Prelacteal infant feeding practices in rural Egypt

How do high ambient temperatures affect infant feeding practices? A prospective cohort study of postpartum women in Bobo-Dioulasso, Burkina Faso

OBJECTIVE

To examine the effects of high ambient temperature on infant feeding practices and childcare.

DESIGN

Secondary analysis of quantitative data from a prospective cohort study.

SETTING

Community-based interviews in the commune of Bobo-Dioulasso, Burkina Faso. Exclusive breastfeeding is not widely practised in Burkina Faso.

PARTICIPANTS

866 women (1:1 urban:rural) were interviewed over 12 months. Participants were interviewed at three time points: cohort entry (when between 20 weeks' gestation and 22 weeks' postpartum), three and nine months thereafter. Retention at nine-month follow-up was 90%. Our secondary analysis focused on postpartum women (n=857).

EXPOSURE

Daily mean temperature (°C) measured at one weather station in Bobo-Dioulasso. Meteorological data were obtained from publicly available archives (TuTiempo.net).

PRIMARY OUTCOME MEASURES

Self-reported time spent breastfeeding (minutes/day), exclusive breastfeeding of infants under 6 months (no fluids other than breast milk provided in past 24 hours), supplementary feeding of infants aged 6-12 months (any fluid other than breast milk provided in past 24 hours), time spent caring for children (minutes/day).

RESULTS

The population experienced year-round high temperatures (daily mean temperature range=22.6°C-33.7°C). Breastfeeding decreased by 2.3 minutes/day (95% CI -4.6 to 0.04, p=0.05), and childcare increased by 0.6 minutes/day (0.06 to 1.2, p=0.03), per 1°C increase in same-day mean temperature. Temperature interacted with infant age to affect breastfeeding duration (p=0.02), with a stronger (negative) association between temperature and breastfeeding as infants aged (0-57 weeks). Odds of exclusive breastfeeding very young infants (0-3 months) tended to decrease as temperature increased (OR=0.88, 0.75 to 1.02, p=0.09). There was no association between temperature and exclusive breastfeeding at 3-6 months or supplementary feeding (6-12 months).

CONCLUSIONS

Women spent considerably less time breastfeeding (~25 minutes/day) during the hottest, compared with coolest, times of the year. Climate change adaptation plans for health should include advice to breastfeeding mothers during periods of high temperature.

A systematic review of hot weather impacts on infant feeding practices in low-and middle-income countries

BACKGROUND

Increased rates of exclusive breastfeeding could significantly improve infant survival in low- and middle-income countries. There is a concern that increased hot weather due to climate change may increase rates of supplemental feeding due to infants requiring fluids, or the perception that infants are dehydrated.

OBJECTIVE

To understand how hot weather conditions may impact infant feeding practices by identifying and appraising evidence that exclusively breastfed infants can maintain hydration levels under hot weather conditions, and by examining available literature on infant feeding practices in hot weather.

METHODS

Systematic review of published studies that met inclusion criteria in MEDLINE, EMBASE, Global Health and Web of Science databases. The quality of included studies was appraised against predetermined criteria and relevant data extracted to produce a narrative synthesis of results.

RESULTS

Eighteen studies were identified. There is no evidence among studies of infant hydration that infants under the age of 6months require supplementary food or fluids in hot weather conditions. In some settings, healthcare providers and relatives continue to advise water supplementation in hot weather or during the warm seasons. Cultural practices, socio-economic status, and other locally specific factors also affect infant feeding practices and may be affected by weather and seasonal changes themselves.

CONCLUSION

Interventions to discourage water/other fluid supplementation in breastfeeding infants below 6 months are needed, especially in low-middle income countries. Families and healthcare providers should be advised that exclusive breastfeeding (EBF) is recommended even in hot conditions.

Breastfeeding Insufficiencies: Common and Preventable Harm to Neonates

Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread. Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder. Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers' milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.

A mixed-methods systematic review on barriers to exclusive breastfeeding

INTRODUCTION

The World Health Organization recommends exclusive breastfeeding for every newborn during the first 6 months of life, yet women come across various challenges to continuing it.

AIM

This systematic review was intended to identify barriers to exclusive breastfeeding among mothers.

METHODS

MEDLINE, Cumulative Index to Nursing and Allied health literature, ProQuest, Web of Science and Scopus databases were searched from January 1990 to October 2017. The systematic review included quantitative, qualitative and mixed-methods studies to identify barriers to exclusive breastfeeding among mothers of reproductive age with an infant aged between 0 and 12 months. All studies were screened based on titles, abstracts and full text by two reviewers independently. The methodological quality of included studies was assessed using appropriate tools. Of the 9737 eligible records, 44 studies were included for analysis. Classification of barriers to exclusive breastfeeding was adopted from the conceptual framework of factors affecting breastfeeding practices given by Hector and colleagues.

RESULTS

In total 32 barriers were grouped under individual, group and society level factors. Meta-analysis indicated that mothers who smoked had 2.49 times more odds of not exclusively breastfeeding than non-smoking mothers and mothers who had undergone caesarean section had 1.69 times more risk of cessation of exclusive breastfeeding than mothers who have had a vaginal childbirth.

CONCLUSION

The systematic review revealed a complex interplay of various barriers related to exclusive breastfeeding. It is recommended that context-specific strategies should be designed in accordance with barriers existing in a region or country.

Prelacteal feeding and associated factors in Ethiopia: systematic review and meta-analysis

Background

Prelacteal feeding can be defined as giving any solid or liquid foods other than breast milk during the first three days after birth. It affects timely initiation of breastfeeding and exclusive breastfeeding practices. Even though the issue was investigated in Ethiopia, fragmented and inconsistent findings were reported. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of prelacteal feeding and associated factors in Ethiopia.

Methods

The preferred reporting items for systematic reviews and meta-analyses guideline was followed. Articles were systematically searched through different searching mechanisms. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment of each individual study. The total of 28 studies were included and analyzed. The random effect model was used to estimate the pooled prevalence; subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. Both Egger’s, and Begg’s test were used to check publication bias. The effects between associated factor variables, and prelacteal feeding practices were tested.

Results

A total of 492 studies were retrieved and 28 studies were included in the meta-analysis. The pooled prevalence of prelacteal feeding practice in Ethiopia was 25.29% (95% Confidence Interval [CI] 17.43, 33.15) with severe heterogeneity (I² = 99.7, p < 0.001) and no publication bias. Antenatal care (Odds Ratio [OR] 0.25, 95% CI 0.09, 0.69), counselling on infant feeding (OR 0.37, 95% CI 0.22, 0.63), timely initiation of breastfeeding (OR 0.28, 95% CI 0.21, 0.38) and an urban residence (OR 0.47, 95% CI 0.26, 0.86) had lower odds, while home birth had higher odds (OR 3.93, 95% CI 2.17, 7.10) of prelacteal feeding in Ethiopia.

Conclusions

In Ethiopia, one in four children were given prelacteal foods. Mothers who gave birth at home are more prone to give prelacteal foods. Whereas, antenatal care, timely initiation of breastfeeding, counseling on infant feeding and an urban residence decreases prelacteal feeding practices in Ethiopia. Therefore, the government and health institutions should focus to increase maternal health service utilization and promote infant and young child feeding practices according to the guideline.

Magnitude of prelacteal feeding practice and its association with place of birth in Ethiopia: a systematic review and meta-analysis, 2017

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.

Does postnatal care have a role in improving newborn feeding? A study in 15 sub-Saharan African countries

Background

Breastfeeding is known as a key intervention to improve newborn health and survival while prelacteal feeds (liquids other than breastmilk within 3 days of birth) represents a departure from optimal feeding practices. Recent programmatic guidelines from the WHO and UNICEF outline the need to improve newborn feeding and points to postnatal care (PNC) as a potential mechanism to do so. This study examines if PNC and type of PNC provider are associated with key newborn feeding practices: breastfeeding within 1 day and prelacteal feeds.

Methods

We use data from the Demographic and Health Surveys for 15 sub-Saharan African countries to estimate 4 separate pooled, multilevel, logistic regression models to predict the newborn feeding outcomes.

Findings

PNC is significantly associated with increased breastfeeding within 1day (OR = 1.35, P < 0.001) but is not associated with PLFs (OR = 1.04, P = 0.195). PNC provided by nurses, midwives and untrained health workers is also associated with higher odds of breastfeeding within 1 day of birth (OR = 1.39, P < 0.001, (OR = 1.95, P < 0.001) while PNC provided by untrained health workers is associated with increased odds of PLFs (OR = 1.20, P = 0.017).

Conclusions

PNC delivered through customary care may be an effective strategy to improve the breastfeeding within 1 day but not to discourage PLFs. Further analysis should be done to examine how these variables operate at the country level to produce finer programmatic insight.

Early newborn ritual foods correlate with delayed breastfeeding initiation in rural Bangladesh

Background

Early and exclusive breastfeeding may improve neonatal survival in low resource settings, but suboptimal breastfeeding still exists in areas with high infant mortality. Prelacteal feeding, the practice of giving a non-breastmilk food as a neonate’s first food, has been associated with suboptimal breastfeeding practices. We examined the association of feeding a non-breastmilk food in the first three days of life (early neonatal food, or ENF) with time from birth to initiation of breastfeeding among 25,286 Bangladeshi mother-neonate pairs, in a secondary analysis of a randomized controlled trial in northwestern rural Bangladesh conducted from 2001–2007.

Methods

Trained interviewers assessed the demographic characteristics during pregnancy. At three months postpartum, the interviewers visited participants again and retrospectively assessed demographic and breastfeeding characteristics surrounding the birth. We assessed the relationship between ENF and time to initiation of breastfeeding in hours in both unadjusted and adjusted linear regression analyses. We also calculated reverse cumulative distribution curves for time to initiation of breastfeeding and analyses were stratified by an infant’s ability to breastfeed normally at birth.

Results

The mean ± SD time from birth to initiation of breastfeeding was 30.6 ± 27.9 hours. Only 2,535 (10.0%) of women reported initiating breastfeeding in the first hour after birth and 10,207 (40.4%) reported initiating breastfeeding in the first 12 hours after birth. In adjusted linear regression analyses, feeding ENF was associated with a significant increase in time, in hours, to breastfeeding initiation both among children not able to breastfeed at birth (37.4; 95% CI 33.3, 41.5) and among children able to breastfeed at birth (13.3; 95% CI 12.7, 14.0).

Conclusions

Feeding ENF was strongly associated with delayed initiation of breastfeeding, even after adjusting for other related factors and stratifying on the neonate’s ability to suckle normally after birth. More research is needed to understand the impact of these findings on optimal breastfeeding in this setting. It is possible that ENF feeding and the ability to breastfeed immediately after birth are interrelated in their respective associations to suboptimal breastfeeding initiation. This study in a large population representative of other populations in rural South Asia, demonstrates significantly longer times to breastfeeding initiation than previously appreciated, with a possible important role of ENF feeding.

Trial registration

The randomized controlled trial on which this analysis is based, “Impact of Maternal Vitamin A or Beta-Carotene Supplementation on Maternal and Infant Mortality in Bangladesh”, was registered with ClinicalTrials.gov as trial number ID GHS-A-00-03-00019-00 and identifier NCT00198822. The identifier was first received September 12, 2005 (retrospectively registered). The first participant was enrolled in August 2001.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0090-9) contains supplementary material, which is available to authorized users.

Trends and Predictors of Prelacteal Feeding Practices in Nigeria (2003-2013)

Prelacteal feeding practices are associated with an increased risk of diarrhoea and many early-life diseases. This paper examined trends and predictors of prelacteal feeding practices in Nigeria. A sample of 6416 infants aged 0–6 months from the Nigeria Demographic and Health Survey data for the period (2003–2013) was used. Trends and multilevel logistic regression analyses were used to determine the predictors. The trends of prelacteal feeding rates fluctuated between 55% and 66% over the study period and were significantly lower among mothers with secondary or higher levels of education (13.1%, 95% confidence interval (CI): 0.54–25.9, p-value = 0.041), delivered at the health facility (13.7%, CI: 1.39–25.9, p-value = 0.029), from more affluent households (18.7%, CI: 1.53–35.9, p-value = 0.033), and lived in urban areas (26.9%, CI: 18.3–35.5, p-value < 0.001). Multivariable analyses revealed that mothers with no schooling, younger mothers (aged 15–24 years), mothers who delivered at home, and delivered by caesarean section were more likely to introduce prelacteal feeds. Many mothers still engage in prelacteal feeding practices in Nigeria, with prelacteal feeding more prevalent in young mothers, mothers with no schooling, and mothers who delivered at home. Interventions involving community health volunteers are needed to improve feeding practices in Nigeria.

Promotion and prelacteal feeding of breastmilk substitutes among mothers in Kathmandu Valley, Nepal

In 1992, Nepal passed the Mother's Milk Substitutes (Control of Sale and Distribution) Act in order to regulate the sale, distribution and promotion of substitutes for breastmilk within Nepal, in an effort to protect and promote breastfeeding. Helen Keller International, in collaboration with Nepal's Ministry of Health and Population's Child Health Division, implemented a study to assess mothers' exposure to promotions for and utilization of breastmilk substitutes in Kathmandu Valley, Nepal. A health facility-based, cross-sectional survey was conducted among 304 mothers being discharged after delivery. Prelacteal feeding of breastmilk substitutes is prevalent (55.9% of mothers, n = 170). Reported recommendations during antenatal checks and after delivery from health professionals to use breastmilk substitutes were prevalent, occurring among 47.4% (n = 144) of mothers; rates of these recommendations were significantly higher for mothers that delivered in private health facilities, as compared with public (67.7% vs. 38.0%, P < 0.001). Mothers that received a recommendation to use a breastmilk substitute from a health worker were 16.7 times more likely to provide a prelacteal feed of a breastmilk substitute, as compared with mothers that did not receive a recommendation (P < 0.001). Few mothers reported observation of commercial advertisements for breastmilk substitutes inside a health facility (reported by 3.6% of mothers). No mothers reported receiving a sample of a breastmilk substitute, bottle or teat from a health professional. More information is needed to determine why there is such a high rate of health worker recommendations for breastmilk substitute use in the first few days after delivery.

KEY MESSAGES

While utilization of breastmilk substitutes is low among mothers of young children in Nepal, prelacteal feeding of breastmilk substitutes is highly prevalent in Kathmandu Valley. Reported recommendations from health professionals to use breastmilk substitutes are common (over 40%) and are associated with prelacteal feeding among Nepal mothers included in this study. Provision of lactation management training to health workers and monitoring their practices regularly could strengthen breastfeeding counselling, aid in reducing high rates of prelacteal feeding and contribute to improved infant feeding practices.

Father's involvement and its effect on early breastfeeding practices in Viet Nam

Fathers have an important but often neglected role in the promotion of healthy breastfeeding practices in developing countries. A community-based education intervention was designed to mobilize fathers' support for early breastfeeding. This study aimed to evaluate an education intervention targeting fathers to increase the proportion of early breastfeeding initiation and to reduce prelacteal feeding. Quasi-experimental study design was used to compare intervention and control areas located in two non-adjacent rural districts that shared similar demographic and health service characteristics in northern Viet Nam. Fathers and expectant fathers with pregnant wives from 7 to 30 weeks gestational age were recruited. Fathers in the intervention area received breastfeeding education materials, counselling services at a commune health centre and household visits. They were also invited to participate in a breastfeeding promotion social event. After intervention, early breastfeeding initiation rate was 81.2% in the intervention area and 39.6% in the control area (P < 0.001). Babies in the intervention area were more likely to be breastfed within the first hour after birth [odds ratio (OR) 7.64, 95% confidence interval (CI) 4.81-12.12] and not to receive any prelacteal feeding (OR 4.43, 95% CI 2.88-6.82) compared with those in the control area. Fathers may positively influence the breastfeeding practices of mothers, and as a resource for early childcare, they can be mobilized in programmes aimed at improving the early initiation of breastfeeding.

Newborn first feed and prelacteal feeds in Mansoura, Egypt

BACKGROUND

Prelacteal feed (feeding any other substance before first breastfeeding) appears to be common despite its harmful effects. By definition a child provided with prelacteal feed (PLF) is not exclusively breastfed and PLF has many implications for the success and early initiation of breastfeeding. Objectives. To describe the prevalence of, nature of, and reasons for and factors associated with PLF.

METHODS

647 mother-infant dyads were studied. Data was collected about the sociodemographic features of the family and baby, maternity care, the type of first feed before suckling, and causes of PLF. Maternal weight and height were measured and body mass index was calculated.

RESULTS

About 58% of newborns received prelacteal feeds. The commonest PLF was sugar/glucose water (39.6%). The most frequent reasons for giving PLF are tradition (61.0%) and mother's/mother in law's advice (58.3%). The logistic regression revealed that the independent predictors of PLF are urban residence; maternal education; father's education; low, middle, and high social class; maternal obesity; receiving antenatal care at private clinics and no antenatal care; Caesarean section; female babies; low birth weight; and admission to neonatal intensive care.

CONCLUSION

Indiscriminate use of PLF should be discouraged in medical education and in antenatal maternal health education.

Prelacteal feeding practices in Vietnam: challenges and associated factors

BACKGROUND

Despite the importance of early initiation of and exclusive breastfeeding, prelacteal feeds continue to pose a barrier to optimal breastfeeding practices in several countries, including Vietnam. This study examined the factors associated with prelacteal feeding among Vietnamese mothers.

METHODS

Data from 6068 mother-child (<6 m) dyads were obtained from a cross-sectional survey conducted in 11 provinces in Vietnam in 2011. Multivariate logistic regression analyses were used to examine factors associated with prelacteal feeding.

RESULTS

During the first three days after birth, 73.3% of the newborns were fed prelacteals, 53.5% were fed infants formula, and 44.1% were fed water. The odds of feeding prelacteals declined with increased breastfeeding knowledge, beliefs about social norms in favor of exclusive breastfeeding, and confidence in one's own breastfeeding behaviors. Women who harbored misconceptions about breastfeeding had twice the odds of feeding any prelacteals (OR: 2.09, 95% CI: 1.74-2.50). Health care factors increasing the odds of prelacteal feeding included delivery by caesarean section (OR: 2.94, 95% CI: 2.39-3.61) or episiotomy (OR: 1.36, 95% CI: 1.17-1.58) and experiencing breastfeeding problems (OR: 1.31, 95% CI: 1.04-1.66). Health staff support during pregnancy and after birth reduced the odds of feeding formula. However, family support after delivery increased the odds of feeding water to newborns.

CONCLUSIONS

The multiple factors contributing to the high prevalence of prelacteal feeding behaviors stress the need for early and appropriate breastfeeding interventions in Vietnam, particularly during routine healthcare contacts. Improving breastfeeding practices during the first days of an infant's life could be achieved by improving knowledge and confidence of mothers through appropriate perinatal counseling and support. Ensuring that health facilities integrate these practices into routine ante-natal care and post-delivery management is critical.

Early neonatal feeding is common and associated with subsequent breastfeeding behavior in rural Bangladesh

Exclusive breastfeeding of newborns, a practice recommended by WHO, is hindered in many countries by practices such as prelacteal feeding (feeding other foods before breast milk is fed to infants). This paper describes maternal and infant characteristics and trends over time associated with early neonatal feeding (ENF) in Bangladesh. The analysis used data from 24,992 participants in a randomized controlled trial supplementing vitamin A and β-carotene to women in northwestern rural Bangladesh. A majority of newborns (89.2%) were fed substances other than breast milk in the first 3 d of life. Early neonatal feeding practices were found to be significantly associated with lower maternal education, higher gravidity, lower socioeconomic status, and younger maternal age. A perceived inability to suckle normally after birth was closely related to the risk of an infant being fed a food other than breast milk in the first 3 d of life [OR = 0.09 (95% CI: 0.08, 0.11)]. Only 18.8% of newborns fed an early neonatal food were exclusively breastfed between 3 d and 3 mo postpartum compared with 70.6% of those not fed an early neonatal food during this period (P < 0.05). Early neonatal feeding practices should be addressed when scaling-up exclusive breastfeeding in South Asia. Maternal education, antenatal care, and support during labor and delivery may help reduce ENF and promote exclusive breastfeeding.

Evaluation of mothers' knowledge, attitudes, and practice towards the ten steps to successful breastfeeding in Egypt

BACKGROUND

Despite the proven effectiveness of the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative (BFHI), its impact on community practices in Egypt has yet to be assessed. The aim of this investigation was to evaluate the knowledge, attitudes, and practice (KAP) of Egyptian mothers towards the Ten Steps. We interviewed 1,052 breastfeeding mothers with infants less than 24 months of age from 12 governorates representing Upper Egypt (UE) and Lower Egypt (LE).

RESULTS

Marked regional variations are noted in the KAP of the samples from UE and LE. These differences can be explained to some extent by socioeconomic factors. Hospital delivery, lower parity, and a higher level of education were characteristic of mothers in LE compared with UE. More mothers in UE did not know about the protective effects of breastfeeding to the mother. In LE, 75% delayed breastfeeding initiation until after the first hour compared with 61% in UE, with the mothers reporting that they did not experience skin-to-skin care in the first hours after birth. Nipple pain was given as a cause for supplementation in 56% of mothers in UE and 36% in LE (p<0.001). Maintaining milk by expression is practiced by 42.8% of mothers in LE and 12% in UE. Two-thirds of the mothers in both UE and LE offer herbal drinks, and one-third feed infant milk formula before 6 months. Offering pacifiers is more common in LE, and feeding by bottle is more common in UE, being pressured by the mother's social network.

CONCLUSIONS

To increase the impact of BFHI on community breastfeeding practices, BFHI should focus on involving the family members with the mother throughout the implementation of the Ten Steps while encouraging maternal support groups and taking cultural differences into account.

Determinants of breastfeeding initiation among mothers in Kuwait

BACKGROUND

Exclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding.

METHODS

A sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.

RESULTS

In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery.

CONCLUSIONS

The reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.

Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: the P-MaMiE Birth Cohort

Background

Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.

Methods

A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).

Results

The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.

Conclusion

There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.

Breastfeeding practices and health-seeking behavior for neonatal sickness in a rural community

The aim of the study was to evaluate the knowledge of mothers and grandmothers regarding breastfeeding and health-seeking behavior for neonatal sickness in a rural community. A cross-sectional survey, using a triangulation of qualitative (focus group discussion) and quantitative (structured questionnaire) methods was carried out. Although most of the grandmothers and mothers believed in early feeding within 2 h of delivery, they often administered prelacteal feeds such as ghutti and honey. Colostrum was considered beneficial. Most respondents believed that ghutti, water, or both should be given along with breastmilk. Diluted buffalo milk was the preferred choice if supplementation was required. It was thought that weaning should be introduced after 6 months of life. Mothers preferred to give dalia and khichri as the initial weaning food compared to roti and dal water by grandmothers. Both grandmothers and mothers felt that a baby who was playful and not crying excessively was usually healthy. Most of the respondents described the normal pattern of breathing, feeding, urination, and defecation adequately. Most of the grandmothers and mother's felt that by touching forehead and limbs of baby could reliably assess temperature. Refusal to feed was considered as a marker of a sickness by most grandmothers and mothers. However, they also believed that health-seeking for poor feeding could be delayed for 1 day. Respiratory distress was described by the presence of fast respiration, chest retractions, or noisy breathing. Most respondents did not know how to assess cyanosis or seizures. Jaundice was descried as yellowish discoloration of skin, eyes, and urine. Failure to pass urine for 4-6 h bothered most of the respondents. The first response to illness was home remedies. The choice of healthcare was unqualified village practitioners followed by government hospital. Knowledge regarding desirable breastfeeding practices was inadequate and quite a few inappropriate beliefs were widely prevalent. Although knowledge regarding sickness was present, health-seeking from qualified providers was considerably delayed with most respondents preferring village practitioners to government hospitals.

Why healthcare workers give prelacteal feeds

OBJECTIVE

Because prelacteal feeds can adversely affect breastfeeding, UNICEF/WHO discourage their use unless medically indicated. The study was carried out to determine the proportion of healthcare workers who routinely give prelacteal feeds, and their reasons for doing so; further, to determine whether any differences exist between medically and non-medically trained healthcare workers in their administration of prelacteal feeds.

DESIGN

Survey.

SETTING

Primary, secondary and tertiary health facilities in Kaduna township Nigeria.

SUBJECTS

Of 1100 healthcare workers sampled, 747 (68%) responded. Of these 80% had received medical training, 20% had not.

METHODS

Use of a pretested validated questionnaire.

RESULTS

Large proportions of both medical and non-medically trained healthcare workers stated they routinely give prelacteal feeds (doctors, 68.2%; nurses, 70.2%; and non-medical, 73.6%). However their reasons for doing so differed significantly (P=0.00001). Nurses gave mainly for perceived breast milk insufficiency, doctors for prevention of dehydration, hypoglycaemia and neonatal jaundice and non-medical staff to prepare the gastrointestinal tract for digestion and to quench thirst.

CONCLUSIONS

Most healthcare workers (medical and non-medical) routinely and unnecessarily give prelacteal feeds. Therefore training and retraining programmes in lactation management are necessary and must include non-medical staff. These programmes, while emphasizing the danger of giving prelacteal feeds, must deal with the misconceptions of each group. Deliberate efforts have to be made to incorporate clinical training in breastfeeding in curricula of Schools of Medicine and Nursing.

Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania

OBJECTIVE

To investigate and compare feeding practices among infants of less than 7 months of age in a rural and an urban area in Tanzania.

DESIGN

Cross-sectional, questionnaire-based interview of mothers and focus group discussions with extension workers and community leaders.

SETTING

Eleven villages in a rural district and 10 wards in an urban district in the Morogoro region, Tanzania, west of Dar es Salaam.

SUBJECTS

Probability samples of mothers with infants of less than 7 months of age from each area).

RESULTS

Exclusive breast-feeding was rarely practised in either the rural or urban areas investigated. However, the urban mothers initiated breast-feeding earlier, discarded colostrum less frequently, breast-fed exclusively for a longer period, gave breast milk as the first feed more often and delayed the introduction of solid foods for longer than their rural counterparts. The rural mothers, on the other hand, breast-fed their previous infants slightly longer than the urban mothers.

CONCLUSIONS

The better performance of urban mothers could be partly due to sustained breast-feeding support in hospital settings and other campaigns which may not have reached the rural areas. In both the rural and urban areas more efforts are needed to encourage exclusive breast-feeding, to avoid premature complementation and, in the case of the urban areas, to protect extended breast-feeding.

The incidence and duration of breast feeding

Information obtained from a variety of sources shows different rates of initiation and duration of breast feeding and different supplementation strategies. Among populations of developing countries, in general, the mothers resident in rural-areas are more likely to breast feed than those in urban areas; in addition the better off or more highly educated are less likely to breast feed. In contrast in the developed countries, the better educated and the higher social class mothers are more likely to breast feed. There is some evidence that delay in initiation of breast feeding, lack of professional support, conflicting advice from health professionals and the presence of free samples of artificial milk (whether or not given to the mother) can result in a mother failing to establish breast feeding. Additionally, mothers who smoke cigarettes are less likely to breast feed successfully. Whilst breast feeding is almost universal in a number of developing countries, many also commonly use complementary feeds. In some countries, particularly in Asia, it is still commonplace for a child not to be given the mother's colostrum, and therefore for the first breast feed to occur well after the first 24 h.

Breast-feeding in Egypt

Planning, implementation and evaluation of programmes to promote appropriate infant feeding practices require detailed, current information about these practices in the target populations. To estimate the prevalences and identify the correlates of overall breast-feeding and of exclusive breast-feeding in different age periods during infancy, a cohort of 152 apparently healthy neonates and their mothers were followed during October 1987 through April 1989 in rural Bilbeis, Sharqiya Governorate, Egypt. Feeding data were collected through twice weekly home visits thus reducing the potential for bias in our findings due to respondent recall errors. The prevalence of overall breastfeeding in the infants declined from 100% in age period 0-11 weeks to 89% in age period 36-47 weeks. Mothers with previous living children were associated with significantly higher (odds ratio [OR]: 6.53, 95% confidence interval [CI]: 1.33-32.09) and ownership of refrigerators was associated with significantly lower (OR: 0.18, 95% CI: 0.05-0.67) overall breast-feeding prevalences in age periods 24-35 and 36-47 weeks, respectively. The prevalence of exclusive breast-feeding in breast-fed infants dropped from 20% in age period 0-11 weeks to 0% in age period 36-47 weeks. After multivariate adjustment, prelacteal feeding was significantly negatively (OR: 0.12, 95% CI: 0.04-0.37) associated with exclusive breast-feeding in age period 0-11 weeks. Nearly 90% of Bilbeis infants were breast-fed at age 47 weeks, but the initiation of supplementation at 0-11 weeks in 80% of breast-fed infants is contrary to current recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987-88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r = 0.6188, p = 0.0001). The BAC cut-off value of < 9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p = 0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.