeding (PLF) remains a key challenge in Bangladesh. This study
examines the prevalence and underlying factors associated with PLF, for which
data from a weighted sample of 4982 Bangladeshi mothers with children aged 0 to
36 months from the 2017-18 Bangladesh Demographic and Health Survey was used.
Step-by-step multivariate logistic regression was performed to identify the
association of significant determinants of PLF practices. Nearly 29% newborns
received PLF before breastmilk and timely initiation of breastfeeding did not
happen in case of 20.5% babies. The odds of PLF were significantly higher among
the inhabitants of Dhaka division compared to other regions. In addition,
birth-related factors such as optimal ANC visits (P < .01),
home delivery (P < .01) and delivered by cesarean section
(P < .01) showed significantly higher odds of
introducing PLF to the newborns. Our results demonstrated the need for
developing targeted policies and actions to prevent such practices of PLF in
order to improve optimal breastfeeding behavior in Bangladesh.
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Ayalew DD, Kassie BA, Hunegnaw MT, Gelaye KA, Belew AK. Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia. Nutr Metab Insights 2022; 15:11786388211065221. [PMID: 35023927 PMCID: PMC8744188 DOI: 10.1177/11786388211065221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The world is now suffering from malnutrition and remains one of the leading causes of death for under 5 children. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Therefore, the aim of this study was to assess the EIBF practices and determinants among children aged less than 24 months in West Belessa district, Northwest Ethiopia, 2019. METHODS A community-based cross-sectional study was conducted from January 2 to February 28, 2019 in the West Belessa district. A total of 569 mother-children pairs were participated in the study. Study particnapants were selected by using simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable and Multivariable logistic regression analysis were done. Odds ratio with 95% confidence was done to determine the level of significance value less than .05 considered as significant with the outcome variable. RESULT The prevalence of early initiation of breastfeeding (EIBF) was found to be 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR = 2.76, 95%CI [1.21, 6.27]), antenatal care (ANC) (AOR = 3.79, 95%CI [2.58, 9.94]), and number of antenatal care visit (AOR = 1.85, 95%CI [1.03, 3.85]) were significantly associated with early initiation of breastfeeding. CONCLUSION AND RECOMMENDATION In this study, more than three fourth of children were received early initiation of breastfeeding within 1 hour after delivery. Age of the mother, antenatal, and number of antenatal care were associated with EIBF. Therefore, during this contact period, improve antenatal services by increasing accessibility and providing counseling is important to improve EIBF utilization.
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Affiliation(s)
- Desalew Degu Ayalew
- Department of Human Nutrition,
Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Belayneh Ayanaw Kassie
- Department of Midwifery, College of
Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tamir Hunegnaw
- Department of Human Nutrition,
Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and
Biostatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Aysheshim Kassahun Belew
- Department of Human Nutrition,
Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Beyene GM, Azale T, Gelaye KA, Ayele TA. Effect of antenatal depression on the initiation of breastfeeding in South Gondar zone, Northwest Ethiopia: A population-based prospective cohort study. Heliyon 2022; 8:e08759. [PMID: 35079650 PMCID: PMC8777141 DOI: 10.1016/j.heliyon.2022.e08759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/20/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delayed initiation of breastfeeding has been found to increase early neonatal morbidity, mortality, and impaired mother-infant bonding. However, there is no study that revealed the effect of antenatal depression on breastfeeding initiation in Ethiopia. This study aimed to see the effect of antenatal depression on the practice of initiation of breastfeeding among women in urban Ethiopia. METHODS The Edinburgh Postnatal Depression Scale (EPDS) was administered to 970 women in the second and third trimesters of pregnancy to screen for antenatal depression. Information was collected on initiation of breastfeeding of newborns and mother's socio-demographic, obstetric, clinical, psychosocial, and behavioral factors. A logistic regression model was used to adjust for the confounders and determine association between antenatal depression and initiation of breastfeeding. RESULTS The cumulative incidence of late initiation of breastfeeding (LIBF) was found to be 166 (18.34%). The cumulative incidence of LIBF in those born from depressed pregnant women was 37% as compared to 8.4% in nondepressed. Antenatal depression at the second and third trimester of pregnancy remained a potential predictor of late initiation of breastfeeding after adjusting for potential confounders (AOR = 6.42: (95% CI 3.72, 11.05)). A significant association was also seen between infants who were born by cesarean section, a complication of current pregnancy, inadequate ANC follow-up, lack of advice about the importance of early initiation of breastfeeding (EIBF), home delivery, and low quartile of wealth index and late initiation of breastfeeding. CONCLUSIONS These findings suggest that screening for antenatal depression can help to identify women at risk for late initiation of breastfeeding. Health care providers shall have to give emphasis on the treatment of antenatal depression to benefit both the mother and the physical health, growth, and development of the fetus.
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Affiliation(s)
- Getnet Mihretie Beyene
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sakib MS, Ripon Rouf ASM, Tanny TF. Determinants of Early Initiation of Breastfeeding Practices of Newborns in Bangladesh: Evidence From Bangladesh Demographic and Health Survey. Nutr Metab Insights 2021; 14:11786388211054677. [PMID: 34720590 PMCID: PMC8554558 DOI: 10.1177/11786388211054677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/03/2021] [Indexed: 11/15/2022] Open
Abstract
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.
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Soumah AM, Baldé MD, Tassembedo M, Ouédraogo O, Garanet F, Ouédraogo AM, Yara A, Koulibaly M, Camara I, Kouanda S. Determinants of the practice of exclusive breastfeeding in Guinea: evidence from 2018 Guinean demographic and health survey. BMC Nutr 2021; 7:44. [PMID: 34365968 PMCID: PMC8351369 DOI: 10.1186/s40795-021-00450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding is critical for infant survival and development. However, the rate of exclusive breastfeeding in the first 6 months of life is low in sub-Saharan Africa. With the current trend in breastfeeding rates in many countries including in Guinea, the World Health Assembly target of at least 50% of children aged less than 6 months being exclusively breastfeed by 2025 is likely to be compromised and lives a numerous infant that are be at risk. The objective of this study was to identify the individual and contextual determinants of the practice of Exclusive Breastfeeding (EBF) in Guinea. METHOD We conducted a secondary analysis of data from the 2018 Guinea Demographic and Health Survey (DHS). The study population consisted of women who gave birth between the ages of 15 and 49. Our sample consisted of women who had their last birth six (06) months prior to collection. The enumeration areas were our second level. A multilevel logistic regression was performed using Stata version 15.1 software. Three statistical models were implemented: The final model was obtained using the bottom-up step-by-step method. The intra-class correlation coefficient was calculated. RESULTS On the 851 women included in our study, 33% reported having exclusively breastfed during the first 6 months of life of their children. After a multivariate analysis, the variables associated with exclusive breastfeeding are: children aged 2-3 months (OR = 0.53 CI95% = [0.36-0.79]) and children aged 4-5 months (OR = 0.23 IC95% = [0.14-0.36]), women in the Faranah area (OR = 2.69 IC95% = [1.21-5.94]) and those in Mamou (OR = 2.27 IC95% = [1.00-5.94]), women who gave birth in a health facility (OR = 1.94 IC95% = [1.34-2.80]) and women living in polygamous households (OR = 0.68 IC95% = [0.48-0.98]). CONCLUSION The practice of exclusive breastfeeding remains low in Guinea. For the achievement of Sustainable Development Goals, particularly the improvement of exclusive breastfeeding practices, the individual and contextual determinants identified in this study should be taken into consideration in policies and programmes.
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Affiliation(s)
| | | | | | | | - Franck Garanet
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso.,Institut de recherche en science de la santé, Ouagadougou, Burkina Faso
| | - Adja Mariam Ouédraogo
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso.,Institut de recherche en science de la santé, Ouagadougou, Burkina Faso
| | | | | | | | - Seni Kouanda
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso.,Institut de recherche en science de la santé, Ouagadougou, Burkina Faso
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Gebremariam AD, Tiruneh SA, Engidaw MT, Tesfa D, Azanaw MM, Yitbarek GY, Asmare G. Development and Validation of a Clinical Prognostic Risk Score to Predict Early Neonatal Mortality, Ethiopia: A Receiver Operating Characteristic Curve Analysis. Clin Epidemiol 2021; 13:637-647. [PMID: 34366681 PMCID: PMC8336991 DOI: 10.2147/clep.s321763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 01/27/2023] Open
Abstract
Background Early neonatal death is the death of a live-born baby within the first seven days of life, which is 73% of all postnatal deaths in the globe. This study aimed to develop and validate a prognostic clinical risk tool for the prediction of early neonatal death. Methods A prospective follow-up study was conducted among 393 neonates at Debre Tabor Referral hospital, Northwest Ethiopia. Multivariable logistic regression model was employed to identify potential prognostic determinants for early neonatal mortality. Area under receiver operating characteristics curve (AUROC) was used to check the model discrimination probability using ‘pROC’ R-package. Model calibration plot was checked using ‘givitiR’ R-package. Finally, a risk score prediction tool was developed for ease of applicability. Decision curve analysis was done for cost-benefit analysis and to check the clinical impact of the model. Results Overall, 15.27% (95% CI: 12.03–19.18) of neonates had the event of death during the follow-up period. Maternal undernutrition, antenatal follow-up less than four times, birth asphyxia, low birth weight, and not exclusive breastfeeding were the prognostic predictors of early neonatal mortality. The AUROC for the reduced model was 88.7% (95% CI: 83.8–93.6%), which had good discriminative probability. The AUROC of the simplified risk score algorithm was 87.8% (95% CI, 82.7–92.9%). The sensitivity and specificity of the risk score tool was 70% and 89%, respectively. The true prediction accuracy of the risk score tool to predict early neonatal mortality was 86%, and the false prediction probability was 13%. Conclusion We developed an early neonatal death prediction tool using easily available maternal and neonatal characteristics for resource-limited settings. This risk prediction using risk score is an easily applicable tool to identify neonates at a higher risk of having early neonatal mortality. This risk score tool would offer an opportunity to reduce early neonatal mortality, thus improving the overall early neonatal death in a resource-limited setting.
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Affiliation(s)
- Alemayehu Digssie Gebremariam
- Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health (Epidemiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tesfa
- Department of Public Health (Reproductive Health), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- Department of Public Health (Epidemiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Science (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getnet Asmare
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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A Quality Improvement Initiative: Improving First-hour Breastfeeding Initiation Rate among Healthy Newborns. Pediatr Qual Saf 2021; 6:e433. [PMID: 34235356 PMCID: PMC8225365 DOI: 10.1097/pq9.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction "No matter where a newborn takes his or her first breath, the desire to give that baby the best start in life is universal." The best gift a mother can give her baby is the gift of health. The gift of health can be given to the baby through early and adequate breastfeeding. Globally, only 2 out of 5 newborns are put to the breast within the first hour of life. Therefore, initiating breastfeeding is an evidence-based intervention for improving neonatal survival. Methods We aimed to improve the first-hour breastfeeding initiation rate from the existing 12%-80% over 3 months through a quality improvement (QI) process. The setting was antenatal, perinatal, and postnatal wards of the Maharishi Markandeshwar Institute of Medical Sciences And Research Hospital. The participants were postpartum mothers with stable newborns 35 weeks and older of gestation born by normal vaginal delivery. Procedure for QI A team of nurses and obstetricians was formed; we analyzed possible reasons for delayed initiation of breastfeeding by process cycle matrix chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. The outcome measure is the proportion of eligible babies breastfed within 1 hour of delivery. Results After 3 months, the first-hour initiation of breastfeeding increased from 12% to 80%, without additional resources. Conclusions A QI approach achieved an improvement in first-hour breastfeeding rates after normal vaginal delivery.
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Agampodi TC, Dharmasoma NK, Koralagedara IS, Dissanayaka T, Warnasekara J, Agampodi SB, Perez-Escamilla R. Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation. Int Breastfeed J 2021; 16:32. [PMID: 33832496 PMCID: PMC8034146 DOI: 10.1186/s13006-021-00378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka. Methods We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed. Results Main barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding. Conclusion EBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00378-0.
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Affiliation(s)
- Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
| | - Neerodha Kithmini Dharmasoma
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Iresha Sandamali Koralagedara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Thushari Dissanayaka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Rafael Perez-Escamilla
- Department of Social and Behavioral Science, Yale School of Public Health, New Haven, USA
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Tran HT, Nguyen TT, Giang HTN, Huynh LT, Barnett D, Mathisen R, Murray JCS. Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam. Nutrients 2021; 13:nu13041151. [PMID: 33807207 PMCID: PMC8066195 DOI: 10.3390/nu13041151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Pasteurized donor milk (PDM) is typically prescribed to preterm or low birthweight newborns when their mother’s own milk is unavailable. In surplus, PDM is prescribed to meet the nutritional needs of healthy newborns in the first few days of life. However, its overuse can undermine efforts to promote and support breastfeeding, waste resources, and reduce the availability of PDM for at-risk newborns. We conducted this study to examine factors associated with the prescription and prolonged use (>48 h) of privately purchased PDM to healthy newborns. Methods: Prospective observational study of 2440 mothers of healthy, term, and normal birthweight newborns born at Da Nang Hospital for Women and Children between April and August 2019. In addition to the descriptive analysis, we performed multiple logistic regressions to examine factors associated with the prescription of PDM (n = 2440) and prolonged PDM use among those who used PDM (n = 566). Results: Twenty-three percent (566/2440) of healthy, term, and birthweight ≥2500 g newborns received PDM and were included in the study. The prevalence of PDM use was higher for cesarean births (OR: 2.05; 95% CI: 1.66, 2.55) and among male newborns (OR: 1.33; 95% CI: 1.09, 1.62), but lower for farmers or workers (vs. other jobs; OR: 0.71; 95% CI: 0.54, 0.93), family income <10 million VND (vs. ≥10 million VND; OR: 0.67; 95% CI: 0.55, 0.82), and duration of skin-to-skin ≥90 min (vs. <90 min; OR: 0.54; 95% CI: 0.39, 0.76). Prolonged PDM use (12.4% of 566 newborns who used PDM) was associated with the mother having a higher socioeconomic status job (professional, small trader or homemaker; OR: 4.00; 95% CI: 1.39, 12.5), being a first-time mother (OR: 3.39; 95% CI: 1.92, 6.01) or having a cesarean birth (OR: 2.09; 95% CI: 1.02, 4.28). Conclusions: The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
- Correspondence: ; Tel.: +84-903-543-115
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
| | - Hoang Thi Nam Giang
- International Cooperation and Scientific Research Office, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam;
| | - Le Thi Huynh
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang 50206, Vietnam
| | - Debbie Barnett
- Milk Bank Scotland, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK;
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (T.T.N.); (R.M.)
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Raihana S, Alam A, Huda TM, Dibley MJ. Factors associated with delayed initiation of breastfeeding in health facilities: secondary analysis of Bangladesh demographic and health survey 2014. Int Breastfeed J 2021; 16:14. [PMID: 33482847 PMCID: PMC7821485 DOI: 10.1186/s13006-021-00360-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background Irrespective of the place and mode of delivery, ‘delayed’ initiation of breastfeeding beyond the first hour of birth can negatively influence maternal and newborn health outcomes. In Bangladesh, 49% of newborns initiate breastfeeding after the first hour. The rate is higher among deliveries at a health facility (62%). This study investigates the maternal, health service, infant, and household characteristics associated with delayed initiation of breastfeeding among health facility deliveries in Bangladesh. Methods We used data from the 2014 Bangladesh Demographic and Health Survey. We included 1277 last-born children born at a health facility in the 2 years preceding the survey. ‘Delayed’ breastfeeding was defined using WHO recommendations as initiating after 1 h of birth. We performed univariate and multivariable logistic regression to determine factors associated with delayed initiation. Results About three-fifth (n = 785, 62%) of the children born at a health facility delayed initiation of breastfeeding beyond 1 h. After adjusting for potential confounders, we found delayed initiation to be common among women, who delivered by caesarean section (adjusted Odds Ratio (aOR): 2.93; 95% CI 2.17, 3.98), and who were exposed to media less than once a week (aOR: 1.53; 95% CI 1.07, 2.19). Women with a higher body mass index had an increased likelihood of delaying initiation (aOR: 1.05; 95% CI 1.01, 1.11). Multiparous women were less likely to delay (aOR: 0.71; 95% CI 0.53, 0.96). Conclusions Delayed initiation of breastfeeding following caesarean deliveries continues to be a challenge, but several other health facility and maternal factors also contributed to delayed initiation. Interventions to promote early breastfeeding should include strengthening the capacity of healthcare providers to encourage early initiation, especially for caesarean deliveries.
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Affiliation(s)
- Shahreen Raihana
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. .,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tanvir M Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Sociodemographic Factors Predicting Exclusive Breastfeeding in Ethiopia: Evidence from a Meta-analysis of Studies Conducted in the Past 10 Years. Matern Child Health J 2021; 25:72-94. [PMID: 33389586 DOI: 10.1007/s10995-020-03059-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the association between EBF and educational status, household income, marital status, media exposure, and parity in Ethiopia. METHODS PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library databases were searched using key terms for all studies published in English between September 2009 and March 2019. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran's Q test, τ2, and I2 statistics. In addition, Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis were conducted. RESULTS Out of 553 studies retrieved, 31 studies fulfilled our inclusion criteria. Almost all included studies were conducted among mothers with newborn less than 23 months old. Maternal primary school education (OR 1.39; 95% CI 1.03-1.89; I2 = 86.11%), medium household income (OR 1.27; 95% CI 1.05-1.55; I2 = 60.9%) and being married (OR 1.39; 95% CI 1.05-1.83; I2 = 76.96%) were found to be significantly associated with EBF. We also observed an inverse dose-response relationship of EBF with educational status and income. However, EBF was not significantly associated with parity, media exposure, and paternal educational status. CONCLUSIONS In this meta-analysis, we showed the relevant effect of maternal education, income, and marital status on EBF. Therefore, multifaceted, effective, and evidence-based efforts are needed to increase the national level of exclusive breastfeeding in Ethiopia.
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Mekasha A, Tazu Z, Muhe L, Abayneh M, Gebreyesus G, Girma A, Berhane M, McClure EM, Goldenberg RL, Nigussie AK. Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study. Glob Pediatr Health 2020; 7:2333794X20970005. [PMID: 33283024 PMCID: PMC7689001 DOI: 10.1177/2333794x20970005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/05/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Aim. To determine the risk factors for death among preterm
neonates. Methods and materials. The data set used was derived
from a prospective, multi-center, observational clinical study conducted in 5
tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were
infants admitted into neonatal intensive care unit. Results.
Risk factors were determined using statistical model developed for this study.
The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to
36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The
significant risk factors for preterm death were low gestational age, low birth
weight, being female, feeding problem, no antenatal care visits and vaginal
delivery among mothers with higher educational level.
Conclusions. The study identified several risk factors for
death among preterm neonates. Most of the risk factors are preventable. Thus, it
is important to address neonatal and maternal factors identified in this study
through appropriate ANC and optimum infant medical care and feeding practices to
decrease the high rate of preterm death.
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Affiliation(s)
- Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Tazu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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24
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Ali NB, Karim F, Billah SKM, Hoque DMDE, Khan ANS, Hasan MM, Simi SM, Arifeen SEL, Chowdhury MAK. Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh? PLoS One 2020; 15:e0242135. [PMID: 33186387 PMCID: PMC7665793 DOI: 10.1371/journal.pone.0242135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/28/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh. METHOD We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders. RESULTS The prevalence of EIBF practices were 69.6%(95% CI:67.8-71.3); 72.2%(95% CI:67.8-71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3-75.6) mother's in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35-0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12-0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding. DISCUSSIONS This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.
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Affiliation(s)
- Nazia Binte Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S. K. Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Mohammad Mehedi Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sonjida Mesket Simi
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams E. L. Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
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Bryce E, Mullany LC, Khatry SK, Tielsch JM, LeClerq SC, Katz J. Coverage of the WHO's four essential elements of newborn care and their association with neonatal survival in southern Nepal. BMC Pregnancy Childbirth 2020; 20:540. [PMID: 32938433 PMCID: PMC7493414 DOI: 10.1186/s12884-020-03239-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/02/2020] [Indexed: 12/01/2022] Open
Abstract
Background Despite recent improvements in child survival, neonatal mortality continues to decline at a slower rate and now represents 47% of under-five deaths globally. The World Health Organization developed core indicators to better monitor the quality of maternal and newborn health services. One such indicator for newborn health is “the proportion of newborns who received all four elements of essential care”. The four elements are immediate and thorough drying, skin to skin contact, delayed cord clamping, and early initiation of breastfeeding. Although there is existing evidence demonstrating an association with decreased neonatal mortality for each element individually, the cumulative impact has not yet been examined. Methods This analysis uses data from a randomized trial to examine the impact of sunflower versus mustard seed oil massage on neonatal mortality and morbidity in the Sarlahi district in Southern Nepal from 2010 to 2017. The proportion of newborn infants receiving an intervention was the exposure and neonatal mortality was the outcome in this analysis. Neonatal mortality was defined as a death between three hours and less than 28 days of age. Associations between neonatal mortality and the essential elements were estimated by Cox proportion hazards models. The hazard ratios and corresponding 95% confidence intervals were reported. Results 28,121 mother-infant pairs and 753 neonatal deaths were included. The percent receiving the individual elements ranged from 19.5% (skin to skin contact) to 68.2% (delayed cord clamping). The majority of infants received one or two of the elements of essential care, with less than 1% receiving all four. Skin to skin contact and early initiation of breastfeeding were associated with lower risk of neonatal mortality (aHR = 0.64 [0.51, 0.81] and aHR = 0.72 [0.60, 0.87], respectively). The risk of mortality declined as the number of elements received increased; receipt of one element compared to zero was associated with a nearly 50% reduction in risk of mortality and receipt of all four elements resulted in a 72% decrease in risk of mortality. Conclusions The receipt of one or more of the four essential elements of newborn care was associated with improved neonatal survival. The more elements of care received, the more survival improved.
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Affiliation(s)
- Emily Bryce
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.,Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, PO Box 335, Tripureshwor, Kathmandu, Nepal
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.,Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, PO Box 335, Tripureshwor, Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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26
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Hodgins S, Rajbhandari B, Joshi D, Ban B, Khatry S, Mullany LC. Community-based cluster randomized controlled trial: empowering households to identify and provide appropriate care for low-birthweight newborns in Nepal. BMC Public Health 2020; 20:1274. [PMID: 32838783 PMCID: PMC7446145 DOI: 10.1186/s12889-020-09317-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/29/2020] [Indexed: 01/24/2023] Open
Abstract
Background Most newborn deaths occur among those of low birthweight (LBWt), due to prematurity &/or impaired fetal growth. Simple practices can substantially mitigate this risk. In low-income country settings where many births occur at home, strategies are needed that empower mothers to determine if their babies are at higher risk and, if so, to take measures to reduce risk. Earlier studies suggest that foot-length may be a good proxy for birthweight. An earlier Nepal study found a 6.9 cm cut-off performed relatively well, differentiating normal from low birthweight. Methods Community-based, cluster-randomized controlled trial. Objective: to determine whether family-administered screening, associated with targeted messages improves care practices known to mitigate LBWt-associated risks. Participants: women participating in a parent trial in rural Nepal, recruited late in pregnancy. Women were given a 6.9 cm card to assess whether the baby’s foot is small; if so, to call a number on the card for advice. Follow-up visits were made over the 2 weeks following the birth, assessing for 2 behavioral outcomes: reported skin-to-skin thermal care, and care-seeking outside the home; assessed restricting to low birthweight (using 2 cutoffs: 2500 g and 2000 g). Randomization: 17 clusters intervention, 17 control. The study also documented performance along the presumed causal chain from intervention through behavioral impact. Results 2022 intervention, 2432 control. Intervention arm: 519 had birthweight < 2500 g (vs. 663 among controls), of which 503 were available for analysis (vs. 649 among controls). No significant difference found on care-seeking; for those < 2500 g RR 1.13 (95%CI: 0.97–1.131). A higher proportion of those in the intervention arm reported skin-to-skin thermal care than among controls; for those < 2500 g RR 2.50 (95%CI: 2.01–3.1). However, process measures suggest this apparent effect cannot be attributed to the intervention; the card performed poorly as a proxy for LBWt, misclassifying 84.5% of those < 2000 as normal weight. Conclusions Although the trial found an apparent effect on one of the behavioral outcomes, this cannot be attributed to the intervention; most likely it was a result of pure chance. Other approaches are needed for identifying small, at-risk babies in such settings, and targeting them for appropriate care messaging. Trial registration ClinicalTrials.gov NCT02802332, registered 6/16/2016.
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Affiliation(s)
- Stephen Hodgins
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
| | - Binamra Rajbhandari
- International Rescue Committee, 38 Main Motor Road, Wilberforce, Freetown, Sierra Leone
| | - Deepak Joshi
- Save the Children, Nepal Country Office, Airport Gate Area, Shambhu Marg, Kathmandu, Nepal
| | - Bharat Ban
- Independent consultant, Kathmandu, Nepal
| | | | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21228, USA
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Abekah-Nkrumah G, Antwi MY, Nkrumah J, Gbagbo FY. Examining working mothers' experience of exclusive breastfeeding in Ghana. Int Breastfeed J 2020; 15:56. [PMID: 32552899 PMCID: PMC7302356 DOI: 10.1186/s13006-020-00300-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/07/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Gordon Abekah-Nkrumah
- Department of Public Administration and Health Services Management, University of Ghana Business School, P. O. Box 78, Legon, Accra, Ghana.
| | - Maame Yaa Antwi
- Department of Public Administration and Health Services Management, University of Ghana Business School, P. O. Box 78, Legon, Accra, Ghana
| | - Jacqueline Nkrumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, P.O Box 25, Winneba, Central Region, Ghana
| | - Fred Yao Gbagbo
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, P.O Box 25, Winneba, Central Region, Ghana
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Mituki‐Mungiria D, Tuitoek P, Varpolatai A, Ngotho D, Kimani‐Murage E. Effectiveness of community health workers in improving early initiation and exclusive breastfeeding rates in a low-resource setting: A cluster-randomized longitudinal study. Food Sci Nutr 2020; 8:2719-2727. [PMID: 32566189 PMCID: PMC7300079 DOI: 10.1002/fsn3.1559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 11/09/2022] Open
Abstract
Little evidence exists in Kenya on the potential of community health workers (CHWs) in promoting exclusive breastfeeding (EBF) and early breastfeeding initiation (EBI) in resource-restricted settings where very low EBF rates (2% to 12%) have been documented. The study utilized CHWs and assessed their effectiveness in promoting EBF and EBI. The cluster-randomized longitudinal design was used and sixteen villages from Kiandutu Slum in Thika randomly assigned into either intervention group (IG) or comparison group (CG). Pregnant women attending Maternal Child Health (MCH) clinic were recruited. The IG received nutrition education sessions conducted by CHWs at home, two prenatally and six postnatally, plus the routine MCH care. The CG went through routine MCH care only. Infants feeding data were collected at 6, 10, 14, and 24 weeks postpartum by research assistants blinded to the intervention allocation. Differences in EBF and EBI in the two groups were tested using χ 2 tests, Kaplan-Meier survival analysis and generalized estimating equations. Of the 526 recruited in the study, 431 remained and were included in the analysis (IG = 176) and CG (225). The prevalence of EBF at 24 weeks was 45.3% in the IG compared with 15.0% in the CG, revealing a statistically significant difference log rank = 20.277, (1, n = 314) p < .001. The difference was not statistically significant in EBI prevalence between the IG (58.2%) and CG (60.3%; χ 2 = 0.008, p = .928). The CHWs have potential effectiveness in promoting EBF but not EBI. The link between the health center and CHWs should be strengthened to promote EBF.
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Affiliation(s)
| | | | | | - Douglas Ngotho
- Faculty of Health SciencesEgerton UniversityEgertonKenya
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29
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Shafaei FS, Mirghafourvand M, Havizari S. The effect of prenatal counseling on breastfeeding self-efficacy and frequency of breastfeeding problems in mothers with previous unsuccessful breastfeeding: a randomized controlled clinical trial. BMC WOMENS HEALTH 2020; 20:94. [PMID: 32370804 PMCID: PMC7201717 DOI: 10.1186/s12905-020-00947-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022]
Abstract
Background Breastfeeding is one of the most important interfering factors in infants’ health. Monitoring mothers’ performance and providing them with the feedback helps to increase their self-efficacy, interest in learning, and level of performance. The present research evaluates the effect of prenatal counseling on the breastfeeding self-efficacy and frequency of breastfeeding problems in mothers with previous unsuccessful breastfeeding. Methods This randomized controlled clinical trial was conducted on 108 pregnant women with unsuccessful breastfeeding in Tabriz health centers during 2017–2018. The participants were randomly assigned to intervention and control groups. The intervention group had four prenatal counseling sessions and the controls only received routine care. Then, the mothers who gave birth to their children received a counseling session up to 4 months after the delivery. The Breastfeeding Self-Efficacy (BSES) questionnaire and the frequency of breast feeding problems checklist on the 15th day, and 2nd and 4th month were completed both by the intervention and control groups. Results The mean (SD) of breastfeeding self-efficacy was 119.3 (10.5), 128.3 (8.3) and 133.8 (10.3) in the intervention group and 105.3 (16.1), 105.7 (19.7) and 109.4 (24.7) in the control group on the 15th day, 2nd and 4th month after the delivery, respectively. There was a significant difference in terms of breastfeeding self-efficacy between intervention and control group on the 15th day (p < 0.001), and 2nd (p < 0.001) and 4th (p < 0.001) month after the delivery. The frequency of breastfeeding problems on the 15th (p = 0.008), 2nd (p < 0.001) and 4th (p < 0.001) after the delivery was significantly different in most cases of the intervention group when compared to the controls. Conclusion The results indicated that prenatal counseling can increase mothers’ breastfeeding self-efficacy and solves most breastfeeding problems during postpartum period. Trial registration IRCT20100109003027N19.
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Affiliation(s)
- Fahimeh Sehhatie Shafaei
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shiva Havizari
- Student Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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30
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Scelza BA, Hinde K. Crucial Contributions : A Biocultural Study of Grandmothering During the Perinatal Period. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2020; 30:371-397. [PMID: 31802396 PMCID: PMC6911617 DOI: 10.1007/s12110-019-09356-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Maternal grandmothers play a key role in allomaternal care, directly caring for and provisioning their grandchildren as well as helping their daughters with household chores and productive labor. Previous studies have investigated these contributions across a broad time period, from infancy through toddlerhood. Here, we extend and refine the grandmothering literature to investigate the perinatal period as a critical window for grandmaternal contributions. We propose that mother-daughter co-residence during this period affords targeted grandmaternal effort during a period of heightened vulnerability and appreciable impact. We conducted two focus groups and 37 semi-structured interviews with Himba women. Interviews focused on experiences from their first and, if applicable, their most recent birth and included information on social support, domains of teaching and learning, and infant feeding practices. Our qualitative findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being. We show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants. These findings demonstrate that the role of grandmother can be crucial, even when alloparenting is common and breastfeeding is frequent and highly visible. Situated within the broader anthropological and clinical literature, these findings substantiate the claim that humans have evolved in an adaptive sociocultural perinatal complex in which grandmothers provide significant contributions to the health and well-being of their reproductive-age daughters and grandchildren.
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Affiliation(s)
- Brooke A Scelza
- Department of Anthropology, UCLA, Los Angeles, CA, 90095-1553, USA. .,Center for Behavior, Evolution and Culture, UCLA, Los Angeles, CA, 90095-1553, USA.
| | - Katie Hinde
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 85287, USA.,Center for Evolution and Medicine, Arizona State University, Tempe, AZ, 85287, USA
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31
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Shobo OG, Umar N, Gana A, Longtoe P, Idogho O, Anyanti J. Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study. BMJ Open 2020; 10:e032835. [PMID: 32317258 PMCID: PMC7204917 DOI: 10.1136/bmjopen-2019-032835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
| | - Nasir Umar
- Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Gana
- Office of the Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Peter Longtoe
- Monitoring and Evaluation Department, Society for Family Health, Abuja, Nigeria
| | - Omokhudu Idogho
- Office of the Managing Director, Society for Family Health, Abuja, Nigeria
| | - Jennifer Anyanti
- Office of the Deputy Managing Director, Society for Family Health, Abuja, Nigeria
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Applegate JA, Ahmed S, Harrison M, Callaghan-Koru J, Mousumi M, Begum N, Moin MI, Joarder T, Ahmed S, George J, Mitra DK, Ahmed ASMNU, Shahidullah M, Baqui AH. Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh. PLoS One 2020; 15:e0231490. [PMID: 32287286 PMCID: PMC7156040 DOI: 10.1371/journal.pone.0231490] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/24/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Many infants with possible serious bacterial infections (PSBI) do not receive inpatient treatment because hospital care may not be affordable, accessible, or acceptable for families. In 2015, WHO issued guidelines for managing PSBI in young infants (0-59 days) with simpler antibiotic regimens when hospital care is not feasible. Bangladesh adopted WHO's guidelines for implementation in outpatient primary health centers. We report results of an implementation research study that assessed caregiver acceptability of the guidelines in three rural sub-districts of Bangladesh during early implementation (October 2015-August 2016). METHODS We included 19 outpatient primary health centers involved in the initial rollout of the infection management guidelines. We extracted data for all PSBI cases (N = 192) from facility registers to identify gaps in referral feasibility, simplified antibiotic treatment, and follow-up. Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with both caregivers (6 FGDs; 23 IDIs) and providers (2 FGDs; 28 IDIs) to assess caregiver acceptability of the guidelines. RESULTS Referral to the hospital was not feasible for many families (83.3%; N = 160/192) and acceptance varied by infection severity. Barriers to referral feasibility included economic and household factors, and previous experiences with poor quality of care at the sub-district hospital. Conversely, providers and caregivers indicated high acceptability of simplified antibiotic treatment. 80% (N = 96/120) of infants with clinical severe infection for whom referral was not feasible returned to the facility for the second antibiotic injection. Some providers reported developing local solutions-including engaging informal providers in treatment of the infant-to address organizational barriers and promote treatment compliance. Follow-up of young infants receiving simplified treatment is critical, but only 67.4% (N = 87/129) of infants received fourth day follow-up. Some providers' reported deviations from the guidelines that shifted responsibility of follow-up to the caregiver, which may have contributed to lapses. CONCLUSION Caregivers' perception of trust and communication with providers were influential in caregiver acceptability of care. Few caregivers accepted referral to the sub-district hospital, suggesting low acceptability of this option. When referral was not feasible, many caregivers reported satisfaction with simplified antibiotic treatment. Local solutions described by providers require further examination in this context to assess the safety and potential value of these strategies in outpatient treatment. Our findings suggest strengthening providers' interpersonal skills could improve caregiver acceptability of the guidelines.
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Affiliation(s)
- Jennifer A. Applegate
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Meagan Harrison
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jennifer Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | | | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, Bangladesh
| | | | - Taufique Joarder
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sabbir Ahmed
- USAID’s MaMoni Health Systems Strengthening Project, Save the Children, Washington, DC, United States of America
| | - Joby George
- USAID’s MaMoni Health Systems Strengthening Project, Save the Children, Washington, DC, United States of America
| | - Dipak K. Mitra
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | | | - Mohammod Shahidullah
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Abdullah H. Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Yaya S, Bishwajit G, Shibre G, Buh A. Timely initiation of breastfeeding in Zimbabwe: evidence from the demographic and health surveys 1994-2015. Int Breastfeed J 2020; 15:10. [PMID: 32070375 PMCID: PMC7029501 DOI: 10.1186/s13006-020-00255-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/12/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Timely initiation of breastfeeding or breastfeeding within 60 min of birth has been shown to be associated with significantly lower risk of infant mortality. The World Health Organization recommends starting breastfeeding within the first hour of birth, yet many women in sub-Saharan Africa do not observe this recommendation. To date, there is limited evidence of timely initiation of breastfeeding for Zimbabwe. Therefore, we undertook this study with the aim of calculating the trend in timely initiation of breastfeeding and to explore the correlates. METHODS We used five rounds of Zimbabwe Demographic and Health Survey data conducted between 1999 and 2015. Participants were 15,923 mothers currently breastfeeding or who had a childbirth within five years preceding the surveys. Outcome variable was self-reported timing of timely breastfeeding for singleton births which was categorized as early (< 60 min), late (≥ 60 min to < 2 4 h) and very late (≥ 24 h). RESULTS Prevalence of timely initiation of breastfeeding was 60.3% (95% Confidence Interval [CI] 57.44, 63.02) in 1999, 66.9% (95% CI 64.32, 69.4) in 2006, 65.8% (95% CI 63.7, 67.8) in 2011 and 58.3% (95% CI 56.3, 60.4) in 2015. It increased by 27 and 22% in 2006 and 2011 compared with that of the 1999 level respectively. We found no socio-economic and gender-based differentials in the prevalence of timely initiation of breastfeeding. Compared with women aged 15-19 years old, women 25-29 and 30-34 years old had higher odds of practicing timely initiation of breastfeeding. The odds of practicing timely initiation of breastfeeding among Muslim women (adjusted odds ratio [aOR] 1.2, 95% CI 1.07, 1.36) was 20% higher when compared with Christian mothers. Women who wanted to have their last child later (aOR 0.89, 95% CI 0.81, 0.97) had 11% lower odd of practicing timely initiation of breastfeeding when compared with women who wanted children then. CONCLUSIONS The prevalence of timely initiation of breastfeeding in Zimbabwe was 58.3% in 2015, well over the 50% target recommended by WHO for all countries to attain by 2025.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
| | - Ghose Bishwajit
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada
| | - Gebretsadik Shibre
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amos Buh
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Alebel A, Wagnew F, Petrucka P, Tesema C, Moges NA, Ketema DB, Yismaw L, Melkamu MW, Hibstie YT, Temesgen B, Bitew ZW, Tadesse AA, Kibret GD. Neonatal mortality in the neonatal intensive care unit of Debre Markos referral hospital, Northwest Ethiopia: a prospective cohort study. BMC Pediatr 2020; 20:72. [PMID: 32061260 PMCID: PMC7023807 DOI: 10.1186/s12887-020-1963-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality remains a serious global public health problem, but Sub-Saharan Africa (SSA), in particular, is largely affected. Current evidence on neonatal mortality is essential to inform programs and policies, yet there is a scarcity of information concerning neonatal mortality in our study area. Therefore, we conducted this prospective cohort study to determine the incidence and predictors of neonatal mortality at Debre Markos Referral Hospital, Northwest Ethiopia. METHODS This institutionally-based prospective cohort study was undertaken among 513 neonates admitted to the neonatal intensive care unit of Debre Markos Referral Hospital between December 1st, 2017 and May 30th, 2018. All newborns consecutively admitted to the neonatal intensive care unit during the study period were included. An interviewer administered a questionnaire with the respective mothers. Data were entered using Epi-data™ Version 3.1 and analyzed using STATA™ Version 14. The neonatal survival time was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables were compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of neonatal mortality. RESULTS Among a cohort of 513 neonates at Debre Markos Referral Hospital, 109 (21.3%) died during the follow-up time. The overall neonatal mortality rate was 25.8 deaths per 1, 000 neonate-days (95% CI: 21.4, 31.1). In this study, most (83.5%) of the neonatal deaths occurred in the early phase of neonatal period (< 7 days post-partum). Using the multivariable Cox-regression analysis, being unemployed (AHR: 1.6, 95% CI: 1.01, 2.6), not attending ANC (AHR: 1.9, 95% CI: 1.01, 3.5), not initiating exclusive breastfeeding (AHR: 1.7, 95% CI: 1.02, 2.7), neonatal admission due to respiratory distress syndrome (AHR: 2.0, 95% CI: 1.3, 3.1), and first minute Apgar score classification of severe (AHR: 2.1, 95% CI: 1.1, 3.9) significantly increased the risk of neonatal mortality. CONCLUSION In this study, we found a high rate of early neonatal mortality. Factors significantly linked with increased risk of neonatal mortality included: unemployed mothers, not attending ANC, not initiating exclusive breastfeeding, neonates admitted due to respiratory distress syndrome, and first minute Apgar score classified as severe.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Fasil Wagnew
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Cheru Tesema
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Nurilign Abebe Moges
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - lieltework Yismaw
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | | | | | | | - Zebenay Workneh Bitew
- Department of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Animen Ayehu Tadesse
- Department of Medical Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getiye Dejenu Kibret
- College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
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Dharel D, Dhungana R, Basnet S, Gautam S, Dhungana A, Dudani R, Bhattarai A. Breastfeeding practices within the first six months of age in mid-western and eastern regions of Nepal: a health facility-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:59. [PMID: 32000701 PMCID: PMC6990469 DOI: 10.1186/s12884-020-2754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/20/2020] [Indexed: 11/20/2022] Open
Abstract
Background The World Health Organization recommends initiation of breastfeeding within 1 hour of birth and exclusive breastfeeding up to 6 months of age. Infant feeding practices, including suboptimal breastfeeding practices, are associated with stunting. Rate of stunting was highest in the Mid-western region and lowest in the Eastern region of Nepal. This study aimed to assess the breastfeeding practices in these two regions, as well as to identify factors associated with partial breastfeeding. Methods We conducted a health facility-based cross-sectional study in the Mid-western and Eastern regions of Nepal from December 2017 to May 2018. Investigators administered a pre-tested questionnaire among consecutive 574 mother-infant dyads at different levels of health facilities. We dichotomized the breastfeeding pattern to partial breastfeeding and full (exclusive or predominant) breastfeeding. We conducted multivariable logistic regression to identify factors associated with partial breastfeeding within 6 months of age. Results There were 574 infants included in the study, all of which received at least some breastfeeding. Only 23.2% of infants were exclusively breastfed until 6 months, with 28.2% predominantly breastfed and 48.6% partially breastfed. Partial breastfeeding rate was 52.3% in the Mid-western region and 44.4% in the Eastern region. Breastfeeding was initiated within an hour from birth in 67.2% of infants. One-quarter of infants were given pre-lacteal feed, honey being the commonest. Knowledge of the recommended duration of exclusive breastfeeding was inadequate in 16, and 65% of mothers reported breastfeeding problems in the first 6 months. Firstborn and low birth weight infants had a significantly higher rate of partial breastfeeding. Partial breastfeeding was also higher when infants were not breastfed within 1 hour from birth, mothers reported having breastfeeding-related problems or had inadequate knowledge of the duration of exclusive breastfeeding. Conclusion Nearly half of the infants were fully breastfed at 6 months of age in Nepal. The rate of partial breastfeeding was higher with inadequate knowledge on duration of exclusive breastfeeding or late initiation of breastfeeding or perceived breastfeeding problems. Hence, programs should address knowledge and practice gaps in breastfeeding practices, particularly among mothers of low birth weight and firstborn infants.
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Affiliation(s)
- Dinesh Dharel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2T9, Canada. .,BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | - Sushma Basnet
- Lifeline Hospital Institute of Health Sciences, Damak, Jhapa, Nepal
| | - Swotantra Gautam
- BP Koirala Institute of Health Sciences, Dharan, Nepal.,Population Health Research Institute (PHRI), Hamilton, Canada
| | | | - Rajesh Dudani
- John H Stroger Hospital of Cook Country, Chicago, USA
| | - Asmita Bhattarai
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Woldeamanuel BT. Trends and factors associated to early initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding in Ethiopia: evidence from the Ethiopia Demographic and Health Survey 2016. Int Breastfeed J 2020; 15:3. [PMID: 31924229 PMCID: PMC6953467 DOI: 10.1186/s13006-019-0248-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Initiation of breastfeeding immediately after birth, exclusive breastfeeding, and continuous breastfeeding for at least 2 years lower the risk of newborn deaths. This study was conducted to examine the trends and factors associated with early initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding in Ethiopia. METHODS Data for this study were extracted from the Ethiopian Demographic and Health Survey 2016. A total of 5122 children were included in the analysis. Multivariate logistic regression analysis, and Cox proportional hazards model were fitted to find the factors associated with breastfeeding practices. Reported p - values < 0.05 or a 95% Confidence Interval of Odds Ratio/Hazard Ratio excluding one was considered as significant association with early initiation of breastfeeding, exclusive breastfeeding, duration of breastfeeding and independent variables. RESULTS About 81.8% of the children initiated breastfeeding within 1 h of birth and during the day before an interview, 47% were exclusively breastfed during the first 6 months. The median duration of breastfeeding was 22 months (22 ± 0.50 months 95% Confidence Interval [CI] 21.01-22.99). Rural residents (Odds Ratio [OR] 0.71, 95% CI 0.51, 0.99), mothers with no antenatal follow up (OR 0.75, 95% CI 0.57, 0.99), caesarean birth (OR 0.80, 95% CI 0.66, 0.96) and home delivery were associated with low initiation of breastfeeding within 1 h of birth. Mothers with no/primary education (OR 0.62, 95% CI 0.40, 0.96), no baby postnatal checkup (OR 0.53, 95% CI 0.39, 0.73), average/larger size of a child at birth (OR 0.80, 95% CI 0.65, 0.99) and deliveries outside of health centers were significantly associated with non-exclusive breastfeeding at the time of the interview. Further, mothers living in Amhara (Hazard Ratio [HR] 1.31, 95% CI 1.05, 1.64), Oromia (HR 1.27, 95% CI 1.04, 1.54), and Benishangul-Gumuz (HR 1.34, 95% CI 1.09, 1.65) regions had a longer duration of breastfeeding while Muslims, employed mothers, multiple births and poor economic level of households were associated with shorter durations of breastfeeding. CONCLUSIONS Rural residence, female sex, home delivery, caesarean birth, small birthweight baby and large family size were associated with late initiation of breastfeeding. Living in Affar, Somali, and Harari, primary education level of mothers, giving birth outside of health facilities, no antenatal care follow up, and no postnatal check-up were associated with non-exclusive breastfeeding, while younger age mothers, Muslims, giving birth outside of health facilities, and employed mothers were associated with shorter time to cessation of breastfeeding. Providing health education and counseling for mothers during and after pregnancy should be encouraged.
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Determinants of Early Initiation of Breastfeeding among Mothers of Children Aged Less than 24 Months in Northwestern Romania. Nutrients 2019; 11:nu11122988. [PMID: 31817702 PMCID: PMC6950271 DOI: 10.3390/nu11122988] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 12/30/2022] Open
Abstract
Early initiation of breastfeeding (EIBF), defined as putting newborns to the breast within 1 h of birth, may have important benefits for both infant and mother. The aim of this study was to assess EIBF practices and its determinants in northwestern Romania. This cross-sectional study was conducted from March to June 2019, based on a sample of 1399 mothers of children aged less than 24 months. The sample was recruited from the community, from 29 cities and 41 communes distributed across the six counties of the northwestern region of Romania. Mothers responded by face-to-face interviews to a structured questionnaire. Multivariate logistic regression was used to identify factors independently associated with EIBF. Only 24.3% of the mothers initiated breastfeeding within 1 h of birth. Delivering at a private hospital (adjusted odds ratio (AOR): 5.17, 95% confidence interval (CI) 3.87, 6.91), vaginal delivery (AOR: 4.39, 95% CI 3.29, 5.88), mother–newborn skin-to-skin contact for 1 h or more (AOR: 55.6, 95% CI 23.0, 134.2), and breastfeeding counseling during antenatal visits (AOR: 1.48, 95% CI 1.12, 1.97) were factors associated with increased likelihood of EIBF. Overall, the practice of EIBF was poor. Targeting modifiable factors associated with EIBF may be used to improve early initiation practice.
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Ezeh OK, Ogbo FA, Stevens GJ, Tannous WK, Uchechukwu OL, Ghimire PR, Agho KE. Factors Associated with the Early Initiation of Breastfeeding in Economic Community of West African States (ECOWAS). Nutrients 2019; 11:nu11112765. [PMID: 31739498 PMCID: PMC6893771 DOI: 10.3390/nu11112765] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Osita Kingsley Ezeh
- School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 1797, Australia; (O.K.E.); (P.R.G.)
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia;
| | - Garry John Stevens
- Humanitarian and Development Research Initiative (HADRI), School of Social Sciences and Psychology, Western Sydney University, Locked Bag1797, Penrith, NSW 2751, Australia;
| | - Wadad Kathy Tannous
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia;
| | - Osuagwu Levi Uchechukwu
- Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW 2560, Australia;
| | - Pramesh Raj Ghimire
- School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 1797, Australia; (O.K.E.); (P.R.G.)
| | - Kingsley Emwinyore Agho
- School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 1797, Australia; (O.K.E.); (P.R.G.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia;
- Correspondence: ; Tel.: +612-46203635
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Abebe L, Aman M, Asfaw S, Gebreyesus H, Teweldemedhin M, Mamo A. Formula-feeding practice and associated factors among urban and rural mothers with infants 0-6 months of age: a comparative study in Jimma zone Western Ethiopia. BMC Pediatr 2019; 19:408. [PMID: 31684900 PMCID: PMC6827217 DOI: 10.1186/s12887-019-1789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants are in a state of rapid development and maturation; the growth rate is most rapid during the first 4 to 6 months of life. Few studies indicated that in developing countries including Ethiopia the prevalence and duration of breastfeeding is declining and being replaced by formula milk. Therefore, this study aimed to assess the formula-feeding practice and its associated factors among urban and rural mothers with infants 0-6 months of age in the Jimma Zone, Western Ethiopia. METHODS A community-based cross-sectional study was conducted from November 7, 2015, to January 10, 2016, in the Jimma Zone. The quantitative data were collected from a sample of 714 respondents using a multistage sampling technique. Data were collected through a structured questionnaire and the multivariate logistic regression model was used to show predictors of the formula-feeding practice among mothers with infants 0-6 months of age. RESULT The proportion of mothers who feed their baby formula-based was 47.2%, of which 34.5% were living in rural areas and 65.5% were living in urban areas. Among the mothers living in urban areas, the likelihood of formula-feeding was significantly associated with maternal educational status and attitude towards formula-feeding. On the other hand, being attended by relatives/friends and the traditional birth attendant was significantly associated with the formula-feeding practice among mothers who live in rural areas. CONCLUSION Nearly half of the mothers in the study area practice formula-feeding for their infant. Therefore, sustained community based nutritional health education is recommended for pregnant and lactating mothers to reduce the practice of formula-feeding for infants.
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Affiliation(s)
- Lakew Abebe
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Mamusha Aman
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Shifera Asfaw
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Sciences, Aksum University, P.O. Box 298, Aksum, Ethiopia
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Science, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Abebe Mamo
- Departments of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
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Raihana S, Dibley MJ, Rahman MM, Tahsina T, Siddique MAB, Rahman QS, Islam S, Alam A, Kelly PJ, Arifeen SE, Huda TM. Early initiation of breastfeeding and severe illness in the early newborn period: An observational study in rural Bangladesh. PLoS Med 2019; 16:e1002904. [PMID: 31469827 PMCID: PMC6716628 DOI: 10.1371/journal.pmed.1002904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In Bangladesh, neonatal sepsis is the cause of 24% of neonatal deaths, over 65% of which occur in the early-newborn stage (0-6 days). Only 50% of newborns in Bangladesh initiated breastfeeding within 1 hour of birth. The mechanism by which early initiation of breastfeeding reduces neonatal deaths is unclear, although the most likely pathway is by decreasing severe illnesses leading to sepsis. This study explores the effect of breastfeeding initiation time on early newborn danger signs and severe illness. METHODS AND FINDINGS We used data from a community-based trial in Bangladesh in which we enrolled pregnant women from 2013 through 2015 covering 30,646 newborns. Severe illness was defined using newborn danger signs reported by The Young Infants Clinical Science Study Group. We categorized the timing of initiation as within 1 hour, 1 to 24 hours, 24 to 48 hours, ≥48 hours of birth, and never breastfed. The analysis includes descriptive statistics, risk attribution, and multivariable mixed-effects logistic regression while adjusting for the clustering effects of the trial design, and maternal/infant characteristics. In total, 29,873 live births had information on breastfeeding among whom 19,914 (66.7%) initiated within 1 hour of birth, and 4,437 (14.8%) neonates had a severe illness by the seventh day after birth. The mean time to initiation was 3.8 hours (SD 16.6 hours). The proportion of children with severe illness increased as the delay in initiation increased from 1 hour (12.0%), 24 hours (15.7%), 48 hours (27.7%), and more than 48 hours (36.7%) after birth. These observations would correspond to a possible reduction by 15.9% (95% CI 13.2-25.9, p < 0.001) of severe illness in a real world population in which all newborns had breastfeeding initiated within 1 hour of birth. Children who initiated after 48 hours (odds ratio [OR] 4.13, 95% CI 3.48-4.89, p < 0.001) and children who never initiated (OR 4.77, 95% CI 3.52-6.47, p < 0.001) had the highest odds of having severe illness. The main limitation of this study is the potential for misclassification because of using mothers' report of newborn danger signs. There could be a potential for recall bias for mothers of newborns who died after being born alive. CONCLUSIONS Breastfeeding initiation within the first hour of birth is significantly associated with severe illness in the early newborn period. Interventions to promote early breastfeeding initiation should be tailored for populations in which newborns are delivered at home by unskilled attendants, the rate of low birth weight (LBW) is high, and postnatal care is limited. TRIAL REGISTRATION Trial Registration number: anzctr.org.au ID ACTRN12612000588897.
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Affiliation(s)
- Shahreen Raihana
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, New South Wales, Australia
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Michael J. Dibley
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, New South Wales, Australia
| | - Mohammad Masudur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Health Promotion, Education, & Behavior, Norman J Arnold School of Public Health, University of South Carolina, Columbia, United States of America
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadequr Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sajia Islam
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Alam
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, New South Wales, Australia
| | - Patrick J. Kelly
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, New South Wales, Australia
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanvir M Huda
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, New South Wales, Australia
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Senanayake P, O'Connor E, Ogbo FA. National and rural-urban prevalence and determinants of early initiation of breastfeeding in India. BMC Public Health 2019; 19:896. [PMID: 31286907 PMCID: PMC6615079 DOI: 10.1186/s12889-019-7246-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF) reduces the risk of neonatal mortality. Previous studies from India have documented some factors associated with EIBF. However, those studies used data with limited sample size that potentially affect the application of the evidence. Additionally, the effectiveness of national breastfeeding programmes requires up-to-date analysis of new and robust EIBF data. The present study aimed to investigate the prevalence and determinants of EIBF in India and determine to what extent these factors differ by a mother's residence in the rural or urban area. METHODS This study used information from a total weighted sample of 94,401 mothers from the 2015-2016 India National Family Health Survey. Multivariate logistic regression was used to investigate the association between the study factors and EIBF in India and rural-urban populations, after adjusting for confounders and sampling weight. RESULTS Our analysis indicated that 41.5% (95% confidence interval (CI): 40.9-42.5, P < 0.001) of Indian mothers initiated breastfeeding within 1-h post-birth, with similar but significant different proportions estimated for those who resided in rural (41.0, 95% CI: 40.3-41.6, P < 0.001) and urban (42.9, 95% CI: 41.7-44.2, P < 0.001) areas. Mothers who had frequent health service contacts and those with higher educational attainment reported higher EIBF practice. Multivariate analyses revealed that higher educational achievement, frequent antenatal care visits and birthing in a health facility were associated with EIBF in India and rural populations (only health facility birthing for urban mothers). Similarly, residing in the North-Eastern, Southern, Eastern and Western regions were also associated with EIBF. Birthing through caesarean, receiving delivery assistance from non-health professionals and residing in rural areas of the Central region were associated with delayed EIBF in all populations. CONCLUSION We estimated that more than half of Indian mothers delayed breastfeeding initiation, with different rural-urban prevalence. Key modifiable factors (higher maternal education and frequent health service contacts) were associated with EIBF in India, with notable difference in rural-urban populations. Our study suggests that targeted and well-coordinated infant feeding policies and interventions will improve EIBF for all Indian mothers.
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Affiliation(s)
- Praween Senanayake
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Elizabeth O'Connor
- Medical Education Unit, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia. .,Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State, Nigeria.
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Bhandari S, Thorne-Lyman AL, Shrestha B, Neupane S, Nonyane BAS, Manohar S, Klemm RDW, West KP. Determinants of infant breastfeeding practices in Nepal: a national study. Int Breastfeed J 2019; 14:14. [PMID: 30988689 PMCID: PMC6448244 DOI: 10.1186/s13006-019-0208-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development. Methods We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering. Results The prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains. Conclusions Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy. Electronic supplementary material The online version of this article (10.1186/s13006-019-0208-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiva Bhandari
- PoSHAN Study Team, Lalitpur, Nepal.,2Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Andrew L Thorne-Lyman
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | - Bareng Aletta Sanny Nonyane
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Swetha Manohar
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Rolf D W Klemm
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.,4Helen Keller International, New York, NY USA
| | - Keith P West
- 3Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Ayalew T, Tewabe T, Ayalew Y. Timely initiation of breastfeeding among first time mothers in Bahir Dar city, North West, Ethiopia, 2016. Pediatr Res 2019; 85:612-616. [PMID: 30661083 DOI: 10.1038/s41390-019-0299-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Timely initiation of breastfeeding is one important intervention to prevent childhood morbidities and mortalities. Globally, not more than 35 and 39% in developing countries, 52% in Ethiopia and 38% in Amhara region were initiated with breastfeeding early. METHODS A community based cross-sectional study was conducted from 20 March to April, 2016. A total of 423 mothers who have infants less than 6 month old were included in this study. The data were collected using interviewer administered questionnaire. Binary logistic regression analysis were used to identify factors associated with timely initiation of breastfeeding. RESULTS Prevalence of timely initiation of breastfeeding was 65%. Being male [AOR 2.148 (1.232, 3.745)], breastfeeding counseling [AOR 2.163 (1.187, 3.942)], place of delivery [AOR 8.639 (2.089, 5.720)], normal labor [AOR 4.094 (1.414, 8.728], and religious father support [AOR 1.962 (1.113, 3.458)] were determinants for timely initiation of breastfeeding. CONCLUSIONS Timely initiation of breastfeeding in the study area was 65%. Sex of infant, breastfeeding counseling, birth place, mode of delivery, and religious father support were predictors of timely initiation of breastfeeding. Strengthening timely initiation of breastfeeding through provision of antenatal care services, educating mothers and strengthening health professionals knowledge, and skills on breastfeeding counseling were recommended.
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Affiliation(s)
- Tilksew Ayalew
- Lecturer, Department of nursing, Bahir Dar University, College of Medicine and Health science, Bahir Dar, Ethiopia
| | - Tilahun Tewabe
- Lecturer, college of medicine and health sciences, Bahir Dar University, College of Medicine and Health science, Bahir Dar, Ethiopia.
| | - Yohannis Ayalew
- Lecturer, Department of public health, Addis Ababa University College of Health Sciences School of Allied Health Sciences, Addis Ababa, Ethiopia
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Analinta A. HUBUNGAN ANTARA PEMBERIAN ASI EKSKLUSIF DENGAN KEJADIAN DIARE PADA BALITA DI KELURAHAN AMPEL, KECAMATAN SEMAMPIR, KOTA SURABAYA 2017. AMERTA NUTRITION 2019. [DOI: 10.20473/amnt.v3i1.2019.13-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Diarrhea is an endemic disease in Indonesia and often cause death. In 2015 there were eighteen times the outbreak of diarrhea spread in eleven provinces, eighteen districts / cities, with the number one patient. 213 people and 30 deaths (CFR 2.47%). According to Surabaya City Health Office, there were 65.447 cases of diarrhea in 2015, in other words there were 23 cases of diarrhea in 1000 population. Objectives: This study aimed to analyze the relationship between exclusive breastfeeding and diarrhea in RW XIII and RW XIV Kelurahan Ampel, Subdistrict Semampir, City of Surabaya in 2017. Methods: This was observational analytics study with cross sectional design. The population in this research were all the children under five in the area in RW XIII and RW XIV in Kelurahan Ampel. Sampling technique used was simple random sampling involving 39 respondents. Primary data were collected by interview with questionnaire, Focus Group Discussion (FGD). Data were analyzed statistically using Fisher’s Exact Test. Results: The result of this this study, there was relationship between exclusive breastfeeding and diarrhea (p=0.000). Conclusion: There was a significant relationship between exclusive breastfeeding and diarrhea.ABSTRAKLatar Belakang: Diare adalah penyakit endemis di Indonesia dan sering menyebabkan kematian. Pada tahun 2015 terjadi delapan belas kali kejadian luar biasa diare yang tersebar di sebelas provinsi, delapan belas kabupaten/kota, dengan jumlah penderita satu. 213 orang dan kematian 30 orang (CFR 2,47%). Menurut Dinas Kesehatan Kota Surabaya, pada tahun 2015 terdapat 65.447 kasus diare, dengan kata lain terdapat 23 kasus diare pada 1000 penduduk. Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan asi eksklusif dengan diare pada balita di RW XIII dan RW XIV Kelurahan Ampel, Kecamatan Semampir, Kota Surabaya 2017.Metode: Jenis penelitian adalah analitik observasional dengan desain cross sectional. Populasi pada penelitian ini yaitu seluruh balita yang berada di wilayah di RW XIII dan RW XIV di Kelurahan Ampel. Teknik pengambilan data menggunakan simple random sampling didapatkan 39 responden. Data Primer dikumpulkan dengan wawancara dengan kuesioner, Focus Group Discussion (FGD). Analisis data menggunakan uji statistik Fisher’s Exact.Hasil: Hasil penelitian menunjukkan pemberian ASI eksklusif memiliki hubungan dengan kejadian diare (p=0,000).Kesimpulan: Terdapat hubungan yang bermakna antara pemberian ASI Eksklusif dengan kejadian diare.
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Rahman A, Akter F. Reasons for formula feeding among rural Bangladeshi mothers: A qualitative exploration. PLoS One 2019; 14:e0211761. [PMID: 30807588 PMCID: PMC6391007 DOI: 10.1371/journal.pone.0211761] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Atiya Rahman
- Research and Evaluation Division (RED), BRAC, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Akter
- Research and Evaluation Division (RED), BRAC, Mohakhali, Dhaka, Bangladesh
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Maternal Education, Fertility, and Child Survival in Comoros. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122814. [PMID: 30544762 PMCID: PMC6313670 DOI: 10.3390/ijerph15122814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/21/2018] [Accepted: 12/08/2018] [Indexed: 12/05/2022]
Abstract
Reduction in child mortality is a demographic progress of significant socioeconomic development relevance in Africa. This paper analyzed the effect of maternal education and fertility on child survival in the Islands of Comoros. The 2012 Demographic and Health Survey (DHS) data were used. A two-stage probit regression method was used for data analysis. The results showed that about 75% of the children’s mothers had given birth to between one and five children, while more than half did not have any form of formal education. The results of the two-stage probit regression showed that while child survival reduced significantly (p < 0.05) with the age of the heads of households, residence in the Ngazidja region, being born as twins, mother’s number of business trips, and number of marital unions, it increased with maternal education, fertility, male household headship, and the child being breastfed immediately after birth. It was concluded that efforts to enhance maternal education would reduce child mortality. It is also critical to promote child breastfeeding among women, while regional characteristics promoting differences in child mortality in Comoros Islands should be properly addressed with keen focus on the Ngazidja region.
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Thet MM, Aung T, Diamond-Smith N, Sudhinaraset M. The influence of a community-level breast-feeding promotion intervention programme on breast-feeding practices in Myanmar. Public Health Nutr 2018; 21:3091-3100. [PMID: 30109844 PMCID: PMC10260781 DOI: 10.1017/s1368980018001799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Breast-feeding in the first 6 months of life is critical for ensuring both child health and well-being. Despite efforts to improve breast-feeding practices, recent studies have reported that Myanmar continues to have low rates of exclusive breast-feeding.Design/Setting/SubjectsA community-based breast-feeding promotion programme using trained community members was implemented for 1 year in hard-to-reach townships of Myanmar. The present study assessed the breast-feeding practices using a cross-sectional survey of 610 mothers of children under 2 years old: specifically, breast-feeding within 24 h, exclusive breast-feeding up to 6 months and breast-feeding duration. RESULTS Using Cox models for breast-feeding duration before 24 months, the hazard of breast-feeding cessation was lower in programme v. non-programme townships (hazard ratio (HR)=0·55; 95 % CI 0·32, 0·95). Mothers who worked as shop owners or ran a family business had lower hazard of breast-feeding cessation (HR=0·13, P<0·05) v. those who worked as supervisors, managers, self-employed and businesswomen. The hazard of breast-feeding cessation was higher in women in higher wealth quintiles v. those in the lowest quintile (lower quintile, HR=3·49, P<0·1; higher quintile, HR=3·50, P<0·1; highest quintile, HR=3·47, P<0·1). CONCLUSIONS The intervention did not affect exclusive breast-feeding practices or breast-feeding within the first 24 h. Potential reasons include existing high levels of early initiation of breast-feeding due to ongoing government-led maternal and child health activities, and social and traditional practices related to complementary feeding. Community-based breast-feeding programmes should continue to promote exclusive breast-feeding and develop strategies to support working mothers.
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Affiliation(s)
- May Me Thet
- Strategic Information Department, Population Services International Myanmar, No. 16 Shwe Gone Taing Street 4, Yangon, Myanmar
| | - Tin Aung
- Strategic Information Department, Population Services International Myanmar, No. 16 Shwe Gone Taing Street 4, Yangon, Myanmar
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California–San Francisco, San Francisco, CA, USA
| | - May Sudhinaraset
- Community Health Sciences, University of California–Los Angeles, Los Angeles, CA, USA
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Takele WW, Tariku A, Wagnew F, Ekubagewargies DT, Getinet W, Derseh L, Anlay DZ. Magnitude of prelacteal feeding practice and its association with place of birth in Ethiopia: a systematic review and meta-analysis, 2017. Arch Public Health 2018; 76:63. [PMID: 30377528 PMCID: PMC6196449 DOI: 10.1186/s13690-018-0308-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prelacteal feeding is one of the commonest inappropriate child feeding practice which exposes to malnutrition, infection, and neonatal mortality. However, there is no systematic review and meta-analysis that estimates the pooled prevalence of prelacteal feeding and its association with place of birth in Ethiopia. Therefore, this study aimed at investigating the magnitude of prelacteal feeding practice and its association with home delivery in the country. METHODS Primary studies were accessed through, HINARI and PubMed databases. Additionally, electronics search engines such as Google Scholar, and Google were used. The Joana Briggs Institute quality appraisal checklist was used to appraise the quality of studies. Data were extracted using Microsoft Excel spreadsheet. Heterogeneity between the studies was examined using the I2 heterogeneity test. The DerSimonian and Liard random-effect model was used. The random effects were pooled after conducting subgroup and sensitivity analyses. Publication bias was also checked. RESULTS A total of 780 primary studies were accessed. However, about 24 studies were included in the qualitative description and quantitative analysis of the prevalence of prelacteal feeding. To examine the association between home delivery and prelacteal feeding practice, only six studies were included. The prevalence of prelacteal feeding ranged from 6.1-75.8%. The pooled prevalence of prelacteal feeding among Ethiopian children was 26.95% (95% CI: 17.76%, 36.14%). The highest prevalence was observed in the Afar region. The pooled odds of prelacteal feeding among women who gave birth at home was increased by 5.16 (95% CI: 3.7, 7.2) folds as compared to those who gave birth at Health institutions. CONCLUSION Prelacteal feeding practice in Ethiopia was found to be high. Home delivery was strongly associated with prelacteal feeding practice. Therefore, promoting institutional delivery and strengthening of the existing child nutrition strategies are recommended.
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Affiliation(s)
- Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Daniale Tekelia Ekubagewargies
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondale Getinet
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lema Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degefaye Zelalem Anlay
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dudeja S, Sikka P, Jain K, Suri V, Kumar P. Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1376-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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