Breastfeeding Practices, Demographic Variables, and Their Association with Morbidities in Children

The Association of Maternal Smoking and Drinking Changes During Pregnancy and Postpartum Breastfeeding Pattern and Duration

Objectives: To conduct a secondary data analysis of how changes in smoking and drinking during pregnancy impact status of any breastfeeding and breastfeeding duration in a national cohort. Materials and Methods: A cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System (PRAMS) data between 2009 and 2017 (n = 334,203). Univariate and multivariate analyses were conducted on the status of any breastfeeding and breastfeeding duration. Results: A dose-dependent inverse relationship was found in which women who smoked the same or more or resumed smoking during pregnancy showed the lowest likelihood and shortest duration of breastfeeding, followed by reduced smokers, quitters, and nonsmokers. Women with a history of alcohol use were significantly more likely to breastfeed compared with women without a history of alcohol use. Conclusions: The profile of smoking change during pregnancy impacts the likelihood and duration of breastfeeding in a dose-dependent and inverse manner. No such relationship was found with drinking change during pregnancy. Public Health Implications: Significant public health efforts should focus on implementing and sustaining evidence-based interventions for prenatal smoking cessation and educating providers and maternal populations on the adverse effect of postpartum alcohol exposure.

Comparing the effects of breastfeeding in the laid-back and cradle position upon the experiences of primiparous women: a parallel randomized clinical trial

BACKGROUND AND AIM

Appropriate positioning is crucial to successful breastfeeding and its continuation. Positioning can create, prevent, or correct breastfeeding problems. This study aimed to determine and compare the effects of both the laid-back and cradle positions upon the breastfeeding experiences of primiparous (cisgender) women.

METHODS

A parallel randomized clinical trial was conducted with a sample of primiparous women (n = 168) with a gestational age of between 31 and 34 weeks, referring to the perinatal clinic of Shahid Gharazi Hospital in Malayer (Hamadan Province, Iran). Participants were recruited via convenience sampling and allocated to one of two groups: intervention (laid-back position) (n = 85) and control (cradle position) (n = 83) using the random block method. Breastfeeding education was given to both groups during two sessions (weeks 31-34 and 35--37 of pregnancy) by "baby-friendly" accredited hospitals in Iran. The intervention group was instructed on how to breastfeed using the laid-back position. The control group was instructed on how to breastfeed using the cradle position. In the immediate postnatal period, breastfeeding positions were assessed in both groups. Breastfeeding experiences were measured once at the time of participants returning home and again at both 1 week and 2 weeks following birth, using the breastfeeding experience scale. Data analysis was undertaken using the SPSS software version 21. A value of P < 0.05 was considered significant.

RESULTS

No statistically significant difference was observed between the two groups in terms of concerns relating to participants nor their breasts, milk insufficiency, neonate, process, or breastfeeding experience at any time point measured. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in intervention group were 26.07 (4.533), 26.85 (3.812), and 26.65 (4.632) respectively. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in control group were 25.42 (3.315), 26.68 (3.872), and 25.41 (4.05) respectively.

CONCLUSION

There is no difference in breastfeeding experiences whether the laid-back or cradle position is used. Thus, broader education on breastfeeding and the provision of comprehensive support may be more effective in optimizing one's experience of breastfeeding.

TRIAL REGISTRATION

Registration date: 2021 July 21, Code: IRCT20180427039436N10, https://irct.ir/user/trial/57054/view.

The Effect of Breastfeeding in the First Hour and Rooming-In of Low-Income, Multi-Ethnic Mothers on In-Hospital, One and Three Month High Breastfeeding Intensity

Despite the known benefits of exclusive breastfeeding, the value of Baby-Friendly Hospital Interventions in increasing breastfeeding rates has been challenged, particularly the interventions of breastfeeding in the first hour of life and rooming-in. This study aimed to measure the association of breastfeeding in the first hour of life and rooming-in with high breastfeeding intensity of low-income, multi-ethnic mothers intending to breastfeed. A prospective, longitudinal cohort study was performed on 149 postpartum mothers who intended to breastfeed their infants. Structured interviews were performed at birth and one and three months. Breastfeeding intensity was defined as the percentage of all feedings that were breast milk, and high breastfeeding intensity was defined as a breastfeeding intensity >80%. The data were analyzed by chi-square, t-test, binary logistic regression analysis, and multivariate logistic regression analysis. Breastfeeding in the first hour was associated with increased high breastfeeding intensity in the hospital (AOR = 11.6, 95% CI = 4.7-28.6) and at one month (AOR = 3.6, 95% CI = 1.6-7.7), but not at three months. Rooming-in was associated with increased high breastfeeding intensity in the hospital (AOR 9.3, 95% CI = 3.6-23.7) and at one month (AOR = 2.4 (1.1-5.3) and three months (AOR 2.7, 95% CI 1.2-6.3). Breastfeeding in the first hour and rooming-in are associated with increasing breastfeeding and should be incorporated into practice.

Factors associated with the knowledge about breastfeeding among antenatal and postnatal women in selected rural villages of Chengalpattu, Tamil Nadu: A community-based cross-sectional study

BACKGROUND

Addressing good breastfeeding practices among antenatal and postnatal mothers is important as it helps in bringing about a positive change in the behavior, attitude, and practice with appropriate health education. Hence, this study was done to determine the awareness level of antenatal and postnatal mothers about the breastfeeding practices and benefits and identify the factors associated with it in rural Chengalpattu, Tamil Nadu, India.

MATERIALS AND METHODS

We conducted this community-based cross-sectional study among 377 antenatal and postnatal mothers in the selected rural villages of Chengalpattu between October 2019 and September 2020. Details regarding the sociodemographic characteristics and awareness/knowledge about the breastfeeding were collected using pretested semistructured questionnaire. Knowledge adequacy was summarized as proportion with 95% confidence interval (CI), and factors associated with knowledge were interpreted as adjusted prevalence ratio (aPR) with 95% CI using log-binomial regression.

RESULTS

About 19.6% (95% CI: 15.7%-24.0%) mothers had inadequate knowledge about breastfeeding. Women who were unemployed (aPR = 1.60; 95% CI: 1.02-2.51), belonging to the lower socioeconomic status (aPR = 2.62; 95% CI: 1.80-3.82), belonging to Muslim religion (aPR = 1.63; 95% CI: 1.14-2.35), and living in joint family (aPR = 1.58; 95% CI: 1.12-2.21) had significant higher risk of inadequate knowledge about breastfeeding practices compared to those who were employed, belonging to puper socioeconomic status, Hindu religion, and living in nuclear family.

CONCLUSION

We found that almost one-fifth of the antenatal and/or postnatal mothers had inadequate knowledge about the breastfeeding benefits and practices. Health education sessions are required to promote the awareness about breastfeeding during antenatal and postnatal check-ups.

Comparison of L-Shape and Side-Lying Positions on Breastfeeding Outcomes among Mothers Delivered by Cesarean Section: A Randomized Clinical Trial

Introduction: Ineffective breastfeeding techniques is one of the factors contributing to poor breastfeeding outcomes in post-cesarean mothers. To assist post-cesarean mothers to find a comfortable breastfeeding position, a trial was conducted to compare different positions of breastfeeding in these individuals.

Methods: A randomized clinical parallel trial was carried out on primipara post-cesarean mothers admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Participants were enrolled by convenience sampling technique, which was further randomized (block size= 4) and allocated to receive either "L" shape (n= 30) or side-lying (n= 30) position for breastfeeding. The assigned intervention was provided at least six times a day for four consecutive days. Data were collected using breastfeeding assessment Tool, maternal breastfeeding evaluation scale and numeric pain rating scale. Data were analyzed using SPSS software version 23.

Results: The baseline characteristics of participants in both groups were similar. The mean comparison of breastfeeding outcome and maternal satisfaction indicated no significant difference between the two positions. However, the mean scores of maternal pain were statistically significant. Hence, it was inferred that the maternal pain was significantly less in post-cesarean mothers in "L" shape compared to side-lying.

Conclusion: There is significantly less pain in post-cesarean mothers during breastfeeding in "L" shape than side-lying. Furthermore, maternal satisfaction and breastfeeding outcomes were found to be similar in both positions.

Infant and young child feeding (IYCF) practices and their determinants in two Urban districts of India

Introduction:

It is essential to maintain optimal nutrition during the early years of life when the growth rate is maximum.

Aims and Objectives:

Our study investigated the prevalence of various feeding practices. We also explored their association with different sociodemographic, biomedical variables, and childhood morbidity.

Methodology:

This was a cross-sectional community-based study. Data were collected through a questionnaire-based survey of mothers of school-going children aged 2–6 years in the districts of Anand and Vadodara, Gujarat.

Results:

A total of 367 mothers participated in the study. About 78% of the mothers did early initiation of breastfeeding within 1 h of birth, and 68% gave colostrum to the newborn. Around 30% of the mothers practiced bottle feeding, and 25% gave prelacteal feeds. Most mothers received good family support for breastfeeding (93.73%). On univariate analysis, we found the following associations of feeding practices—breastfeeding initiation with the gender of the baby (P value—0.006) and type of delivery (P value < 0.001); the duration of exclusive breastfeeding with the time difference between two deliveries (P value—0.027) and maternal age (P value—0.004); prelacteal feeds with the type of delivery (P value—0.034); feeding difficulty with the time difference between two deliveries (P value < 0.001) and breastfeeding at night with maternal education (P value—0.002). The time of the initiation of breastfeeding was associated with cough and cold episodes. No other association was found between breastfeeding variables and health indicators.

Conclusion:

Maternal age, maternal education, the time difference between two deliveries, the type of delivery, and gender of the baby were significantly associated with different Infant and Young Child Feeding (IYCF) practices. Identifying these factors might help in the development of strategies for optimizing feeding practices.

What predicts the knowledge of breastfeeding practices among late adolescent girls? evidence from a cross-sectional analysis

INTRODUCTION

Breastfeeding is one of the most effective ways to ensure infant health and survival. Inadequate breastfeeding practices, and knowledge among adolescent mothers have led to unprecedented infant and child morbidity and mortality. Given, the high global prevalence of adolescent mothers it is imperative to understand how the knowledge of breastfeeding practices operates among adolescent girls across different socio-economic settings.

MATERIALS & METHODS

Data was carried out from Understanding the Lives of Adolescents and Young Adults (UDAYA) survey, conducted in 2015-16. Descriptive statistics along with bivariate analysis was done to examine the preliminary results. For analysing the association between the binary outcome variable and other explanatory variables, binary logistic regression method was used. The explanatory variables were educational status of the respondent, media exposure, working status, ever pregnant status (only for married adolescent girls), sex and age of the household head, educational status of the head of the household, caste, religion, wealth index, residence and states.

RESULTS

About 42%, 50%, and 42% of married adolescent girls had knowledge of immediate breastfeeding, yellowish milk, and exclusive breastfeeding respectively. The odds of knowledge about immediate breastfeeding [married-AOR: 1.57; CI: 1.09-2.28 and unmarried-AOR: 1.30; CI: 1.08-1.55], yellowish milk feeding [married-AOR: 2.09; CI: 1.46-3.01 and unmarried-AOR: 1.39; CI: 1.17-1.66], and exclusive breastfeeding [married-AOR: 1.74; CI: 1.2-2.52 and unmarried-AOR: 1.46; CI: 1.22-1.76] were significantly more among adolescent girls aged 19 years old compared to 15 years old girls. Adolescent married and unmarried girls with 10 & above years of schooling were 1.82 times [AOR: 1.82; CI: 1.52-2.18] and 2.69 times [AOR: 2.69; CI: 2.08-3.47] more likely to have knowledge about immediate breastfeeding, 1.74 times [AOR: 1.74; CI: 1.45-2.09] and 2.10 times [AOR: 2.10; CI: 1.68-2.62] more likely to have knowledge about yellowish milk feeding, and 3.13 times [AOR: 3.13; CI: 2.6-3.78] and 3.87 times [AOR: 3.87; CI: 2.95-5.08] more likely to have knowledge about exclusive breastfeeding respectively than girls with no schooling.

CONCLUSION

Breastfeeding practices and interpersonal counselling from elders in the household should be encouraged. Ongoing breastfeeding promotion programs of the government should promote high education of adolescent girls. Mass media interventions should be encouraged.

Prevalence and Determinants of Early Initiation (EI), Exclusive Breastfeeding (EBF), and Prelacteal Feeding among Children Aged 0-24 Months in Slums of Pune City, in Maharashtra

Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city.A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators.Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding.Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums.

The Patterns and Social Determinants of Breastfeeding in 12 Selected Regions in China: A Population-Based Cross-Sectional Study

BACKGROUND

With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.

RESEARCH AIM

We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.

METHODS

The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.

RESULTS

The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0-5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).

CONCLUSIONS

The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

Individual breastfeeding support with contingent incentives for low-income mothers in the USA: the 'BOOST (Breastfeeding Onset & Onward with Support Tools)' randomised controlled trial protocol

INTRODUCTION

National breastfeeding rates have improved in recent years, however, disparities exist by socioeconomic and psychosocial factors. Suboptimal breastfeeding overburdens the society by increasing healthcare costs. Existing breastfeeding supports including education and peer support have not been sufficient in sustaining breastfeeding rates especially among low-income women. The preliminary outcomes of contingent incentives for breastfeeding in addition to existing support show promising effects in sustaining breastfeeding among mothers in the Special Supplemental Nutrition Programme for women, infants and children (WIC).

METHODS AND ANALYSIS

This trial uses a parallel randomised controlled trial. This trial is conducted at two sites in separate states in the USA. Mothers who were enrolled in WIC and initiated breastfeeding are eligible. Participants (n=168) are randomised into one of the two study groups: (1) standard care control (SC) group consisting of WIC breastfeeding services plus home-based individual support or (2) SC plus breastfeeding incentives (SC +BFI) contingent on demonstrating successful breastfeeding. All participants receive standard breastfeeding services from WIC, home-based individual support and assessments. Participants in SC receive financial compensation based on the number of completed monthly home visits, paid in a lump sum at the end of the 6-month intervention period. Participants in SC +BFI receive an escalating magnitude of financial incentives contingent on observed breastfeeding, paid monthly during the intervention period, as well as bonus incentives for selecting full breastfeeding food packages at WIC. The primary hypothesis is that monthly incentives contingent on breastfeeding in SC +BFI will significantly increase rates of any breastfeeding compared with SC. The primary outcome is the rate of any breastfeeding over 12 months. Randomisation is completed in an automated electronic system. Staff conducting home visits for support and assessments are blinded to study groups.

ETHICS AND DISSEMINATION

The Advarra Institutional Review Board has approved the study protocol (Pro00033168). Findings will be disseminated to our participants, scientific communities, public health officials and any other interested community members.

TRIAL REGISTRATION NUMBER

NCT03964454.

Facilitators and challenges to exclusive breastfeeding in Belagavi District, Karnataka, India

Objective

A primary objective of this study was to identify specific facilitators and challenges around exclusive breastfeeding (EBF) in our community in India, from the perspective of breastfeeding mothers and their support networks.

Methods

We conducted eight focus groups incorporating 75 women and their support networks in the Belagavi District, Karnataka State, India. We used a directed content analysis to guide the analysis.

Results

The specific facilitator that emerged as a theme, broad support for and knowledge about breastfeeding on the individual, family and community levels, was a seeming contraction to the identified specific challenge, the paradox of the common practice of supplemental feeds.

Conclusions

Despite voicing strong support for and knowledge about EBF, participants were familiar with a variety of supplemental feeding practices in their communities. In place of universal condemnation of all supplemental feeding, policy makers might consider strategies to address the most potentially dangerous of these practices.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effect of Nutrition Education on Knowledge, Complementary Feeding, and Hygiene Practices of Mothers With Moderate Acutely Malnourished Children in Uganda

BACKGROUND

Inappropriate infant and young child complementary feeding practices related to a lack of maternal knowledge contributes to an increased risk of malnutrition, morbidity, and mortality. There is a lack of data regarding the effect of nutrition education on maternal knowledge, feeding, and hygiene practices as part of a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition in low-income countries like Uganda.

OBJECTIVE

To determine whether nutrition education improves knowledge, feeding, and hygiene practices of mothers with infants and young children diagnosed with moderate acute malnutrition.

METHODS

A cross-sequential study using a pretest-posttest design included 204 mother-infant pairs conveniently sampled across 24 randomly selected clusters. Weekly nutrition education sessions were embedded in a supplementary porridge intervention for 3 months. Mean scores and proportions for knowledge, feeding, and hygiene practices were determined at baseline and end line. The difference between mean scores at the 2 time points were calculated with the paired t test analysis, while the proportions between baseline and end line were calculated using a z test analysis.

RESULTS

Mean scores for knowledge, dietary diversity, and meal frequency were higher at end line compared to baseline (P < .001). Handwashing did not improve significantly (P = .183), while boiling water to enhance water quality improved (P < .001).

CONCLUSION

Nutrition education in conjunction with a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition improved meal frequency, dietary diversity and water quality.

Breastfeeding Knowledge and Behavior Among Women Visiting a Tertiary Care Center in India: A Cross-Sectional Survey

BACKGROUND

Breastfeeding is commonly practiced by a majority of mothers in developing countries, though there are widespread misconceptions about optimal breastfeeding traditions. In addition to culturally prominent rituals and social norms, incorrect and inadequate breastfeeding knowledge is major factors for this high-risk behavior.

OBJECTIVES

To assess knowledge, attitude and practices of breastfeeding among girls and women visiting a tertiary care center in India and to find out the factors, which influence the breastfeeding behaviors.

DESIGN/METHODS

It is a cross-sectional, questionnaire-based study done among women attending outpatient and inpatient Department of Obstetrics & Gynecology of S.S. Hospital, Banaras Hindu University, India. A face-to-face interview using a pre-designed, self-administered, standardized questionnaire regarding knowledge, attitude, and practices of breastfeeding was conducted. The information was collected and analyzed using SPSS statistical software.

FINDINGS

Among 1000 women enrolled in the study, 89% were married, 25% were primiparous, and 52% were multiparous. More than 50% were illiterate, 91% unemployed, and 90% had hospital delivery. Of the total 770 mothers, only 55% received proper antenatal care during pregnancy, of which only 40% were counseled about breastfeeding. Regarding knowledge and attitude about breastfeeding, majority females (71.4%) considered breast milk as best food for a newborn, which was better in younger women <20 years (86%). Regarding breastfeeding behavior, only 45% mothers initiated breastfeeding within one hour of delivery, which was worse in home delivered mothers (25%). Most (82%) mothers fed colostrum to their babies but 27% of mothers gave pre-lacteal feeds. Illiterate mothers (56.3%), mothers with only primary education (70%), and unemployed mothers (53.85%) continued to do exclusive breastfeeding without initiating complementary feeds even after six months.

CONCLUSION(S)

Although breastfeeding is practiced by a majority of mothers in a developing country like India, there is a significant gap in knowledge and optimal breastfeeding behaviors. Healthy breastfeeding behavior can be encouraged among mothers by proper counseling by health care workers and organizing educational programs focusing women especially with low education and limited resources.

Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses

OBJECTIVE

To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia.

DESIGN

A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle-Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done.

SETTING

All observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver's age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver's age (OR=1·09; 95 % CI 0·84, 1·41).

CONCLUSIONS

There was no association between maternal/caregiver's age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.

Barriers to exclusive breastfeeding in rural community of central Gujarat, India

Context:

Exclusive breastfeeding (EBF) in first the 6 months of life is the most effective way to satisfy nutritional and psychological needs of a baby. However, EBF rate for India remained low at 54.9% during 2015–2016. It is therefore essential to understand the reasons for such a low EBF rate in the country so that appropriate interventions can be developed and implemented.

Objectives:

(1) To estimate the prevalence of EBF in rural community of central Gujarat and (2) to identify barriers to EBF in this community.

Materials and Methods:

A community-based cross sectional study was conducted among mothers of 330 infants of age 6 months to 1 year using pretested questionnaire. Two-stage cluster sampling technique was used to select the sample. χ² test, t-test, and logistic regression were applied to assess the significance of associations.

Results:

EBF rate in the studied population was detected to be 49.7%. Early marriage of parents, less educated parents, male child, Christian religion, working mother, less number of antenatal visits, operative delivery, late initiation of breastfeeding, not feeding colostrum, lack of knowledge about EBF, and poor counseling of mother regarding EBF were identified as barriers to EBF.

Conclusion:

Prevalence of EBF was found to be lower than the national average in the rural community of central Gujarat. Effective strategies at local, state, and national levels should aim at addressing the barriers to EBF that are identified in this study.

Assessment of initiation of breastfeeding practice in Kassala, Eastern Sudan: a community-based study

Background

The World Health Organization (WHO) encourages early initiation of breastfeeding within the first hour after birth with the objective of saving children’s lives. There are few published research papers about factors associated with the initiation of breastfeeding in Sudan.

The aim of this study was to investigate the prevalence of and factors associated with the timely initiation of breastfeeding among mothers with children two years and under in Kassala, Eastern Sudan.

Methods

A community-based cross-sectional study was conducted from December 2016 to March 2017. Mothers were interviewed using a structured questionnaire.

Results

A total of 250 mother-child pairs participated in the study. The mean (standard deviation) of maternal age and children’s age was 27.1 (5.68) years and 11.9 (6.9) months, respectively.

Of the 250 mothers, 218 (87.2%) initiated breastfeeding within the first hour. In multivariable logistic regression analysis, factors associated with the delay of breastfeeding initiation were having a male baby (Adjusted Odds Ratio [AOR] 3.90, 95% Confidence Interval [CI]1.33, 11.47), and mothers with medical disorders (AOR 5.07, 95% CI 1.22, 21.16).

Conclusion

There was a high prevalence of early initiation of breastfeeding. An association with delayed initiation of breastfeeding was found amongst mothers who had medical disorders and those who had a male infant. Wherever possible, early initiation of breastfeeding should be promoted for all infants, regardless of gender.

Intention, magnitude and factors associated with bottle feeding among mothers of 0-23 months old children in Holeta town, Central Ethiopia: a cross sectional study

Background

World Health Organization (WHO) recommends that bottle feeding should be avoided for infant and young child feeding since it has an impact on optimal breastfeeding, appropriate complementary feeding and bottles with a nipple are prone to contamination. The objectives of this study were to determine intention, magnitude and factors associated with bottle feeding among mothers of 0–23 months infants and children.

Methods

Community based cross sectional study was conducted from February to May 2016. A total of 422 mothers who had children 0–23 months were included in the study. Systematic random sampling was used to select the study subjects. Data were collected using a pre-tested interviewer administered structured questionnaire. The data were cleaned, coded, entered in to EPI-INFO version 3.5.4, and transferred and analyzed using SPSS. Odds ratio was calculated with 95% CI to identify factors associated with bottle feeding practice. P-values less than 0.05 were considered as statistically significant.

Results

The prevalence of bottle-feeding in this study was 19.6% and another 27.6% mothers have intention of bottle feeding. Being infant age of 0–5 months [AOR = 0.27;95% CI:(0.12,0.62)] and being a housewife [AOR = 0.37;95% CI:(0.21,0.67)] were negatively associated while having three under five children [AOR = 2.77;95% CI:(1.07,7.14)], not attending PNC follow-up [AOR = 2.13;95% CI:(1.19,4.97)], lower age of mothers [AOR = 3.38;95% CI:(1.48,7.73)] and not counseled on bottle feeding [AOR = 2.18;95% CI:(1.24,3.83)] were positively associated with bottle feeding.

Conclusion

The prevalence of bottle feeding in the study area was high compared to the national prevalence of bottle feeding. Working outside home, lower maternal age, older age of children, having more than one under five children in the household, not attending PNC follow-up and not counseled on bottle feeding were found to be risk factors associated with bottle feeding practice in the study area.

Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers

BACKGROUND AND OBJECTIVE

Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers.

METHODS

A randomized, 2-arm parallel-group design, from February 2015 through February 2016. Half of the randomized participants received monthly financial incentives contingent on observed breastfeeding for 6 months (Incentive), and the other half received usual WIC services only (Control). Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled. Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $20 to $70 for a total possible of $270.

RESULTS

The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits).

CONCLUSIONS

Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.