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Weber AM, Guo Y, Zhang E, Gruber S, Medina A, Zhou H, Darmstadt GL. Associations of in-hospital postpartum feeding experiences with exclusive breastfeeding practices among infants in rural Sichuan, China. Int Breastfeed J 2023; 18:34. [PMID: 37443078 DOI: 10.1186/s13006-023-00567-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In rural China, exclusive breastfeeding (EBF) prevalence is low and hospitals often fail to attain baby-friendly feeding objectives, such as ≥ 75% of newborns exclusively breastfed from birth to discharge. Empirical evidence for the impact of increased hospital compliance with recommended feeding guidelines on continued EBF in rural China is lacking. We sought to measure and model the association of newborns' in-hospital feeding experiences with EBF practice in infancy to inform policies for EBF promotion. METHODS Data were cross-sectional from 785 caregivers of infants < 6 months of age, collected from November to December 2019 in four underdeveloped counties/districts in Sichuan Province. In-hospital feeding practices were determined, and prevalence of current infant feeding practices was calculated from 24-h recall and categorized according to WHO/UNICEF Infant and Young Child Feeding categories as EBF, breastfed with non-milk liquids, mixed feeding, breastfed with solids, and not breastfed. Relative risk ratios were estimated using adjusted multinomial logistic regression to examine risk factors for non-EBF practices compared to EBF, including in-hospital feeding experiences. The regression model was used to investigate change in EBF prevalence under alternative in-hospital experiences. RESULTS Only 38.1% of under-six-month-old infants were being exclusively breastfed when data were collected; 61.8% and 77.6% had been fed water and infant formula, respectively, in the hospital. Infants who were fed water or formula before discharge were estimated as 2-3 times as likely to be non-EBF than EBF up to age six months. According to our model, EBF prevalence would have increased to 53.7% (95% confidence interval (CI) 46.1, 61.2) had ≥ 75% of infants been exclusively breastfed and water-based feeds eliminated in-hospital. CONCLUSIONS Given the importance of infants' first feeding experiences in the establishment and continuation of EBF, it is imperative that rural Chinese hospitals actively seek to limit infant formula feeds to medically indicated situations and eliminate water-based feeds.
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Affiliation(s)
- Ann M Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, USA.
| | - Yian Guo
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Evelyn Zhang
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | | | - Alexis Medina
- Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Huan Zhou
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, Section 3, South Renmin Road, Chengdu City, Sichuan Province, 610041, People's Republic of China.
| | - Gary L Darmstadt
- Department Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Alves RDV, de Oliveira MIC, Domingues RMSM, Pereira APE, Leal MDC. Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project. Reprod Health 2023; 20:10. [PMID: 36609292 PMCID: PMC9817241 DOI: 10.1186/s12978-022-01538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative's Step 4 recommends: "support mothers to start breastfeeding as soon as possible after birth", thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the "Adequate Childbirth Project", a quality-of-care improvement project, and to analyze determinants of this outcome. METHODS Secondary analysis of data collected by the cross-sectional evaluative "Healthy Birth Study", conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns' severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. RESULTS The prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6-59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528-0.782), lower economic status (aOR 0.687; CI 95% 0.504-0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529-0.797), preterm birth (aOR 0.660; CI 95% 0.460-0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559-0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102-3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065-1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791-2.525) and female newborn (aOR 1.194; CI 95% 1.008-1.415) were factors positively associated with the outcome. CONCLUSIONS The private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life.
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Affiliation(s)
- Rachael de Vasconcelos Alves
- grid.411173.10000 0001 2184 6919Postgraduate Program in Public Health, Universidade Federal Fluminense, Rua Marquês de Paraná, no 303, Anexo, 4° Andar, Centro, Niterói, Rio de Janeiro, CEP: 24033-900 Brazil
| | - Maria Inês Couto de Oliveira
- grid.411173.10000 0001 2184 6919Department of Epidemiology and Biostatistics, Collective Health Institute, Universidade Federal Fluminense, Rua Marquês de Paraná, no 303, anexo, 3° Andar, Centro, Niterói, Rio de Janeiro, CEP: 24033-900 Brazil
| | - Rosa Maria Soares Madeira Domingues
- grid.418068.30000 0001 0723 0931National Institute of Infectious Diseases Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil no 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro CEP: 21040-360 Brazil
| | - Ana Paula Esteves Pereira
- grid.418068.30000 0001 0723 0931National School of Public Health, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões no 4480, Sala 814. Manguinhos, Rio de Janeiro, Rio de Janeiro CEP: 21041-210 Brazil
| | - Maria do Carmo Leal
- grid.418068.30000 0001 0723 0931National School of Public Health, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões no 4480, Sala 809. Manguinhos, Rio de Janeiro, Rio de Janeiro CEP: 21041-210 Brazil
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Factors Influencing Early Initiation of Breastfeeding in Healthy Term Newborns: A Cross-Sectional Study at a Tertiary Care Center in South India. Neonatal Netw 2022; 41:129-136. [PMID: 35644358 DOI: 10.1891/11-t-738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Despite well-known benefits, rates of exclusive breastfeeding and early initiation of breastfeeding are very low. This study was conducted to identify most important and easily modifiable barriers to Early Initiation of Breast Feeding (EIBF).Methods: This hospital-based cross-sectional study was conducted from January 2018 to December 2018. Data on factors which could impact EIBF was collected by interviewing with mothers using semi-structured questionnaire.Results: Only 306 (33.7 percent) of the total 908 mother-neonate dyads enrolled received breastfeeding within 1 hour of birth. Factors affecting EIBF included: delivery by lower segment cesarean section (LSCS), lack of prenatal advice on breastfeeding, use of prelacteal feeds, and maternal illness.Conclusion: Rates of EIBF were very low in present setting. Counseling during antenatal visits on the importance of EIBF, and having adequate staff to support initiation of BF, may improve the EIBF.
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Karim MR, Al Mamun ASM, Rana MM, Mahumud RA, Shoma NN, Dutt D, Bharati P, Hossain MG. Acute malnutrition and its determinants of preschool children in Bangladesh: gender differentiation. BMC Pediatr 2021; 21:573. [PMID: 34903193 PMCID: PMC8667456 DOI: 10.1186/s12887-021-03033-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Children acute malnutrition (AM) is a global public health concern, especially in low and middle income countries. AM is associated with multiple physiological vulnerabilities, including immune dysfunction, enteric barrier disruption, gut microbiome dysbiosis, and essential nutrient deficits. This study aimed to determine the prevalence of AM and its associated factors among preschool children in Rajshahi district, Bangladesh. Methods This cross-sectional study was conducted from October to December, 2016. Children acute malnutrition was assessed using mid-upper arm circumference. Multiple binary logistic regression analyses were employed to determine the associated factors after adjusting the effect of independent factors of children AM. Result The prevalence of AM amongst preschool children was 8.7%, among them 2.2 and 6.5% were severe acute malnutrition and moderate acute malnutrition, respectively. Z-proportional test demonstrated that the difference in AM between girls (11.6) and boys (5.9%) was significant (p < 0.05). Children AM was associated with being: (i) children aged 6–23 months (aOR = 2.29, 95% CI: 1.20–4.37; p < 0.05), (ii) early childbearing mothers’ (age < 20 years) children (aOR = 3.06, 95% CI: 1.08–8.66; p < 0.05), (iii) children living in poor family (aOR = 3.08, 95% CI: 1.11–8.12; p < 0.05), (iv) children living in unhygienic latrine households (aOR = 2.81, 95% CI: 1.52–5.09; p < 0.01), (v) Hindu or other religion children (aOR = 0.42, 95% CI: 0.19–0.92; p < 0.05). Conclusion The prevalence of AM was high among these preschool children. Some modifiable factors were associated with AM of preschool children. Interventions addressing social mobilization and food security could be an effective way to prevent acute malnutrition among children in Bangladesh.
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Affiliation(s)
- Md Reazul Karim
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | | | - Md Masud Rana
- DASCOH Foundation, Lutheren Mission Complex, Dingadoba, Rajpara, Rajshahi, 6201, Bangladesh
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Nurun Naher Shoma
- DASCOH Foundation, Lutheren Mission Complex, Dingadoba, Rajpara, Rajshahi, 6201, Bangladesh
| | - Dhiman Dutt
- Swiss Red Cross, House# 35, Road # 117, Gulshan-1, Dhaka, 1212, Bangladesh
| | - Premananda Bharati
- Biological Anthropology, Indian Statistical Institute, 203 BT Road, Kolkata, West Bengal, 700 108, India
| | - Md Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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Li JY, Huang Y, Huang YY, Shen Q, Zhou WB, Redding SR, Ouyang YQ. Experience predicts the duration of exclusive breastfeeding: The serial mediating roles of attitude and self-efficacy. Birth 2021; 48:397-405. [PMID: 33884662 DOI: 10.1111/birt.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The relationship between prior breastfeeding experience and the duration of exclusive breastfeeding is of significant interest, but few studies have explored the mechanisms underlying this relationship. The purpose of this study is to address two hypotheses: (a) that attitude and self-efficacy mediate the relationship between previous breastfeeding experience and the duration of exclusive breastfeeding; and (b) that attitude and self-efficacy have serial mediation functions in this relationship. METHODS The data collection process was divided into two stages. The original stage included 394 women hospitalized after delivery who completed socio-demographic questionnaires (including previous breastfeeding experience), the Iowa Infant Feeding Attitude Scale (IIFAS), and the Breastfeeding Self-efficacy Short-Form Scale (BSES-SF). Follow-up data about duration of exclusive breastfeeding were obtained at six months postpartum. RESULTS Mediation analysis indicated that previous breastfeeding experience directly affected the duration of exclusive breastfeeding and that the rate of the total indirect effect was 22.878%. Self-efficacy mediated previous breastfeeding experience and duration of exclusive breastfeeding, whereas attitude and self-efficacy played the series mediational role between previous breastfeeding experience and duration of exclusive breastfeeding. Cluster analysis supported these results. CONCLUSIONS The duration of exclusive breastfeeding can be promoted by improving breastfeeding attitude and self-efficacy in women without breastfeeding experience.
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Affiliation(s)
- Jun-Yan Li
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Yi Huang
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Yi-Yan Huang
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Quan Shen
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
| | - Wen-Bin Zhou
- Department of Psychology, Hubei Provincial Corps Hospital, Chinese People Armed Police Forces, Wuhan, China
| | | | - Yan-Qiong Ouyang
- School of Health Sciences, Wuhan University, Wuchang District, Wuhan, China
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Yuan ZW, Ma L, Ge WL, Li XY, Zhang XQ, Zeng JJ, Yang J, Qu PF. The Influencing Factors of Breastfeeding for Full-Term Singleton Within Six Months of Birth in Xi'an Before the Covid-19 Pandemic. Front Pediatr 2021; 9:801436. [PMID: 35359339 PMCID: PMC8961653 DOI: 10.3389/fped.2021.801436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The study is designed to understand the situation of full-term infants breastfeeding within 6 months of birth in Xi'an before the Covid-19 pandemic and analyze the influencing factors of exclusive breastfeeding. METHODS Five hospitals in Xi'an province have been selected as research centers. Full-term infants who met the inclusion and exclusion criteria were recruited from these centers between January 1 and February 28, 2019. The feeding situation at 10 days, 42 days, 3 months, and 6 months after birth were investigated. A self-designed breastfeeding questionnaire was used for investigation and follow-up. SPSS 22.0 was applied for statistical analysis of the data. RESULTS The exclusive breastfeeding rate of full-term infants on days 10 and 42 and at months three and six after birth was 61.38%, 54.78%, 48.83%, and 38.78%, respectively, with a decreasing trend over time. During breastfeeding within 48 h after delivery, 1,653 cases (91.83%) of puerpera had different grades of pain, including 1,325 cases (80.16%) of mild discomfort, 321 cases (19.42%) of moderate pain, and seven cases (0.42%) of severe pain. Within 24-48 h postpartum, 1,607 (89.27%) mothers faced problems related to postpartum breastfeeding. Among them, 694 (43,19%) neonates could not be fed effectively; 665 (41.38%) mothers had wound pain and had inconvenience to turn over; 598 (37.21%) neonates were difficult to wake up; 439 (27.32%) mothers had incorrect feeding posture; 181 (11.26%) mothers experienced other problems. The Cox risk regression model showed that weight gain during pregnancy was higher than the recommended standard. Living in suburban counties was a risk factor of exclusive breastfeeding for full-term infants. Participation in breastfeeding courses during pregnancy, feeding more than eight times daily after delivery, were the protective factors of exclusive breastfeeding for full-term infants. CONCLUSION The body weight gain of parturients should be controlled within a reasonable range during pregnancy. Parturients were encouraged by medical staff to participate in breastfeeding courses or watch the breastfeeding process during pregnancy to increase their self-confidence and improve the rate of exclusive breastfeeding for full-term infants. In addition, it is necessary to strengthen the publicity of breastfeeding in suburban areas to promote breastfeeding.
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Affiliation(s)
- Zhan-Wang Yuan
- Department of Nursing Care (Nursing Department), Northwest Women's and Children's Hospital, Xi'an, China
| | - Li Ma
- Department of Nursing Care (Nursing Department), Northwest Women's and Children's Hospital, Xi'an, China
| | - Wen-Li Ge
- Department of President's Office, Northwest Women's and Children's Hospital, Xi'an, China
| | - Xiao-Ying Li
- Department of Maternity (Maternity Department), Northwest Women's and Children's Hospital, Xi'an, China
| | - Xiao-Qin Zhang
- Department of Maternity (Maternity Department), Northwest Women's and Children's Hospital, Xi'an, China
| | - Jing-Jie Zeng
- Outpatient Department, Xi'an Gaoxin Hospital, Xi'an, China
| | - Jun Yang
- Medical Department, Xi'an Huyi District Women's and Children's Health Family Planning Service Center, Xi'an, China
| | - Peng-Fei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
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Tang L, Lee AH, Binns CW, Duan L, Liu Y, Li C. WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial. BMC Med Inform Decis Mak 2020; 20:300. [PMID: 33213446 PMCID: PMC7676472 DOI: 10.1186/s12911-020-01322-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive breastfeeding for the first 6 months of life is the optimal way to feed infants. However, recent studies suggest that exclusive breastfeeding rates in China remain low and are well below the recommended target. There has been evidence that a lack of awareness of, or exposure to, breastfeeding information is associated with poor breastfeeding practices. WeChat, the most widely used social networking platform in China, has shown some potential to promote health behaviours. We thus hypothesised that a breastfeeding intervention program delivered via WeChat would achieve at least a 10% increase in exclusive breastfeeding prevalence at 6 months compared to the control group. Methods A two-arm, parallel, multicentre randomised controlled trial of 1000 pregnant women will be conducted at four maternity hospitals of Chengdu, China. Eligible women who consent to participate in the trial will be recruited at 28–30 weeks of gestation, and randomly allocated to either the intervention group (participants receive breastfeeding-related information from WeChat) or the control group (participants receive non-breastfeeding information from WeChat) using a central randomisation system on a 1:1 ratio at each participating site. The primary outcomes are exclusive breastfeeding rate and full breastfeeding rate at 6 months postpartum. All randomised participants will be included in the outcome analyses with missing data being imputed based on the best-case and worst-case scenarios. Multilevel mixed regression models will be used in the primary analyses to assess the effectiveness of intervention program on the breastfeeding rates. Discussion This trial uses the most widely used social media program as a means of delivering messages to mothers to increase exclusive breastfeeding in China. Increasing exclusive breastfeeding will contribute to meeting the health and environmental goals of the Sustainable Development Guidelines. Trial registration ClinicalTrials.gov, NCT04499404. Registered 5 August 2020—Retrospectively registered, https://clinicaltrials.gov/show/NCT04499404
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Affiliation(s)
- Li Tang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Australia
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, Australia
| | - Lian Duan
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yi Liu
- Chengdu Jinjiang Maternity and Child Health Hospital, Chengdu, China
| | - Chunrong Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Li J, Duan Y, Bi Y, Wang J, Lai J, Zhao C, Fang J, Yang Z. Predictors of exclusive breastfeeding practice among migrant and non-migrant mothers in urban China: results from a cross-sectional survey. BMJ Open 2020; 10:e038268. [PMID: 32895284 PMCID: PMC7476475 DOI: 10.1136/bmjopen-2020-038268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To explore and compare the predictors for exclusive breast feeding (EBF) among migrant and non-migrant mothers in China. DESIGN A large-scale cross-sectional study. SETTING 12 counties/districts were covered in China. PARTICIPANTS A total number of 10 408 mothers were recruited, of whom 3571 mothers of infants aged 0-5 months in urban China were used for analysis. OUTCOME The practice of EBF was calculated based on the foods and drinks consumed in the last 24 hours, as recommended by WHO. RESULTS Around 30% of Chinese mothers with infants aged 0-5 months practised EBF in urban areas, with no significant difference between migrant and non-migrant mothers (p=0.433). Among the migrant mothers, factors associated with EBF included residence in big cities (adjusted OR, AOR 1.68 (95% CI 1.20 to 2.34)), premature birth (AOR 0.27 (95% CI 0.09 to 0.81)), knowledge about EBF (AOR 2.00 (95% CI 1.51 to 2.65)), low intention of breast feeding in the first month postpartum (AOR 0.59 (95% CI 0.36 to 0.97)) and mothers working in agriculture-related fields or as casual workers (AOR 1.77 (95% CI 1.18 to 2.64)). Among non-migrant mothers, in addition to similar predictors including residence in big cities (AOR 1.40 (95% CI 1.13 to 1.73)), knowledge about EBF (AOR 1.25 (95% CI 1.02 to 1.53)) and low intention of breast feeding in the first month post partum (AOR 0.46 (95% CI 0.31 to 0.70)], early initiation of breast feeding (EIBF) (AOR 1.78 (95% CI 1.35 to 2.33)) and caesarean delivery (AOR 0.74 (95% CI 0.60 to 0.89)) were also factors associated with EBF. CONCLUSIONS There was no significant difference in the prevalence of EBF between migrant and non-migrant mothers in urban China. Premature birth and maternal occupation in agriculture-related fields or casual work were distinctive factors associated with EBF for migrants, while EIBF and caesarean delivery were unique predictors for non-migrants. TRIAL REGISTRATION NUMBER ChiCTR-ROC-17014148; Pre-results.
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Affiliation(s)
- Jia Li
- Business School, Nanjing University of Information Science & Technology, Nanjing, China
- Child Development Center, China Development Research Foundation, Beijing, China
| | - Yifan Duan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ye Bi
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianqiang Lai
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhao
- Child Development Center, China Development Research Foundation, Beijing, China
| | - Jin Fang
- Child Development Center, China Development Research Foundation, Beijing, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Li J, Nguyen TT, Wang X, Mathisen R, Fang J. Breastfeeding practices and associated factors at the individual, family, health facility and environmental levels in China. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e13002. [PMID: 32603547 PMCID: PMC7591310 DOI: 10.1111/mcn.13002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
We examined the association between breastfeeding practices and associated factors using cross-sectional data from face-to-face interviews with 9,745 mother-child dyads in China. The study collected information on breastfeeding practices and potential associated factors at the individual, family, health facility and environmental levels in China. We used survey commands in Stata to consider sampling weight and survey design effects. Although breastfeeding was the norm (97.4% ever breastfed), the prevalence of early initiation of breastfeeding (EIBF) in 0-11 months old was 8.2%, exclusive breastfeeding (EBF) in 0-5 months old was 27.8% and breastfeeding on the previous day in 6-11 months old was 77.5%. The prevalence of EIBF was lower for caesarean delivery and among mothers belonging to ethnic minority groups. The prevalence of EBF was higher among mothers who practiced EIBF, received information that encouraged breastfeeding and knew that a baby should be breastfed on demand and exclusively. By contrast, the prevalence of EBF was lower in mothers who received infant formula advice or felt uneasy breastfeeding in public places. The prevalence of breastfeeding on the previous day was higher among mothers whose partners supported breastfeeding and who knew about timing of colostrum production, EBF for 6 months, and to nurse more to stimulate milk production. The prevalence of breastfeeding on the previous day was lower in mothers who received infant formula advice or felt uneasy breastfeeding in public places. In conclusion, we found that the prevalence of EIBF and EBF practices in China was low and associated with factors at individual, family, health facility and environmental levels.
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Affiliation(s)
- Jia Li
- Institute of Economics, School of Social Sciences, Tsinghua University, Beijing, China.,China Development Research Foundation, Beijing, China
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | - Xiaobei Wang
- China Development Research Foundation, Beijing, China
| | | | - Jin Fang
- China Development Research Foundation, Beijing, China
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Ghimire U, Aryal BK, Gupta AK, Sapkota S. Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study. BMC Pediatr 2020; 20:249. [PMID: 32456624 PMCID: PMC7249365 DOI: 10.1186/s12887-020-02154-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal. Methods We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value < 0.05 was considered as significant. Results Out of 398 children, 5.8% were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23–12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88–10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06–71.09) children (0–12 vs. 24–59 months). Conclusions The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.
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Affiliation(s)
- Umesh Ghimire
- New ERA, Kalopul, Rudramati Marga, Kathmandu, 44600, Nepal.
| | | | | | - Suman Sapkota
- Partnership for Social Development, Kathmandu, 446006, Nepal
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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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Tang K, Wang H, Tan SH, Xin T, Qu X, Tang T, Wang Y, Liu Y, Gaoshan J. Association between maternal education and breast feeding practices in China: a population-based cross-sectional study. BMJ Open 2019; 9:e028485. [PMID: 31467048 PMCID: PMC6720234 DOI: 10.1136/bmjopen-2018-028485] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the association between maternal education and breast feeding in the Chinese population, with a consideration of household income and health-seeking behaviours. DESIGN A nationally representative population-based cross-sectional study. SETTING 77 counties from 12 geographically distinct regions in China. PARTICIPANTS 10 408 mothers with children from 0 to 12 months of age, aged 15-53 years old (mean: 29.15, SD: 5.11) were classified into primary school or below group (n=781), middle school group (n=3842), high school/vocational school group (n=1990), college or above group (n=3795), according to their highest completed education. OUTCOMES Five breastfeeding outcomes, including early initiation of breast feeding (EIB), exclusive breast feeding (EBF) under 6 months, predominant breast feeding under 6 months, current breast feeding and children ever breast fed, were calculated based on the standardised questionnaire from the WHO and Wellstart International's toolkit for monitoring and evaluating breastfeeding activities. RESULTS The absolute risk of EIB and EBF in the lowest maternal education level was 64.85% and 26.53%, respectively, whereas the absolute risk of EIB and EBF in the highest maternal education level was 77.21% and 14.06%, respectively. A higher level of maternal education was positively associated with EIB (risk ratio (RR): 1.22; 95% CI: 1.12 to 1.30) and was inversely associated with EBF (RR: 0.59; 95% CI: 0.38 to 0.88). Stratified by household income, a positive association with EIB was observed only in the group with the highest household income and an inverse association with EBF was found in both low household and high household income groups. CONCLUSIONS Mothers with a higher education were more likely to initiate early breast feeding when they were also from a high-income household while also being less likely to exclusively breast feed their babies. Routine and successful nursing is crucial for the health of infants and is influenced by maternal education. Future public health interventions to promote breast feeding should consider the issues related to the educational level of mothers.
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Affiliation(s)
- Kun Tang
- Research Center for Public Health, Tsinghua University, Beijing, China
| | - Hanyu Wang
- Institute for Medical Humanities, Peking University Health Science Centre, Beijing, China
| | - Shi Hui Tan
- School of Basic Medical Sciences, Peking University Health Science Centre, Beijing, China
| | - Tong Xin
- Department of Global Health, Peking University Health Science Centre, Beijing, China
| | - Xueqi Qu
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Tianyu Tang
- Research Center for Public Health, Tsinghua University, Beijing, China
| | - Yuqi Wang
- Institute for Medical Humanities, Peking University Health Science Centre, Beijing, China
| | - Yuning Liu
- School of Public Health, Peking University Health Science Centre, Beijing, China
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Chen C, Cheng G, Pan J. Socioeconomic status and breastfeeding in China: an analysis of data from a longitudinal nationwide household survey. BMC Pediatr 2019; 19:167. [PMID: 31133000 PMCID: PMC6535851 DOI: 10.1186/s12887-019-1551-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background Socioeconomic status is an important factor affecting the initiation and cessation of breastfeeding. However, limited evidence exists regarding the association between socioeconomic status and breastfeeding behavior in China on a national level. This study aims to investigate the relationship between socioeconomic status and the initiation and duration of breastfeeding in China. Methods Data were collected from the China Family Panel Studies, a longitudinal nationwide household survey. A total of 2938 infants born between 2010 and 2014 were included in the study. The logistic regression model was used to investigate the relationship between socioeconomic status and the initiation of breastfeeding. Meanwhile, the Cox proportional hazards model was used to investigate the relationship between socioeconomic status and the risk of breastfeeding cessation. Results Overall, 90.5% of infants were breastfed, while the average duration of breastfeeding was 8.66 months in China. The breastfeeding continuance rate at 12 months declined sharply, to 30.1%. The study’s findings also indicate that socioeconomic status did not significantly affect breastfeeding initiation. However, infants whose mothers had a high school or higher education and who scored 33–58 on the International Socio-Economic Index of Occupational Status (ISEI) were more likely to experience breastfeeding cessation, as were infants whose fathers had an ISEI score of 59–90. Conclusions Efforts to promote breastfeeding practices should be conducted comprehensively to target mothers with a high school or higher education, mothers with a medium occupational status, and fathers with a high occupational status.
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Affiliation(s)
- Chu Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China
| | - Guo Cheng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China. .,West China Research Centre for Rural Health Development, Sichuan University, No.17, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, China.
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14
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Wu X, Gao X, Sha T, Zeng G, Liu S, Li L, Chen C, Yan Y. Modifiable Individual Factors Associated with Breastfeeding: A Cohort Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E820. [PMID: 30845743 PMCID: PMC6427345 DOI: 10.3390/ijerph16050820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/21/2019] [Accepted: 03/01/2019] [Indexed: 12/19/2022]
Abstract
Breast milk is an ideal first food for infants in the initial months of life. This study aimed to identify modifiable individual factors in breastfeeding during the first six months of life in Hunan. This birth cohort study was conducted in three communities in Changsha, Hunan province. Data were collected through maternal health manuals and self-administered questionnaires during the follow-up period. To find risk factors and calculate odds ratios, generalized estimating equation models were applied. The final study included 951 mother-infant pairs. The prevalence of exclusive breastfeeding and any breastfeeding in this study was below the World Health Organization's breastfeeding goals. Infant age, passive smoking after delivery, minor postnatal depression, and feeding-bottles were shown to act negatively on both exclusive breastfeeding and any breastfeeding. In addition, cesarean delivery and delayed breastfeeding initiation had adverse effects on exclusive breastfeeding. Multiparas were less likely to continue any breastfeeding during the first few months. This study highlights the importance of screening probable maternal depression during primary care service and reducing secondhand smoke and feeding-bottle use. The results also suggest that healthcare professionals should provide more assistance and education to multiparas and mothers with cesarean delivery or delayed breastfeeding initiation.
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Affiliation(s)
- Xialing Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Kaifu District, Changsha 410078, China.
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Quality antenatal care protects against low birth weight in 42 poor counties of Western China. PLoS One 2019; 14:e0210393. [PMID: 30650127 PMCID: PMC6335019 DOI: 10.1371/journal.pone.0210393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/21/2018] [Indexed: 11/03/2022] Open
Abstract
Limited data exist related to low birth weight (LBW) incidence and risk factors in Western China. This paper aims to assess LBW and its relationship with antenatal care (ANC) in the poor counties of Western China. A community-based study in rural Western China was conducted in 2011. A kernel distribution was used to estimate the adjusted LBW incidence, and associations between LBW and socio-demographic or maternal factors were examined using multilevel logistic regression. Among 8,964 participants, 65.7% were weighed at birth. Crude LBW incidence was 6.6% and the adjusted rate was 9.3%. The study revealed that risk factors of LBW are being female, raised within a minority group, and with a family income below the national poverty line. For maternal risk factors, LBW was positively associated with not attending at least five or eight ANC visits, not receiving any ANC during the first trimester, and not having access to assess certain ANC content (weight, blood pressure, blood test, urine test, B-scan ultrasound, and folic acid supplement). There is urgent need to promote quality ANC in poor and rural areas of Western China and to prioritize vulnerable women and children who will benefit from quality ANC.
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Ndirangu MN, Gatimu SM, Mwinyi HM, Kibiwott DC. Trends and factors associated with early initiation of breastfeeding in Namibia: analysis of the Demographic and Health Surveys 2000-2013. BMC Pregnancy Childbirth 2018; 18:171. [PMID: 29769063 PMCID: PMC5956738 DOI: 10.1186/s12884-018-1811-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013. METHODS An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006-2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used to analyse respondents' demographic, socioeconomic and obstetric characteristics. Factors associated with EIBF were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis. RESULTS EIBF significantly decreased from 82.5% (confidence interval [CI]: 79.5-85.0) in 2000 to 74.9% (72.5-77.2) in 2013. Factors associated with EIBF in 2000 were urban residence (adjusted odds ratio 0.58, 95% CI: 0.36-0.93), poorer household wealth index (1.82, 1.05-3.17), lack of antenatal care (0.14, 0.03-0.81), small birth size (0.38, 0.24-0.63) and large birth size (0.51, 0.37-0.79). In 2013, factors associated with EIBF were maternal age of 15-19 years (2.28, 1.22-4.24), vaginal delivery (2.74, 1.90-3.93), married mothers (1.57, 1.16-2.14), delivery assistance from health professionals (3.67, 1.23-10.9) and birth order of fourth or above (1.52, 1.03-2.26). CONCLUSIONS Namibia has experienced a declining trend in EIBF rates from 2000 to 2013. Factors associated with EIBF differed between 2000 and 2013. The present findings highlight the importance of continued commitment to addressing neonatal health challenges and strengthening implementation of interventions to increase EIBF in Namibia.
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Affiliation(s)
- M N Ndirangu
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - S M Gatimu
- School of Nursing and Midwifery, Aga Khan University, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - H M Mwinyi
- Kenya Red Cross Society, P.O. Box 40712 - 00100, Nairobi, Kenya
| | - D C Kibiwott
- School of Medicine and Health Sciences, Kabarak University, P.O. Private Bag 20157, Kabarak, Kenya
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17
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Tshering D, Gurung MS, Wangmo N, Pelzom D, Tejativaddhana P, Dzed L. Prevalence of Exclusive Breastfeeding and Factors Associated With Exclusive Breastfeeding of Children in Trongsa District, Bhutan. Asia Pac J Public Health 2018; 30:369-377. [PMID: 29629818 DOI: 10.1177/1010539518768573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The World Health Organization estimated that about 800 000 infant deaths could be prevented annually by exclusively breastfeeding infants for the first 6 months of life. This study aimed to examine the prevalence of exclusive breastfeeding and its associated factors. A total of 192 mothers participated. The prevalence of exclusive breastfeeding practice in Trongsa district was 97% at 1 month, declining to 58% at 6 months. Mothers who returned to formal work were less likely to exclusively breastfeed than those who were farmers or housewives. The main reasons stated by the mothers for not exclusively breastfeeding were lack of the mother's self-confidence that the child is getting enough breastmilk and mothers having to return to work, 59% and 22%, respectively. The rate of exclusive breastfeeding in Trongsa district of Bhutan is high, and every effort should be made to maintain and improve this rate.
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Affiliation(s)
- Dolley Tshering
- 1 Dzongkhag Health Sector, Trongsa, Ministry of Health, Bhutan
| | - Mongal Singh Gurung
- 2 Health Research and Epidemiology Unit, Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
| | - Neyzang Wangmo
- 3 Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Dorji Pelzom
- 4 Bhutan Health Management and Information Unit, Ministry of Health, Thimphu, Bhutan
| | | | - Laigden Dzed
- 6 National Nutrition Programme, Department of Public Health, Ministry of Health, Thimphu, Bhutan
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18
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Lau Y, Tha PH, Ho-Lim SST, Wong LY, Lim PI, Citra Nurfarah BZM, Shorey S. An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28799193 DOI: 10.1111/mcn.12492] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022]
Abstract
This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pyai Htun Tha
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lai Ying Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Peng Im Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Zhao J, Zhao Y, Du M, Binns CW, Lee AH. Maternal education and breastfeeding practices in China: A systematic review and meta-analysis. Midwifery 2017; 50:62-71. [DOI: 10.1016/j.midw.2017.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/20/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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Tang L, Pan XF, Lee AH, Binns CW, Yang CX, Sun X. Maternal lifestyle and nutritional status in relation to pregnancy and infant health outcomes in Western China: protocol for a prospective cohort study. BMJ Open 2017; 7:e014874. [PMID: 28630084 PMCID: PMC5541627 DOI: 10.1136/bmjopen-2016-014874] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Improving the health and nutrition of women and children is a priority for Western China, where the economy is less developed. Due to the dynamic nature of lifestyle, modern food habits and nutrition, there is a need to update our limited knowledge and understanding of maternal lifestyle and nutritional status and their impact on pregnancy and infant health outcomes. While breast milk is the preferred feeding option, infant formula use is widespread in China. It is thus necessary to examine the effects of formula consumption on growth and morbidity. METHODS AND ANALYSIS This is an ongoing prospective cohort study started in 2015 in Chengdu, Sichuan Province. A sample of 1901 pregnant women at 15-20 weeks of gestation were recruited from four maternal and child health hospitals and are followed prospectively to 12 months post partum. Detailed information on maternal lifestyle and nutritional status, obstetric complications, pregnancy outcomes, infant feeding practices, illnesses of the mother and infant and growth trajectory is collected through personal interviews, anthropometric measures and medical records and local health management system records retrieval. Multilevel mixed regression models, adjusted for clustering, will be applied to investigate the association between various exposure variables of interest and the longitudinal outcomes, taking into account the correlated data structure and the nesting of observations. Kaplan-Meier test and Cox regression analysis will be used to analyse the time-to-event data. ETHICS AND DISSEMINATION Ethical approval has been obtained from the ethics committee of West China School of Public Health, Sichuan University and the Human Research Ethics Committee of Curtin University. Results will be presented at national and international conferences and published in peer-reviewed journals.
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Affiliation(s)
- Li Tang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiong-Fei Pan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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The realization of BFHI Step 4 in Finland - Initial breastfeeding and skin-to-skin contact according to mothers and midwives. Midwifery 2017; 50:27-35. [PMID: 28384552 DOI: 10.1016/j.midw.2017.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Breastfeeding and skin-to-skin contact are the best start for infant life. Breastfeeding ensures the best trajectory for development and growth while preventing many diseases later in life. It is recommended that initial breastfeeding occur during the first hour and that generally exclusive breastfeeding is adopted during the first six months. OBJECTIVE The aim of this study is to describe how initial breastfeeding and skin-to-skin contact (Step 4 of the BFHI) is implemented in Finnish maternity hospitals as well as to explain the factors connected to it. The information can be used to develop maternity care during the immediate postpartum period. DESIGN Cross-sectional study. METHODS The data were collected from mothers who had given birth as well as their midwives via questionnaire during the spring of 2014 during one week at eight maternity hospitals in Finland. The response rate was 59% for the new mothers (n=111), while it was 57% for the midwives (n=272). The data were analysed statistically and the open-ended questions in the questionnaire using content specifications. FINDINGS On the basis of the results, initial breastfeeding succeeded well after vaginal birth. Initial breastfeeding began, on average, at 41minutes of age and lasted for 51minutes. Of mothers, 87% regarded it a very positive experience. Initial breastfeeding was delayed mainly because of caesarean section and for reasons related to an infant's condition. Many background factors such as midwives' age, mothers' parity and the mode of childbirth were statistically significant in respect to the success of initial breastfeeding. CONCLUSIONS More attention should be placed on the initial breastfeeding of infants born by caesarean section and primiparous mothers.
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Gao H, Wang Q, Hormann E, Stuetz W, Stiller C, Biesalski HK, Scherbaum V. Breastfeeding practices on postnatal wards in urban and rural areas of the Deyang region, Sichuan province of China. Int Breastfeed J 2016; 11:11. [PMID: 27182280 PMCID: PMC4867090 DOI: 10.1186/s13006-016-0070-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 05/02/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the efforts that have been made to promote breastfeeding in China since the 1990s, there is still a very low prevalence of exclusive breastfeeding. The objective of this study was to assess the current situation of infant feeding practices during the postpartum hospital stay in urban and rural areas of the Deyang region. METHODS Cross-sectional sampling was used in two urban hospitals and five rural clinics in the Deyang region of southwestern China. Interviews with mothers after delivery (urban n = 102, rural n = 99) were conducted before discharge and five focus group discussions were held. RESULTS The prevalence of Caesarean section was high in both urban and rural areas (63.9 % urban vs. 68.4 % rural). After birth, nearly all mothers (98.0 % urban vs. 99.0 % rural) initiated breastfeeding. One week after delivery, the prevalence of exclusive breastfeeding was 8.0 % (9.8 % urban vs. 6.1 % rural), almost exclusive breastfeeding 34.5 % (29.4 % urban vs. 39.8 % rural), mixed feeding 56.0 % (58.8 % urban vs. 53.1 % rural), and exclusive formula feeding 1.5 % (2.0 % urban vs. 1.0 % rural). Breastfeeding initiation (≤ two days after birth) was positively associated (Odds Ratio [OR] 1.97, 95 % Confidence Interval [CI] 1.11, 3.50) with exclusive and almost exclusive breastfeeding, whereas birth length under 50 cm (OR 0.48, 95 % CI 0.26, 0.87), mother's education > 12 years (OR 0.46, 95 % CI 0.24, 0.88) and mother's lack of knowledge about the importance of colostrum (OR 0.35, 95 % CI 0.14, 0.86) were negatively associated with almost exclusive breastfeeding. CONCLUSION Although disparities between urban and rural areas exist, the situation of infant feeding is inadequate in both settings. The high prevalence of Caesarean section, the mothers' poor knowledge of the physiology of breast milk production, the mothers' lack of breastfeeding confidence, the widespread advertising of breast milk substitutes, and the changing perception of the function of breasts, may influence the unfavorable breastfeeding behavior observed in the study area.
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Affiliation(s)
- Haoyue Gao
- />Institute of Social Science in Agriculture (430b), University of Hohenheim, Museumsfluegel, Stuttgart, 70599 Germany
| | - Qi Wang
- />Medical Society of Deyang City, Sichuan, Public Health Bureau of Deyang, Lushan Nan Road No. 299, Jingyang District, Deyang, 618000 China
| | - Elizabeth Hormann
- />Europäisches Institut für Stillen und Laktation, Wittberg 14, Kramsach, 6233 Austria
| | - Wolfgang Stuetz
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
| | - Caroline Stiller
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
| | - Hans Konrad Biesalski
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
- />Food Security Center (793), University of Hohenheim, Wollgrasweg 43, Stuttgart, 70599 Germany
| | - Veronika Scherbaum
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
- />Food Security Center (793), University of Hohenheim, Wollgrasweg 43, Stuttgart, 70599 Germany
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Affiliation(s)
- Colin Binns
- Curtin University, Perth, Western Australia, Australia
| | - Wah-Yun Low
- University of Malaya, Kuala Lumpur, Malaysia
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24
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Factors associated with breastfeeding duration: a prospective cohort study in Sichuan Province, China. World J Pediatr 2015; 11:232-8. [PMID: 25410668 DOI: 10.1007/s12519-014-0520-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends exclusive breastfeeding for 6 months and continued breastfeeding thereafter with appropriate complementary foods for at least 2 years or longer. This study aimed to determine the factors associated with breastfeeding duration in Sichuan Province of China. METHODS A prospective longitudinal study of 695 women, with a follow-up response rate of 71.9%, was conducted in Jiangyou, Sichuan Province in the period of 2010-2011. Participants were interviewed at discharge and followed up by telephone at 1, 3, 6 and 12 months postpartum. Breastfeeding duration was estimated by the Kaplan-Meier method. Cox regression analyses were performed to identify factors associated with the breastfeeding duration. RESULTS The median duration of "any breastfeeding" was 8.0 [95% confidence interval (CI): 7.8, 8.2] months. Maternal age less than 25 years [adjusted hazard ratio (HR): 1.61; 95% CI: 1.32, 1.96] and maternal return to work before 6 months postpartum (adjusted HR: 1.69; 95% CI: 1.32, 2.17) were associated with a shorter duration of breastfeeding. Women who delivered at hospital (adjusted HR: 1.33; 95% CI: 1.05, 1.67), introduced solid foods (adjusted HR: 1.30; 95% CI: 1.02, 1.64) and intended to stop breastfeeding within 6 months, or undecided how long to breastfeed (adjusted HR: 1.41; 95% CI: 1.16, 1.72), were more likely to terminate lactation within 1 year. CONCLUSIONS The duration of breastfeeding in Jiangyou was far below the recommendation of the WHO. Education programs targeting vulnerable subgroups of mothers should be provided in Sichuan to help them maintain breastfeeding as long as possible.
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Zhu B, Zhang J, Qiu L, Binns C, Shao J, Zhao Y, Zhao Z. Breastfeeding Rates and Growth Charts--the Zhejiang Infant Feeding Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7337-47. [PMID: 26133126 PMCID: PMC4515659 DOI: 10.3390/ijerph120707337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/04/2015] [Accepted: 06/23/2015] [Indexed: 11/17/2022]
Abstract
A randomised control trial was undertaken in Hangzhou, China, to study the influence of the growth chart used on breastfeeding rates. Mothers with infants who were being fully breastfed at 6 weeks after birth (n = 1602) were invited to participate in the trial; 1415 agreed to participate and 1295 completed the study. Two growth charts were used, one that was heavier for the first six months of life (Chart A, n = 686) and a lighter growth chart (Chart B, n = 609). Mothers were interviewed and infants measured at 6 weeks and 3, 4, 5 and 6 months after delivery. At 6 months the full breastfeeding rates were 18.1% in the group using the heavier growth chart compared to 22.8% in the lighter growth chart group. After adjusting for potential confounders this difference remained significant (aOR 1.41, 95% confidence intervals 1.02, 1.93). These results suggest that breastfeeding rates may be influenced by the type of growth chart used. Mothers who perceive that their infants are not growing adequately (i.e., using the heavier charts) may introduce other foods to their infants earlier than mothers using the lighter chart. While a larger trial is required to confirm the results, in the interim it is suggested that if heavier growth charts are used, a lower percentile line could be used to assess adequacy of growth.
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Affiliation(s)
- Bingquan Zhu
- Children’s Hospital, Zhejiang University, Hangzhou, Zhejiang 310006 China; E-Mails: ispring2003@ 163.com (B.Z.); (J.Z.); (J.S.)
| | - Jian Zhang
- Children’s Hospital, Zhejiang University, Hangzhou, Zhejiang 310006 China; E-Mails: ispring2003@ 163.com (B.Z.); (J.Z.); (J.S.)
| | - Liqian Qiu
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, China; E-Mail:
| | - Colin Binns
- School of Public Health, Curtin University, Perth 6102, Australia; E-Mail:
| | - Jie Shao
- Children’s Hospital, Zhejiang University, Hangzhou, Zhejiang 310006 China; E-Mails: ispring2003@ 163.com (B.Z.); (J.Z.); (J.S.)
| | - Yun Zhao
- School of Public Health, Curtin University, Perth 6102, Australia; E-Mail:
| | - Zhengyan Zhao
- Children’s Hospital, Zhejiang University, Hangzhou, Zhejiang 310006 China; E-Mails: ispring2003@ 163.com (B.Z.); (J.Z.); (J.S.)
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Zhang K, Tang L, Wang H, Qiu L, Binns CW, Lee AH. Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4520-32. [PMID: 25918908 PMCID: PMC4454923 DOI: 10.3390/ijerph120504520] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 12/28/2022]
Abstract
In China the exclusive breastfeeding rate remains low and infant formula is widely used. This study aimed to elicit and compare mothers' and hospital staff perceptions of the reasons that shaped mothers' decision to formula feed. In-depth interviews with 50 mothers, and four focus group discussions with 33 hospital staff, were conducted in Hangzhou and Shenzhen in November 2014. Responses given by the mothers and hospital staff showed a number of commonalities. The perception of "insufficient breast milk" was cited by the majority of women (n = 37, 74%) as the reason for formula feeding. Mothers' confidence in breastfeeding appears to be further reduced by maternal mothers or mothers-in-law's and "confinement ladies" misconceptions about infant feeding. Inadequate breastfeeding facilities and limited flexibility at their workplace was another common reason given for switching to formula feeding. A substantial proportion of mothers (n = 27, 54%) lacked an understanding of the health benefits of breastfeeding. Antenatal education on breastfeeding benefits for expectant mothers and their families is recommended. Moreover, mothers should be provided with breastfeeding support while in hospital and be encouraged to seek professional assistance to deal with breastfeeding problems after discharge. Employers should also make work environments more breastfeeding-friendly.
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Affiliation(s)
- Ke Zhang
- Women's Hospital, Zhejiang University, Hangzhou, Zhejiang 310006, China.
| | - Li Tang
- Department of Management Sciences, City University of Hong Kong, Hong Kong 999077, China.
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Hong Wang
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong 518038, China.
| | - Liqian Qiu
- Women's Hospital, Zhejiang University, Hangzhou, Zhejiang 310006, China.
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
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Adhikari M, Khanal V, Karkee R, Gavidia T. Factors associated with early initiation of breastfeeding among Nepalese mothers: further analysis of Nepal Demographic and Health Survey, 2011. Int Breastfeed J 2014; 9:21. [PMID: 25493094 PMCID: PMC4260185 DOI: 10.1186/s13006-014-0021-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 11/15/2014] [Indexed: 11/16/2022] Open
Abstract
Background Timely initiation of breastfeeding has been reported to reduce neonatal mortality by 19.1%. The World Health Organisation recommends early initiation of breastfeeding i.e. breastfeeding a newborn within the first hour of life. Knowledge on the rate and the determinants of early initiation of breastfeeding may help health program managers to design and implement effective breastfeeding promotion programs. The aim of this study was to determine the rate and the determinants of early initiation of breastfeeding in Nepal. Methods This study used the data from Nepal Demographic and Health Survey (NDHS) 2011 which is a nationally representative sample study. Chi square test and multiple logistic regression analysis were used to examine the factors associated with early initiation of breastfeeding (within one hour of birth). Results Of 4079 mothers, 66.4% initiated breastfeeding within one hour of delivery. Mothers with higher education (Odds Ratio (OR) 2.56; 95% CI : 1.26, 5.21), mothers of disadvantaged Janjati ethnicity (OR 1.43; 95% CI : 1.04, 1.94), mothers who were involved in agriculture occupation (OR 1.51; 95% CI : 1.16, 1.97), mothers who delivered in a health facility (OR 1.67; 95% CI : 1.25, 2.23), whose children were large at birth (OR 1.46; 95% CI : 1.07, 1.99) were more likely to initiate breastfeeding within the first hour of child birth. Conclusions Results suggest that two thirds of children in Nepal were breastfed within the first hour after birth. Although there was a higher prevalence of early initiation of breastfeeding among mothers who delivered in health facilities compared to mothers who delivered at home, universal practice of early initiation of breastfeeding should be a routine practice. The findings suggest the need of breastfeeding promotion programs among the mothers who are less educated, and not working. Such breastfeeding promotion programmes could be implemented via Nepal’s extensive network of community-based workers.
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Affiliation(s)
- Mandira Adhikari
- Women's Health Project, Population Services International, Nawalparasi, Nepal
| | - Vishnu Khanal
- Independent Consultant, Kathmandu, Nepal ; School of Public Health, Curtin University, Perth, Australia
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Tania Gavidia
- Centre for International Health, Curtin University, Perth, Australia
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Tang L, Lee AH, Binns CW, Yang Y, Wu Y, Li Y, Qiu L. Widespread usage of infant formula in China: a major public health problem. Birth 2014; 41:339-43. [PMID: 25229829 DOI: 10.1111/birt.12132] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The potential health risks of infant formula feeding are well established. This study investigated the opinions and perceptions of mothers and recommendations by hospital staff with respect to infant formula usage in China. METHODS A cross-sectional survey of 726 mothers within 6 months postpartum and 241 hospital staff, using structured questionnaires, was conducted in Hangzhou and Shenzhen, China. RESULTS Overall, 474 of 726 (65.3%) infants aged within 6 months had consumed some infant formula. About 40.0 percent of mothers chose a hybrid brand of formula (manufactured in China but owned by a foreign company), over imported (< 32.0%) and domestic brands (< 28.0%), despite their higher level of confidence on the quality of imported brands. Perceived insufficient breastmilk production (86.2%) was the most common reason for giving infant formula, followed by return to work (24.6%). Of the 241 hospital staff, 97 (40.2%) gave no recommendation about infant formula brand for infants at any age. However, 47.2 percent of the remaining staff recommended a hybrid brand in combination with an imported and/or a domestic product. CONCLUSIONS Perceptions by mothers and recommendations from hospital staff appear to contribute to the widespread usage of infant formula in China. It is important to ensure breastmilk substitutes are prescribed to Chinese infants strictly for medical reasons. Maternal education programs incorporating information on food safety issues and establishment of breastfeeding-friendly workplaces could curtail the common practice of formula feeding in China.
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Affiliation(s)
- Li Tang
- School of Public Health, Curtin University, WA, Australia
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Karkee R, Lee AH, Khanal V, Binns CW. Initiation of Breastfeeding and Factors Associated with Prelacteal Feeds in Central Nepal. J Hum Lact 2014; 30:353-357. [PMID: 24729005 DOI: 10.1177/0890334414529845] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prelacteal feeds and delayed initiation of breastfeeding may lead to undernutrition of the infant but are still prevalent in many countries. OBJECTIVE A prospective cohort community-based study was conducted in central Nepal to ascertain the rate of early breastfeeding initiation and factors associated with the introduction of prelacteal feeds. METHODS Breastfeeding information was collected from 639 women who recently gave birth in the Kaski district of central Nepal. Backward stepwise logistic regression analysis was performed to determine factors associated with the use of prelacteal feeds. RESULTS The incidence of prelacteal feeds was 9.1%, with infant formula being the most common prelacteal food. Approximately 67% and 90% of mothers breastfed within 1 hour and 4 hours of delivery, respectively. Women who reside in urban areas (odds ratio [OR] = 2.68; 95% confidence interval [CI], 1.35-5.39), first-time mothers (OR = 2.15; 95% CI, 1.15-4.02), and those who underwent cesarean section (OR = 10.10; 95% CI, 5.47-18.67) were more likely to give prelacteal feeds to their infants. CONCLUSION The early initiation of breastfeeding with colostrum as the first feed was common in the study area. The introduction of prelacteal feeds was associated with urban residency, first-time motherhood, and cesarean delivery.
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Affiliation(s)
- Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Vishnu Khanal
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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