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Salviano AF, Guedes BM, Carioca AAF, Venancio SI, Buccini G, Lourenço BH. Positive changes in breastfeeding and complementary feeding indicators in Brazil are associated with favorable nurturing care environments. Public Health 2024; 235:33-41. [PMID: 39043006 DOI: 10.1016/j.puhe.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. STUDY DESIGN Ecological time-series study. METHODS Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends. RESULTS No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. CONCLUSIONS Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.
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Affiliation(s)
- A F Salviano
- Public Health Nutrition Program, School of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo, 01246-904, Brazil
| | - B M Guedes
- Public Health Nutrition Program, School of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo, 01246-904, Brazil
| | - A A F Carioca
- Department of Nutrition, University of Fortaleza (UNIFOR), Avenida Washington Soares 1321, Edson Queiroz, Fortaleza, Ceará, 60811-905, Brazil
| | - S I Venancio
- Institute of Health, Rua Santo Antônio 590, Bela Vista, São Paulo, 01314-000, Brazil
| | - G Buccini
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, 4505 S Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - B H Lourenço
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo, SP, 01246-904, Brazil.
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Rahmartani LD, Quigley MA, Carson C. Do various types of prelacteal feeding (PLF) have different associations with breastfeeding duration in Indonesia? A cross-sectional study using Indonesia Demographic and Health Survey datasets. BMJ Glob Health 2024; 9:e014223. [PMID: 38857945 PMCID: PMC11168184 DOI: 10.1136/bmjgh-2023-014223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/16/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Prelacteal feeding (PLF) is anything other than breastmilk given to newborns in the first few days of birth and/or before breastfeeding is established. PLF comes in many forms and is known as a challenge to optimal breastfeeding. Interestingly, both breastfeeding and PLF are common in Indonesia. This study investigated the association between PLF (any PLF, formula, honey, water and other milk) and breastfeeding duration. METHODS This study used Indonesia Demographic and Health Surveys data from 2002, 2007 and 2017. Sample sizes were 5558 (2007), 6268 (2007) and 6227 (2017) mothers whose last child was aged 0-23 months. We used Cox regression survival analysis to assess the association between PLF and breastfeeding duration, estimating hazard ratios (HR) for stopping earlier. RESULTS Overall PLF was prevalent (59%, 67% and 45% in 2002, 2007 and 2017, respectively), with formula being the most common (38%, 50% and 25%). No association between any PLF and breastfeeding duration in 2002 (HR 0.90 (95% CI 0.70 to 1.16)), but in 2007 and 2017, mothers who gave any PLF were more likely to stop breastfeeding earlier than those who did not (HR 1.33 (95% CI 1.11 to 1.61) and 1.47 (95% CI 1.28 to 1.69), respectively), especially in the first 6 months (HR 2.13 (95% CI 1.55 to 2.92) and 2.07 (95% CI 1.74 to 2.47), respectively). This association was more consistent for milk-based PLF. For example, HR in 2017 was 2.13 (95% CI 1.78 to 2.53) for prelacteal formula and 1.73 (95% CI 1.39 to 2.15) for other milk. The associations were inconsistent for the other PLF types. Prelacteal water showed no association while prelacteal honey showed some association with a longer breastfeeding duration in 2002 and 2007. CONCLUSION The impact of PLF on breastfeeding duration varied by type. While this study supports current recommendations to avoid PLF unless medically indicated, the potential consequences of different PLF types on breastfeeding outcomes should be clearly communicated to healthcare providers and mothers. Further research should explore the reasons for the high PLF prevalence in this setting.
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Affiliation(s)
- Lhuri D Rahmartani
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Michalopoulou S, Garcia AL, Wolfson L, Wright CM. Does planning to mixed feed undermine breastfeeding? MATERNAL & CHILD NUTRITION 2024; 20:e13610. [PMID: 38093405 PMCID: PMC10981487 DOI: 10.1111/mcn.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 04/01/2024]
Abstract
Continued breastfeeding is important for infants' health, but it is unclear whether mixed feeding increases the risk of breastfeeding cessation. We aimed to explore associations of mixed feeding and lactation problems with early cessation of breastfeeding. We analysed data from mothers who completed the Scottish National Maternal and Infant Feeding Survey and had previously breastfed their infants. At age 8-12 weeks, mothers (N = 1974) reported their feeding history and intentions, lactation problems and reasons for giving formula milk. The main outcome measure was cessation of breastfeeding before 6-8 weeks and time to cessation. By 6 weeks, 65% had mixed fed at some point, 32% had ceased breastfeeding, 22% were currently mixed feeding and 46% were exclusively breastfeeding. Lactation problems before 2 weeks were common (65%), and strongly associated with stopping breastfeeding (relative risk [RR]: 3.23, 95% confidence interval [CI]: 2.0-5.3) and with mixed feeding (RR: 3.14, 95% CI: 2.5-4.0). However, even after adjustment for breastfeeding problems mothers who planned to mixed feed (RR: 3.39, 95% CI: 2.4-4.9) and those who introduced formula for practicalities (RR: 3.21, 95% CI: 2.3-4.4) were more likely to stop breastfeeding. These variables also predicted later lactation insufficiency (planned mixed feeding RR: 1.39, 95% CI: 1.0-2.0; formula for practicalities RR: 1.76, 95% CI: 1.3-2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR: 0.63, 95% CI: 0.5-0.9) but nonspecialist input was unrelated to risk of cessation (RR: 1.06, 95% CI: 0.2-4.9). In conclusion, choosing to mix feed an infant is strongly associated with stopping breastfeeding, even in the absence of lactation problems.
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Affiliation(s)
- Stamatia Michalopoulou
- Human Nutrition, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowScotlandUK
| | - Ada L. Garcia
- Human Nutrition, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowScotlandUK
| | - Linda Wolfson
- Improving Health and WellbeingScottish GovernmentGlasgowScotlandUK
| | - Charlotte M. Wright
- Human Nutrition, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowScotlandUK
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Mosquera PS, Lourenço BH, Matijasevich A, Castro MC, Cardoso MA. Prevalence and predictors of breastfeeding in the MINA-Brazil cohort. Rev Saude Publica 2024; 57Suppl 2:2s. [PMID: 38422331 PMCID: PMC10897961 DOI: 10.11606/s1518-8787.2023057005563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015-June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2-36.0) and 10.8% (95%CI: 8.9-12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19-1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23-2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44-2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15-2.52). Continued BF frequency was 67.9% (95%CI: 64.9-70.8), 29.3% (95%CI: 26.4-32.4), and 1.7% (95%CI: 0.9-2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01-1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99-7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64-4.66). CONCLUSIONS EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.
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Affiliation(s)
- Paola S. Mosquera
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
| | - Bárbara H. Lourenço
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
| | - Alicia Matijasevich
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, Brasil
| | - Marcia C. Castro
- Harvard T.H. Chan School of Public HealthDepartment of Global Health and PopulationBostonMAEstados UnidosHarvard T.H. Chan School of Public Health. Department of Global Health and Population. Boston, MA, Estados Unidos.
| | - Marly A. Cardoso
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, Brasil
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Tomori C, O'Connor DL, Ververs M, Orta-Aleman D, Paone K, Budhathoki C, Pérez-Escamilla R. Critical research gaps in treating growth faltering in infants under 6 months: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001860. [PMID: 38190356 PMCID: PMC10773941 DOI: 10.1371/journal.pgph.0001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024]
Abstract
In 2020, 149.2 million children worldwide under 5 years suffered from stunting, and 45.4 million experienced wasting. Many infants are born already stunted, while others are at high risk for growth faltering early after birth. Growth faltering is linked to transgenerational impacts of poverty and marginalization. Few interventions address growth faltering in infants under 6 months, despite a likely increasing prevalence due to the negative global economic impacts of the COVID-19 pandemic. Breastfeeding is a critical intervention to alleviate malnutrition and improve child health outcomes, but rarely receives adequate attention in growth faltering interventions. A systematic review and meta-analysis were undertaken to identify and evaluate interventions addressing growth faltering among infants under 6 months that employed supplemental milks. The review was carried out following guidelines from the USA National Academy of Medicine. A total of 10,405 references were identified, and after deduplication 7390 studies were screened for eligibility. Of these, 227 were assessed for full text eligibility and relevance. Two randomized controlled trials were ultimately included, which differed in inclusion criteria and methodology and had few shared outcomes. Both studies had small sample sizes, high attrition and high risk of bias. A Bangladeshi study (n = 153) found significantly higher rates of weight gain for F-100 and diluted F-100 (DF-100) compared with infant formula (IF), while a DRC trial (n = 146) did not find statistically significant differences in rate of weight gain for DF-100 compared with IF offered in the context of broader lactation and relactation support. The meta-analysis of rate of weight gain showed no statistical difference and some evidence of moderate heterogeneity. Few interventions address growth faltering among infants under 6 months. These studies have limited generalizability and have not comprehensively supported lactation. Greater investment is necessary to accelerate research that addresses growth faltering following a new research framework that calls for comprehensive lactation support.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Population, Johns Hopkins University Bloomberg School of Public Health, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Deborah L O'Connor
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Mija Ververs
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Dania Orta-Aleman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katerina Paone
- Department of Social and Behavioral Health, Yale University School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Health, Yale University School of Public Health, Yale University, New Haven, Connecticut, United States of America
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Liu L, Wu Y, Xian X, Feng J, Mao Y, Balakrishnan S, Weber AM, Darmstadt GL, Chen Y, Sylvia S, Zhou H, Rozelle S. In-Hospital Formula Feeding Hindered Exclusive Breastfeeding: Breastfeeding Self-Efficacy as a Mediating Factor. Nutrients 2023; 15:5074. [PMID: 38140332 PMCID: PMC10746093 DOI: 10.3390/nu15245074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Breastfeeding self-efficacy (BSE), defined as a mother's confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.
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Affiliation(s)
- Lu Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (L.L.); (Y.W.); (X.X.)
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (L.L.); (Y.W.); (X.X.)
| | - Xiannan Xian
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (L.L.); (Y.W.); (X.X.)
| | - Jieyuan Feng
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA; (J.F.); (S.R.)
| | - Yuping Mao
- Department of Communication Studies, College of Liberal Arts, California State University Long Beach, Long Beach, CA 90840, USA;
| | - Siva Balakrishnan
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV 89503, USA; (S.B.)
| | - Ann M. Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV 89503, USA; (S.B.)
| | - Gary L. Darmstadt
- Department Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Yunwei Chen
- Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Y.C.); (S.S.)
| | - Sean Sylvia
- Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Y.C.); (S.S.)
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (L.L.); (Y.W.); (X.X.)
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA; (J.F.); (S.R.)
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Nurokhmah S, Middleton L, Februhartanty J, Hendarto A. Trends and determinants of early initiation of breastfeeding in Indonesia: A multivariate decomposition analysis. PLoS One 2023; 18:e0294900. [PMID: 38015943 PMCID: PMC10684084 DOI: 10.1371/journal.pone.0294900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF) is key to reducing neonatal morbidity and mortality, however, little is known about the determinants of the trends of EIBF prevalence in Indonesia. This study aims to assess the contributing factors to the changes in the prevalence of EIBF between 2007 and 2017. METHODS We analysed data from the 2007, 2012, and 2017 Indonesia Demographic and Health Surveys to estimate the trends in EIBF. A multivariate logistic decomposition model was fitted to examine variables associated with changes in the percentage of EIBF from 2007 to 2017. The contributing factors to changes in EIBF prevalence were categorized into either compositional or behavioural changes, with each of them divided into portions or percentages of contribution (pct) of the independent variables. The former refers to the changes in the distribution of samples, while the latter refers to the changes in the behavioural responses toward EIBF in both surveys. All analyses accounted for the complex study design and potential confounding factors. RESULTS An increase in the prevalence of EIBF from 49.9% to 56.5% was recorded between 2012 and 2017, with an overall increase of 16.9 percentage points from 2007 to 2017. At the aggregate level, the compositional differences did not significantly contribute to the changes in the percentage of EIBF, while 98.3pct (p < 0.001) was associated with changes in mothers' behavioural response towards EIBF. The composition changes in the geographical region of Sumatra, and caesarean delivery negatively contributed to the changes in EIBF prevalence with -0.6pct and -14.2pct, respectively. However, the compositional differences in those living in Kalimantan & Sulawesi, first-time mothers, and small-born infants positively contributed to the change. Behaviour changes in mothers with higher education (8.8pct), from higher income households (-17.5pct), and those residing in Sumatra (-8.2pct) and Kalimantan & Sulawesi (-10.2pct) significantly contributed to the upward trend in EIBF prevalence. CONCLUSIONS Almost half of the newborns experienced delayed breastfeeding initiation despite the improvement in the prevalence of EIBF. Therefore, further research and interventions on behaviour change in mother's attitudes towards EIBF, especially among those undergoing caesarean delivery, living in Kalimantan or Sulawesi, and from wealthier households, are recommended to close this gap.
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Affiliation(s)
- Siti Nurokhmah
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia Indonesia–Dr. Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
- Department of Nutrition Science, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
| | - Lucinda Middleton
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Ellengowan Drive, Australia
| | - Judhiastuty Februhartanty
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia Indonesia–Dr. Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
- South-East Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO—RECFON), Jakarta, Indonesia
| | - Aryono Hendarto
- Department of Child Health, Faculty of Medicine, Universitas Indonesia–Dr. Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
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Andresen E, Oras P, Norrman G, Målqvist M, Funkquist EL. Non-medical formula use in newborn infants still common at two Swedish hospitals after a breastfeeding support program. Acta Paediatr 2023; 112:2121-2128. [PMID: 37471522 DOI: 10.1111/apa.16914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
AIM To evaluate the effectiveness of a breastfeeding support programme on reducing infant formula use and to investigate indications for formula in newborn infants in Sweden. METHODS A quasi-experimental study design was carried out. It included 255 mother-infant pairs in a control group, who received standard care and 254 pairs in an intervention group, who took part in a breastfeeding support programme. Data were collected by reviewing patient records from two regional hospitals in Uppsala and Gotland and recruitment took place between 2017 and 2019. RESULTS Median age of mothers were 31 years (range 20-49) and median gestational age of infants were 39 + 6 weeks/days (range 37 + 0 to 42 + 4). The intervention did not reduce infant formula use. In total, 87/507 (17%) of the infants received formula. Among children receiving formula 30/87 (34%) had a medical indication, whereas 57/87 (66%) had no medical indication. Main reasons for medically indicated formula use were hypoglycaemia, 13/30 (43%), and weight loss, 13/30 (43%). Main reasons for non-medical use were mothers'/parents' wishes, 25/57 (44%) and infants' dissatisfaction, 11/57 (19%). CONCLUSION Continued efforts are needed to develop effective breastfeeding interventions with increased focus on infant formula reduction.
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Affiliation(s)
- Erika Andresen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala University, Gävle, Sweden
| | - Paola Oras
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gunilla Norrman
- The Paediatric Clinic, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Vidović Roguljić A, Zakarija-Grković I. 'She was hungry'-Croatian mothers' reasons for supplementing their healthy, term babies with formula during the birth hospitalisation. Acta Paediatr 2023; 112:2113-2120. [PMID: 37431058 DOI: 10.1111/apa.16907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023]
Abstract
AIM To explore why Croatian mothers request formula for their healthy, term newborn infants during the postnatal hospital stay. METHODS Four focus groups discussions were conducted with a total of 25 women who gave birth to healthy newborn infants, between May and June 2021 in Split, Croatia. A homogenous, non-random purposive sampling technique was used. The semi-structured interview schedule contained 15 open-ended questions. Reflexive thematic analysis was applied. RESULTS Three themes were generated. The first theme fear of hunger referred to the mothers' fears arising from difficulties in interpreting newborn infant behaviour and finding solace in giving formula. The second theme too little support-too late reflected participants' unrealised expectations of hospital staff. The third theme non-supportive communication addressed mother's need for empathy during the postpartum hospital stay. CONCLUSION Croatian mothers want to breastfeed, but often feel unsupported in doing so in the maternity hospital setting. Antenatal education of expectant mothers and training of maternity staff in breastfeeding counselling, with a strong emphasis on communication skills, as well as employment of International Board Certified Lactation Consultants and/or volunteer breastfeeding counsellors, were perceived by participants as a way to decrease mothers' requests for formula for their healthy, newborn infants.
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Bhuyan A, Fernandez A, Faerber JA, Japa I, Alvarez A, Cordero R, Tavarez I, Saballos N, Steenhoff AP. Factors Associated With Initiating Breastfeeding and Continuing it for At Least 4 Months in Consuelo, a Rural Town in the Dominican Republic. Glob Pediatr Health 2023; 10:2333794X231200207. [PMID: 37746093 PMCID: PMC10515558 DOI: 10.1177/2333794x231200207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Objective. We assessed the proportion of and factors associated with mothers initiating and continuing breastfeeding (BF) for ≥4 months in a rural town of the Dominican Republic. Methods. A survey was administered to 190 mothers of children cared for at a free clinic in Consuelo. Modified bivariate and multivariable Poisson regressions were utilized in data analysis. Results. BF was initiated in 89.5% of cases and continued ≥4 months in 81.7% of cases. Maternal education beyond secondary school [adjusted RR = 1.13, 95% CI: (1.04-1.24), 0.010], and visiting both public and private antenatal clinics [adjusted RR = 1.25; 95% CI: (1.10-1.37), 0.010] were associated with BF initiation. Public and private antenatal clinic attendance [adjusted RR = 1.01, 95% CI: (0.45-2.23), 0.020], Cesarean section [adjusted RR = 0.81, 95% CI: (0.68-0.98), 0.026], number of biological children [adjusted RR = 0.95, 95% CI: (0.90-1.00), 0.032] and maternal employment [adjusted RR = 0.89, 95% CI: (0.79-0.99), 0.048] were associated with BF continuation. Conclusions. These results provide valuable insights for targeting specific populations in future breastfeeding education interventions.
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Affiliation(s)
- Anjalee Bhuyan
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anabel Fernandez
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Niños Primeros en Salud and Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Jennifer A. Faerber
- Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Ingrid Japa
- Niños Primeros en Salud and Centro de Salud Divina Providencia, Consuelo, Dominican Republic
- Universidad Central del Este, San Pedro de Macorís, Dominican Republic
| | - Angie Alvarez
- Niños Primeros en Salud and Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Ramona Cordero
- Niños Primeros en Salud and Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Ivelisse Tavarez
- Niños Primeros en Salud and Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Nahara Saballos
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew P. Steenhoff
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Niños Primeros en Salud and Centro de Salud Divina Providencia, Consuelo, Dominican Republic
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11
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Tomori C. Global lessons for strengthening breastfeeding as a key pillar of food security. Front Public Health 2023; 11:1256390. [PMID: 37674689 PMCID: PMC10477442 DOI: 10.3389/fpubh.2023.1256390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
Breastfeeding is identified as a central pillar of food security by the World Health Organization, however globally significant challenges remain in achieving breastfeeding targets for early initiation, exclusive breastfeeding for 6 months, and continued breastfeeding for 2 years and beyond. Inadequate support in health systems, poor maternity protections and workplace policies, and insufficient regulation of commercial milk formulas, among other barriers, continue to undermine this key pillar across nations. This paper highlights the central importance of breastfeeding for food security across diverse global settings by examining three case studies: Honduras, Pakistan and the USA. The cases highlight the complex layering and intersections of key challenges that threaten breastfeeding in the era of pandemics, the climate crisis, conflict and global inequality. Lessons drawn from these case studies, combined with additional insights, reinforce the importance of multisectorial collaboration to scale up investment in creating equitable, enabling environments for breastfeeding. These structural and systems approaches can successfully strengthen the breastfeeding ecosystem to ensure greater first food system resilience in the face of global crises, which compound maternal and infant vulnerabilities. Additionally, the cases add urgency for greater attention to prioritizing breastfeeding and incorporating IYCF-E protocols into disaster preparedness and management into the policy agenda, as well as ensuring that first food security is considered in energy policy. An integrated approach to policy change is necessary to recognize and strengthen breastfeeding as a pivotal part of ensuring food security across the globe.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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12
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Neves PA, Armenta-Paulino N, Arroyave L, Ricardo LI, Vaz JS, Boccolini CS, Richter L, Peréz-Escamilla R, Barros AJ. Prelacteal feeding and its relationship with exclusive breastfeeding and formula consumption among infants in low- and middle-income countries. J Glob Health 2022; 12:04104. [PMID: 36560875 DOI: 10.7189/jogh.12.04104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Early feeding practices are important determinants of optimal feeding patterns later in life. We aimed to investigate if giving any fluids or foods other than breast milk during the first three days after birth (prelacteal feeds) affects exclusive breastfeeding and consumption of formula among children under six months of age in low and middle-income countries (LMICs). Methods We conducted a retrospective cohort study using data from 85 nationally representative Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) in LMICs (2010-2019). We considered three exposures: any prelacteal feeding (PLF), milk-based only prelacteal feeding (MLK), and water-based only prelacteal feeding (WTR), according to the DHS/MICS definition. The outcomes were exclusive breastfeeding, based on the World Health Organization definition, and consumption of formula among infants under six months of age. We used Poisson models adjusting for sociodemographic indicators, antenatal care, birth assistance, and early initiation of breastfeeding to estimate the effects of the exposures on the outcomes. Findings were grouped by each country, as well as by regions of the world and national income classification. Results We included data from 91 282 children. PLF, MLK, and WTR had a prevalence of 33.9% (95% confidence interval (CI) = 33.6-34.2), 22.2% (95% CI = 21.9-22.4), and 9.4% (95% CI = 9.2-9.6), respectively. Exclusive breastfeeding and consumption of formula had a prevalence of 35.2% (95% CI = 34.9-35.5) and 27.7% (95% CI = 27.4-28.0), respectively. In the crude analysis, children who were given PLF were 40% less likely to be exclusively breastfed (prevalence ratio (PR) = 0.60; 95% CI = 0.56-0.64) and nearly twice more likely to receive formula (PR = 1.89; 95% CI = 1.72-2.08); the direction of the associations was the same across income groups and regions of the world. In the adjusted analysis, the observed crude effects were only slightly reduced (exclusive breastfeeding - PR = 0.62; 95% CI = 0.59-0.66, consumption of formula - PR = 1.72; 95% CI = 1.59-1.85). MLK showed a stronger impact on the outcomes than PLF, especially for formula consumption (adjusted PR = 1.81; 95% CI = 1.67-1.97) and in low-income countries. WTR was only negatively associated with exclusive breastfeeding (adjusted PR = 0.69; 95% CI = 0.63-0.75), but not with formula consumption (adjusted PR = 1.09; 95% CI = 0.99-1.20). Conclusions Feeding babies prelacteal foods shortens exclusive breastfeeding duration and increases the likelihood of formula consumption in children under six months of age in LMICs. Pro-breastfeeding interventions must be prioritized during antenatal care and throughout the stay in the maternity facility to properly protect, support, and promote exclusive breastfeeding since birth.
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Affiliation(s)
- Paulo Ar Neves
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Nancy Armenta-Paulino
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Surgery and Medical and Social Sciences Department, University of Alcalá de Henares, Alcalá de Henares (Madrid), Spain
| | - Luisa Arroyave
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiza Ic Ricardo
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Juliana S Vaz
- Faculty of Nutrition, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cristiano S Boccolini
- Institute of Scientific and Technological Communication and Information in Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Linda Richter
- DSI-NRF Centre of Excellence in Child Development, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Aluísio Jd Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
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13
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Vaz JS, Gatica-Domínguez G, Neves PAR, Vidaletti LP, Barros AJD. Early initiation of breastfeeding is inversely associated with public and private c-sections in 73 lower- and middle-income countries. Sci Rep 2022; 12:21081. [PMID: 36473921 PMCID: PMC9727135 DOI: 10.1038/s41598-022-25564-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Although studies in low- and middle-income countries (LMICs) have examined the effects of c-sections on early initiation of breastfeeding (EIBF), the role of the place of birth has not yet been investigated. Therefore, we tested the association between EIBF and the type of delivery by place of birth. Data from 73 nationally representative surveys carried out in LMICs between 2010 and 2019 comprised 408,013 women aged 15 to 49 years. Type of delivery by place of birth was coded in four categories: home vaginal delivery, institutional vaginal delivery, c-section in public, and c-section in private health facilities. We calculated the weighted mean prevalence of place of birth and EIBF by World Bank country income groups. Adjusted Poisson regression (PR) was fitted taking institutional vaginal delivery as a reference. The overall prevalence of EIBF was significantly lower among c-section deliveries in public (PR = 38%; 95% CI 0.618-0.628) and private facilities (PR = 45%; 95% CI 0.54-0.566) compared to institutional vaginal deliveries. EIBF in c-sections in public facilities was slightly higher in lower-middle (PR = 0.650, 95% CI 0.635-0.665) compared to low (PR = 0.544, 95% CI 0.521-0.567) and upper-middle income countries (PR = 0.612, 95% CI 0.599-0.626). EIBF was inversely associated with c-section deliveries compared to institutional vaginal deliveries, especially in private facilities compared to public ones.
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Affiliation(s)
- Juliana S. Vaz
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil ,grid.411221.50000 0001 2134 6519Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | - Giovanna Gatica-Domínguez
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
| | - Paulo A. R. Neves
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
| | - Luís Paulo Vidaletti
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
| | - Aluísio J. D. Barros
- grid.411221.50000 0001 2134 6519International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3rd Floor, Pelotas, RS 96020-220 Brazil
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14
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Pérez-Escamilla R. What Will It Take to Improve Breastfeeding Outcomes in the United States Without Leaving Anyone Behind? Am J Public Health 2022; 112:S766-S769. [PMID: 36288518 PMCID: PMC9612201 DOI: 10.2105/ajph.2022.307057] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Rafael Pérez-Escamilla
- Rafael Pérez-Escamilla is a tenured professor at the Yale School of Public Health, New Haven, CT, where he directs the Maternal Child Health Promotion Program, the Global Health Concentration, and the Office of Public Health Practice
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15
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Alayón S, Varela V, Mukuria‐Ashe A, Alvey J, Milner E, Pedersen S, Yourkavitch J. Exclusive breastfeeding: Measurement to match the global recommendation. MATERNAL & CHILD NUTRITION 2022; 18:e13409. [PMID: 35997020 PMCID: PMC9480953 DOI: 10.1111/mcn.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life. To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0–5.9 months of age, as recommended by WHO and UNICEF. This measure tends to overestimate the percentage of infants that are exclusively breastfed for the entire recommended period. We compared five methods of measuring EBF, using data from three large‐scale cross‐sectional surveys. The five methods were: the WHO/UNICEF recommended method (EBF‐24H); an estimate of EBF for 6 months, using the 24‐h recall among infants 4–5.9 and 6–7.9 months (EBF‐24H‐Pul); a since birth recall (EBF‐SB); an estimate of EBF for 6 months, using the since‐birth recall among infants 4–5.9 and 6–7.9 months (EBF‐SB‐Pul); a retrospective measure of EBF collected from infants 6–11.9 months, based on the age of introduction of liquids and foods (EBF‐AI). EBF‐24H‐Pul and EBF‐SB‐Pul produced lower estimates of EBF than other measures, while also aligning better with the WHO recommendation, but may be difficult to estimate from multipurpose surveys due to sample size limitations. The EBF‐AI method produced estimates between these, aligns well with the WHO recommendation and can be easily collected in large‐scale household surveys. Additional validation of the EBF‐24‐Pul, EBF‐SB‐Pul, and EBF‐AI methods is recommended to understand how accurately they measure EBF for the recommended 6‐month period. Exclusive breastfeeding infants for the first 6 months of life is recommended by the World Health Organization and UNICEF for the benefits it provides to both the infant and the mother. The measure currently recommended for global monitoring of exclusive breastfeeding is the prevalence of exclusive breastfeeding among infants less than 6 months, based on a 24‐h recall. Though this measure is easy to collect in large‐scale household surveys, it is often misinterpreted as the percent of infants who are fed according to the recommendation, resulting in an overestimation. Other survey‐derived measures of exclusive breastfeeding are available, for example, such as calculating the midpoint prevalence among infants 4–5.9 and 6–7.9 months, a method developed by Pullum and a since birth recall among infants aged 6–11.9 months of age. These are similarly feasible to collect in household surveys and align better with the practice of exclusive breastfeeding for 6 months as recommended by the WHO.
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Affiliation(s)
- Silvia Alayón
- USAID Advancing Nutrition Arlington Virginia USA
- Save the Children US Washington District of Columbia USA
| | - Veronica Varela
- USAID Advancing Nutrition Arlington Virginia USA
- John Snow, Inc. Arlington Virginia USA
| | - Altrena Mukuria‐Ashe
- USAID Advancing Nutrition Arlington Virginia USA
- Save the Children US Washington District of Columbia USA
| | - Jeniece Alvey
- Public Health Institute/USAID Global Health Technical Professionals Washington District of Columbia USA
| | - Erin Milner
- Public Health Institute/USAID Sustaining Technical and Analytical Resources Washington District of Columbia USA
| | - Sarah Pedersen
- Credence/USAID Global Health Technical Professionals Washington District of Columbia USA
| | - Jennifer Yourkavitch
- USAID Advancing Nutrition Arlington Virginia USA
- Results for Development Washington District of Columbia USA
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