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Di X, Ge XL, Wang D. Effect of care intervention with a health education form for breastfeeding on breast distension, pain, and lactation in postpartum mothers. World J Clin Cases 2024; 12:5059-5066. [DOI: 10.12998/wjcc.v12.i22.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Breastfeeding not only meets the nutritional needs of newborn growth and development but also promotes uterine contraction and discharge of lochia, which helps in maternal recovery. However, some mothers experience abnormal lactation and breast swelling due to a lack of breastfeeding knowledge, painful cesarean incisions, anesthesia, negative emotions, and other factors, resulting in a reduced breastfeeding rate, which adversely affects neonatal and maternal health.
AIM To explore the effects of care intervention with a health education form for breastfeeding on breastfeeding-related conditions.
METHODS In this study, 207 mothers with postpartum breast pain and difficulty lactating were selected and divided into intervention and control groups using a random number table. Both groups of mothers were provided with basic nursing and related treatment measures after delivery. The intervention group additionally received care intervention with a health education form for breastfeeding. The scores of lactation volume, breast distension and pain, breastfeeding rate, breastfeeding self-efficacy, treatment effect, and complication rate of the two groups were compared.
RESULTS After treatment, the breast pain score of the intervention group was significantly lower than that of the control group, while the lactation score, score of Breastfeeding Self-Efficacy Scale Short Form scale, parent-child communication score, maternal-infant interaction score, total score of maternal-infant communication, and breastfeeding rate of the intervention group were significantly higher than those of the control group. After intervention, the overall therapeutic effect of the intervention group was better than that of the control group, and the complication rate of the intervention group was lower than that of the control group.
CONCLUSION Breastfeeding health education and nursing intervention combined with basic clinical treatment have good clinical effects in managing postpartum breast distension and pain and increasing lactation yield.
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Affiliation(s)
- Xi Di
- Postpartum Ward, Liyang People's Hospital of Jiangsu Province, Liyang 213300, Jiangsu Province, China
| | - Xu-Ling Ge
- Health Management Center, Liyang People's Hospital of Jiangsu Province, Liyang 213300, Jiangsu Province, China
| | - Dan Wang
- Department of Obstetrics, Liyang People's Hospital, Liyang 213300, Jiangsu Province, China
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Augustino G, Anaeli A, Sunguya BF. Barriers to exclusive breastfeeding practice among HIV-positive mothers in Tanzania. An exploratory qualitative study. PLoS One 2024; 19:e0296593. [PMID: 38805480 PMCID: PMC11132465 DOI: 10.1371/journal.pone.0296593] [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: 12/19/2023] [Accepted: 05/11/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam. MATERIALS AND METHODS A case study design employing a qualitative approach was used. The study was executed at the Reproductive and Child Health (RCH) Clinic within Amana Regional Referral Hospital, Mnazi Mmoja Health Centre, and Buguruni Health Centre. Data collection ensued through the purposive sampling of healthcare providers and HIV-positive mothers, utilizing in-depth interview techniques. The textual data accrued were analyzed using inductive and deductive content analysis strategies, thereby enabling the delineation and formulation of principal thematic constructs. RESULTS The study involved interviews with twenty-seven key informants, encompassing HIV-positive mothers, nurses, clinicians, and community-based healthcare workers. The analysis of these interviews resulted in the identification of three major themes. Firstly, individual barriers to exclusive breastfeeding were delineated, encompassing sub-themes such as occupation-related hectic schedules, early motherhood-related non-compliance to safe infant feeding directives, postpartum depression, and issues related to breast sores and abscesses. Secondly, household-level barriers were identified, highlighting challenges like food insecurity and inaccessibility to key resources, the influence of male partners and family members on decision-making, and barriers arising from non-disclosure of HIV status affecting Exclusive Breastfeeding (EBF) support. Lastly, community-level barriers were explored, revealing a sub-theme related to the low retentivity of HIV-positive women in the Prevention of Mother-to-Child Transmission (PMTCT) programs. CONCLUSIONS Individual barriers encompass practical, psychological, and physical challenges, while household-level obstacles include food insecurity, limited resources, and family dynamics influencing decisions. At the community level, there's a concern about the low retentivity of HIV-positive women in PMTCT programs, indicating broader societal challenges in supporting exclusive breastfeeding. There is a need for tailored interventions at individual, household, and community levels to promote and support optimal infant feeding practices among HIV-positive women.
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Affiliation(s)
- Goodluck Augustino
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Amani Anaeli
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Bruno F. Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Aderibigbe T, Srisopa P, Henderson WA, Lucas R. Meta-ethnography on the Experiences of Women From Around the World Who Exclusively Breastfed Their Full-Term Infants. J Obstet Gynecol Neonatal Nurs 2024; 53:120-131. [PMID: 38104632 DOI: 10.1016/j.jogn.2023.11.008] [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: 05/26/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE To synthesize evidence from qualitative studies on the experiences of women from around the world who exclusively breastfed their full-term infants. DATA SOURCES CINAHL Plus, PubMed, APA PsycInfo, Scopus, and ProQuest Dissertation & Theses Global. STUDY SELECTION We selected reports of qualitative studies that were conducted in high-, middle-, and low-income countries; published between January 2001 and February 2022 in English; and focused on the experiences of women who exclusively breastfed their full-term infants. DATA EXTRACTION We extracted the following data from included studies: methodological characteristics (i.e., country of origin, authors' disciplines, research design, sample size, sampling, data collection, and data analysis method), participants' demographics (i.e., age, parity, marital status, education, and exclusive breastfeeding duration) and direct participant quotes, and key concepts and themes about women's experiences of exclusive breastfeeding. We managed and stored extracted data using a Microsoft Excel spreadsheet. DATA SYNTHESIS We synthesized reciprocal translations using Noblit and Hare's approach to meta-ethnography. Five overarching themes emerged from the meta-synthesis: Favorable Conditions, Not a Smooth Journey,Support, Determination and Perseverance, and Reflections on Benefits. CONCLUSION In the included studies, participants experienced challenges with exclusive breastfeeding; however, they also recounted benefits. We recommend 6-month maternity leave and support from family and health care professionals to improve rates of exclusive breastfeeding.
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Mgongo M, Ickes SB, Leyaro BJ, Mboya IB, Grounds S, Seiger ER, Hashim TH, Conklin JL, Kimani-Murage EW, Martin SL. Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review. Adv Nutr 2024; 15:100179. [PMID: 38246350 PMCID: PMC10877690 DOI: 10.1016/j.advnut.2024.100179] [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: 06/16/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.
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Affiliation(s)
- Melina Mgongo
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Better Health for the African Mother and Child, Moshi, Tanzania.
| | - Scott B Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States; Kenya Medical Research Institute, Nairobi, Kenya; Program in Nutritional Sciences, and Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States; Department of Kinesiology and Health Sciences, William and Mary, WIlliamsburg, VA, United States
| | - Beatrice J Leyaro
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Innocent B Mboya
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Samantha Grounds
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily R Seiger
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara H Hashim
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Jahanpour OF, Okango EL, Todd J, Mwambi H, Mahande MJ. Mapping regional variability of exclusive breastfeeding and its determinants at different infant's age in Tanzania. BMC Pregnancy Childbirth 2023; 23:769. [PMID: 37924009 PMCID: PMC10623860 DOI: 10.1186/s12884-023-06076-5] [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: 04/02/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023] Open
Abstract
INTRODUCTION Despite its numerous benefits, exclusive breastfeeding (EBF) remains an underutilized practice. Enhancing EBF uptake necessitates a focused approach targeting regions where its adoption is suboptimal. This study aimed to investigate regional disparities in EBF practices and identify determinants of EBF among infants aged 0-1, 2-3, and 4-5 months in Tanzania. METHODS This cross-sectional study utilized data from the 2015/16 Tanzania Demographic and Health Survey. A total of 1,015 infants aged 0-5 met the inclusion criteria, comprising 378 aged 0-1 month, 334 at 2-3 months, and 303 at 4-5 months. EBF practices were assessed using a 24-hour recall method. A generalized linear mixed model, with fixed covariates encompassing infant and maternal attributes and clusters for enumeration areas (EAs) and regions, was employed to estimate EBF proportions. RESULTS Regional disparities in EBF were evident among infants aged 0-1, 2-3, and 4-5 months, with decline in EBF proportions as an infant's age increases. This pattern was observed nationwide. Regional and EA factors influenced the EBF practices at 0-1 and 2-3 months, accounting for 17-40% of the variability at the regional level and 40-63% at the EA level. Literacy level among mothers had a significant impact on EBF practices at 2-3 months (e.g., women who could read whole sentences; AOR = 3.2, 95% CI 1.1,8.8). CONCLUSION Regional disparities in EBF proportions exist in Tanzania, and further studies are needed to understand their underlying causes. Targeted interventions should prioritize regions with lower EBF proportions. This study highlights the clustering of EBF practices at 0-1 and 2-3 months on both regional and EA levels. Conducting studies in smaller geographical areas may enhance our understanding of the enablers and barriers to EBF and guide interventions to promote recommended EBF practices.
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Affiliation(s)
- Ola Farid Jahanpour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
| | | | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Medical Research, Mwanza, Tanzania
| | - Henry Mwambi
- School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Michael J Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
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Gizaw AT, Sopory P, Sudhakar M. Barriers and coping responses towards infant and young child feeding practices in rural Ethiopia: a descriptive qualitative study. BMJ Open 2023; 13:e077008. [PMID: 37821129 PMCID: PMC10582866 DOI: 10.1136/bmjopen-2023-077008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To explore barriers and coping responses toward infant and young child practices (IYCFP) in rural Ethiopia. METHODS A descriptive qualitative study using semi-structured in-depth interviews and focus group discussions was conducted with 98 mothers having infants and young children aged 0-24 months in rural Ethiopia. The mothers were selected purposively by stratifying into four age groups of infants and young children in months: 0-5, 6-8, 9-12 and 13-24. Thematic analysis was performed to elucidate the main ideas regarding the barriers and coping responses to IYCFP across the participant stratum using ATLAS.ti analytical software (V.7.5.18). RESULTS Two main themes emerged from the data. First, there was a discourse on optimal IYCFP that reflects the knowledge and efforts to adhere to recommendations for early breastfeeding initiation, exclusive breast feeding for the first 6 months and introduction of complementary foods at 6 months. Second, in a discourse on struggling with everyday realities, barriers against optimal feeding practices and coping responses were presented. Mothers' responses in the four age strata as barriers to IYCFP were inadequate knowledge towards breast milk, perceived insufficiency of breast milk, beliefs, mothers' excessive workload, limited partner support, food price inflation and shortage, gender roles, dowry demand and cultural understanding of marriage. Relying on cheaper food items and backyard garden was used to cope with the barriers. CONCLUSIONS Barriers towards IYCFP are numerous which extend from intrapersonal to sociocultural factors. Therefore, reducing mothers' work burden to enable appropriate IYCFP by empowering women economically and addressing gender inequalities through collective societal approaches for promoting appropriate feeding is vital in rural communities.
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Affiliation(s)
| | - Pradeep Sopory
- Department of Communication, Wayne State University, Detroit, Michigan, USA
| | - Morankar Sudhakar
- Department of Health, Behavior Society, Jimma University, Jimma, Ethiopia
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Jahanpour OF, Todd J, Mwambi H, Okango EL, Mahande MJ. Trends of Exclusive Breastfeeding Practices and Its Determinants in Tanzania from 1999 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6904. [PMID: 37887642 PMCID: PMC10606195 DOI: 10.3390/ijerph20206904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 10/28/2023]
Abstract
Introduction: The benefits of exclusive breastfeeding (EBF) are widely reported. However, it is crucial to examine potential disparities in EBF practices across different regions of a country. Our study uses Tanzania demographic and health survey data to report on the trends of EBF across regions from 1999 to 2016, the patterns of the practice based on geographical location and socioeconomic status, and explores its determinants across the years. Methods: Descriptive statistics were used to establish the trends of EBF by geographical location and wealth quintile. A generalized linear mixed model was developed to incorporate both infant and maternal attributes as fixed covariates while considering enumeration areas and regions as clusters. The fitted model facilitated the estimation of EBF proportions at a regional level and identified key determinants influencing EBF practices across the survey periods. Moreover, we designed breastfeeding maps, visually depicting the performance of different regions throughout the surveys. Results: Across the various survey rounds, a notable regional variation in EBF practices was observed, with coastal regions generally exhibiting lower adherence to the practice. There was a linear trend between EBF and geographical residence (p < 0.05) and socioeconomic standing (p < 0.05) across the survey periods. Rural-dwelling women and those from the least affluent backgrounds consistently showcased a higher proportion of EBF. The prevalence of EBF declined as infants aged (p < 0.001), a trend consistent across all survey waves. The associations between maternal attributes and EBF practices displayed temporal variations. Furthermore, a correlation between exclusive breastfeeding and attributes linked to both regional disparities and enumeration areas was observed. The intra-cluster correlation ranged from 18% to 41.5% at the regional level and from 40% to 58.5% at the enumeration area level. Conclusions: While Tanzania's progress in EBF practices is laudable, regional disparities persist, demanding targeted interventions. Sustaining achievements while addressing wealth-based disparities and the decline in EBF with infant age is vital. The study highlights the need for broad national strategies and localized investigations to understand and enhance EBF practices across different regions and socioeconomic contexts.
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Affiliation(s)
- Ola Farid Jahanpour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London UK and National Institute for Medical Research, Mwanza P.O. Box 1708, Tanzania
| | - Henry Mwambi
- School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Elphas Luchemo Okango
- Department of Mathematical Sciences, Strathmore University, Kitale P.O. Box 850-30200, Kenya
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi P.O. Box 2240, Tanzania
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Ngao OD, Mboineki JF. Comparative study of exclusive breastfeeding practice among employed mothers and housewives in Tanzania. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:72. [PMID: 37496065 PMCID: PMC10369810 DOI: 10.1186/s41043-023-00407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is a global concern as it is associated with infant protection against gastrointestinal infections, reduces newborn mortality and prevents a child from becoming overweight or obese. Even though some studies have reported high EBF practices among housewives compared to employed mothers, the influences of practices among the two groups are little documented. OBJECTIVES The study aimed at comparing the EBF among employed mothers and housewives in Tanzania. METHODOLOGY The study was a facility-based comparative cross-sectional study, with a sample size of 246 mothers of children less than 6 months. Convenience sampling was used to select participants. Data were collected by using a validated questionnaire and analyzed by Statistical Package for Social Science, version 23, through descriptive statistics (frequency, proportion and mean) and inferential statistics (Chi-square test (χ2) and binary logistic regression). RESULTS The findings show that 106 (80.9%) of housewives had good EBF compared to 78 (67.8%) employed mothers, which was a significant difference (χ2 = 5.57; P = 0.019). One hundred and seven (81.7%) housewives had adequate knowledge of EBF compared to 84 (73%) employed mothers, but the knowledge between them was not significantly different (χ2 = 2.63; P = 0.071). For employed mothers, only age was significantly associated with EBF (χ2 = 39.49; P = 0.006), while for housewives, none of the sociodemographic characteristics was significantly associated with EBF. CONCLUSION EBF practice was higher among housewives as compared to employed mothers. Age was significantly associated with good practice of EBF among employed mothers. The effort should be strengthened to help employed mothers aged below 28 years to practice EBF. Different programs and approaches that are developed and implemented should target this age group to increase the rate of EBF.
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Affiliation(s)
- Oscar D Ngao
- Department of Nursing Management and Education, School of Nursing and Public Health, The University of Dodoma, P. O. Box 259, Dodoma, Tanzania
| | - Joanes Faustine Mboineki
- Department of Nursing Management and Education, School of Nursing and Public Health, The University of Dodoma, P. O. Box 259, Dodoma, Tanzania.
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Seabela ES, Modjadji P, Mokwena KE. Facilitators and barriers associated with breastfeeding among mothers attending primary healthcare facilities in Mpumalanga, South Africa. Front Nutr 2023; 10:1062817. [PMID: 36998907 PMCID: PMC10043338 DOI: 10.3389/fnut.2023.1062817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
IntroductionDespite the health benefits of breastfeeding for both the mother and the child, early cessation of breastfeeding remains a public health problem in South Africa, attributed to contextual barriers and facilitators. Within the context of Mpumalanga province, which is characterized by low breastfeeding rates and high infant mortality rates in children under 5 years, we explored the facilitators and barriers to breastfeeding among mothers attending the three primary health facilities in Ermelo.MethodsUsing a semi-structured interview guide suggested by the socio-ecological model, three focus group discussions and 12 in-depth interviews were conducted among mothers selected using a purposive sampling. Transcripts from audiotaped and transcribed verbatim interviews were assessed through thematic analysis using NVivo version 10.ResultsMothers were aged between 18 and 42 years and from poor sociodemographic backgrounds. At the individual level, mothers valued breastfeeding facilitated by their commitment, maintaining it, eating healthy foods, and having sufficient breast milk. However, returning to work, insufficient breast milk, misconceptions about breastfeeding, and interference with social life were the barriers for mothers to breastfeed continuously. At the interpersonal level, the family was identified as the main form of support to breastfeeding mothers; however, family interference was also identified as a barrier. At the community level, mothers shared some family beliefs and practices but were still split between societal and cultural norms and traditional beliefs as facilitators or barriers to breastfeeding. At the organizational level, most mothers valued the support provided by healthcare workers on childcare and techniques for breastfeeding at the health facilities. They did however articulate concerns on the miscommunication some healthcare workers offered regarding breastfeeding, which negatively influenced their infant feeding practices.DiscussionIntervention efforts should focus on behaviour change to educate and equip mothers to overcome the barriers that are within their control. Such interventions should further focus on family-centered education and strengthening the proficiency of healthcare workers on advising breastfeeding mothers.
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Affiliation(s)
- Ethel Sekori Seabela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- *Correspondence: Perpetua Modjadji
| | - Kebogile Elizabeth Mokwena
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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Modjadji P, Seabela ES, Ntuli B, Madiba S. Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1513. [PMID: 36674268 PMCID: PMC9864642 DOI: 10.3390/ijerph20021513] [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: 10/04/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Exclusive breastfeeding (EBF) is not a norm in many communities in South Africa despite the World Health Organizations' recommendations for EBF in the first six months of infant's life. Thus, South Africa continues to observe suboptimal and poor practices of EBF. The purpose of the study was to explore the experiences of mothers who are HIV-positive and negative on EBF and examine the extent to which initiation and sustenance of EBF is influenced by cultural beliefs, societal norms, and family norms and practices in Mpumalanga Province. Three focus group discussions and twelve in-depth interviews were conducted among thirty mothers who were purposively selected during their visits to the facilities for childcare services. Interviews were audiotaped, transcribed verbatim, and transcripts were analysed through thematic analysis using NVivo version 10. Mothers were aged between 18 and 42 years, most were unemployed and were living in poor sociodemographic backgrounds in extended family households. We found evidence of factors that influence the decision to EBF and mix feed infants among mothers. Traditional and cultural beliefs and norms that exist within their communities informed decisions mothers took to EBF. These beliefs existed alongside mothers' opinions on breastfeeding (BF) and HIV infection, as well as the fears of harming the baby through HIV infection, leading to early cessation of BF. Mothers were also advised by family members, friends, and even some healthcare workers to use traditional medicines while BF. The association of EBF with sagging breasts and weight loss as well as discomfort with public BF are personal beliefs that influenced initiation and early cessation of EBF. Breastfeeding messages ought to be context specific to improve the knowledge, understanding, acceptance and practice of EBF among HIV-positive and negative mothers. Culturally appropriate counselling messages that address the known cultural practices of the populations affected are essential to changing the beliefs and norms of the communities including extended families of EBF mothers.
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Affiliation(s)
- Perpetua Modjadji
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Ethel Sekori Seabela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Busisiwe Ntuli
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
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Nsibande DF, Magasana V, Zembe W, Kindra G, Mogashoa M, Goga A, Ramokolo V. Health facility users' knowledge, perceptions, and practices about infant feeding in the context of option B+ in South Africa: a qualitative study. Int Breastfeed J 2022; 17:89. [PMID: 36539742 PMCID: PMC9764699 DOI: 10.1186/s13006-022-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND HIV and sub-optimal infant feeding practices remain important threats to child growth, development, and survival in low- and middle-income countries. To our knowledge, few studies have explored health service users' perspective of infant feeding in the context of WHO Option B+ policy to prevent vertical HIV transmission (PMTCT). This paper is a sub-analysis of qualitative data from a mixed-methods multi-level process evaluation of Option B+ implementation in South Africa (SA). In this study we explored health facility users' infant feeding knowledge, perceptions, and practices one year after SA adopted the 2016 updated World Health Organization prevention of mother-to-child transmission of HIV Option B+ infant feeding guidelines. METHODS Nineteen focus group discussions (FGDs) were held with six groups of men and women whose infants were aged < 6 months. Participants were attending randomly selected primary health care facilities within six purposively selected priority districts. The six groups included in the FGDs were: (i) adolescent girls and young women living with HIV (WHIV), (ii) adolescent girls and young women not living with HIV (WNHIV), (iii) older postnatal WHIV (iv) older postnatal WNHIV (v) pregnant women, and (vi) men. Data collection took place between April and December 2018. Data analysis involved coding and thematic framework analysis. RESULTS Women and men have suboptimal knowledge of the recommended breastfeeding duration and exclusive breastfeeding, especially for HIV-exposed infants. Most women received sub-optimal infant feeding counselling and mixed messages from health care workers. Fewer WHIV initiated breastfeeding at birth compared to WNHIV. Most parents believed that HIV-exposed infants should be breastfed for 6 months and many postnatal women on antiretroviral drugs and younger mothers lacked confidence to breastfeed beyond 6 months. Mixed feeding was predominant among all women due to individual, family, and socio-structural barriers. Many men were supportive on infant feeding; however, they lacked the appropriate information and skills to influence their partners' infant feeding decisions. CONCLUSIONS Differences in breastfeeding practices between WHIV and WNHIV are highly influenced by the lack of knowledge of infant feeding policy recommendations. Multiple-level factors deter many mothers from adhering to recommended guidelines. Appropriate ongoing infant feeding counselling and breastfeeding support are required for women and their partners.
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Affiliation(s)
- Duduzile Faith Nsibande
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Vuyolwethu Magasana
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Wanga Zembe
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Gurpreet Kindra
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mary Mogashoa
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Ameena Goga
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa ,grid.49697.350000 0001 2107 2298Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Vundli Ramokolo
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
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Part C, Filippi V, Cresswell JA, Ganaba R, Hajat S, Nakstad B, Roos N, Kadio K, Chersich M, Lusambili A, Kouanda S, Kovats S. How do high ambient temperatures affect infant feeding practices? A prospective cohort study of postpartum women in Bobo-Dioulasso, Burkina Faso. BMJ Open 2022; 12:e061297. [PMID: 36198451 PMCID: PMC9535177 DOI: 10.1136/bmjopen-2022-061297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the effects of high ambient temperature on infant feeding practices and childcare. DESIGN Secondary analysis of quantitative data from a prospective cohort study. SETTING Community-based interviews in the commune of Bobo-Dioulasso, Burkina Faso. Exclusive breastfeeding is not widely practised in Burkina Faso. PARTICIPANTS 866 women (1:1 urban:rural) were interviewed over 12 months. Participants were interviewed at three time points: cohort entry (when between 20 weeks' gestation and 22 weeks' postpartum), three and nine months thereafter. Retention at nine-month follow-up was 90%. Our secondary analysis focused on postpartum women (n=857). EXPOSURE Daily mean temperature (°C) measured at one weather station in Bobo-Dioulasso. Meteorological data were obtained from publicly available archives (TuTiempo.net). PRIMARY OUTCOME MEASURES Self-reported time spent breastfeeding (minutes/day), exclusive breastfeeding of infants under 6 months (no fluids other than breast milk provided in past 24 hours), supplementary feeding of infants aged 6-12 months (any fluid other than breast milk provided in past 24 hours), time spent caring for children (minutes/day). RESULTS The population experienced year-round high temperatures (daily mean temperature range=22.6°C-33.7°C). Breastfeeding decreased by 2.3 minutes/day (95% CI -4.6 to 0.04, p=0.05), and childcare increased by 0.6 minutes/day (0.06 to 1.2, p=0.03), per 1°C increase in same-day mean temperature. Temperature interacted with infant age to affect breastfeeding duration (p=0.02), with a stronger (negative) association between temperature and breastfeeding as infants aged (0-57 weeks). Odds of exclusive breastfeeding very young infants (0-3 months) tended to decrease as temperature increased (OR=0.88, 0.75 to 1.02, p=0.09). There was no association between temperature and exclusive breastfeeding at 3-6 months or supplementary feeding (6-12 months). CONCLUSIONS Women spent considerably less time breastfeeding (~25 minutes/day) during the hottest, compared with coolest, times of the year. Climate change adaptation plans for health should include advice to breastfeeding mothers during periods of high temperature.
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Affiliation(s)
- Chérie Part
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jenny A Cresswell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rasmané Ganaba
- Agence de Formation de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSanté), Bobo-Dioulasso, Burkina Faso
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Britt Nakstad
- Division of Child and Adolescent Health, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Nathalie Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Kadidiatou Kadio
- Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Adelaide Lusambili
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Seni Kouanda
- Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Sari Kovats
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Arocha-Zuluaga GP, Caicedo-Velasquez B, Forero-Ballesteros LC. [Economic, social, and health determinants that influence exclusive breastfeeding in Colombia]. CAD SAUDE PUBLICA 2022; 38:e00186621. [PMID: 36169511 DOI: 10.1590/0102-311xes186621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Exclusive breastfeeding (EBF) is an important practice that offers many benefits, such as nutritional support, prevention of infectious and chronic diseases, and assistance in psychosocial and cognitive development. This study aims to identify the determinants associated with EBF abandonment in 1,527 children under six months of age, based on information collected by the Colombian National Survey of Nutritional Status and the Colombian National Demographic and Health Survey, 2010. This is an observational cross-sectional cohort study, in which a hierarchical Poisson regression model with robust variance was applied; considering in the first level the factors associated with the mother and child and, in the second level, the information of 32 departments and Bogotá. We noticed a high rate abandonment of EBF (57.6%) and its variation between departments. The factors associated with a longer time of EBF were higher maternal schooling level, having a partner, knowledge in breastfeeding, belonging to a lower level of income, living in the eastern region, having delivery assisted by qualified team, and low birth weight. According to the variance partition coefficient (VPC), 3.2% of the probability of abandonment of EBF may be related to factors within the departmental scope. The median odds ratio (MOR) indicates that the individual risk of abandoning EBF of a child would increase by 47% if the child moved from a department with a low prevalence of abandonment to a department with high prevalence. This study allows a better understanding of the abandonment of EBF from its determinants, providing evidence to implement more effective interventions for child nutrition.
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Robert RC, Feijoo BL. Beneficiary and Local Stakeholder Participation in Community-Based Nutrition Interventions. Curr Dev Nutr 2022; 6:nzac131. [PMID: 36157848 PMCID: PMC9492256 DOI: 10.1093/cdn/nzac131] [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: 10/01/2021] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Beneficiary and local stakeholder participation is an essential element to the success of community-based nutrition interventions. We sought to define active participation and review the available evidence on beneficiary and local stakeholder participation in community-based nutrition interventions in Africa. From reviewing the literature, we provide a reflective assessment on the process and findings. Participation falls on a continuum of community involvement from passive (no real involvement) to empowerment and community ownership (full active involvement). However, we found a clear gap in the research on defining active participation and identifying what constitutes active participation on behalf of beneficiaries and local stakeholders. However, progress was found; evidence included the use of participatory methods to engage beneficiaries and local stakeholders in the assessment and design phase. Beneficiary and local stakeholder participation in delivering interventions has moved forward with quantitative measures from process evaluation and implementation science. Research has started on the extent of beneficiary engagement (as recipients) and connecting this to outcomes. Evaluation has benefited from qualitative inquiry with insights from participants on engagement itself, and the barriers and facilitators to engagement. Yet questions remain in each study phase around defining and quantifying active participation and in understanding the personal, social, and motivational elements of active participation. We offer a simple framework to stimulate thought and commitment to research on participation in community-based nutrition interventions.
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Affiliation(s)
- Rebecca C Robert
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
| | - Brittany L Feijoo
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
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Moffat R, Sayer A, DeCook K, Cornia A, Linehan M, Torres S, Mulokozi G, Crookston B, Hall C, West J. A National Communications Campaign to decrease childhood stunting in Tanzania: an analysis of the factors associated with exposure. BMC Public Health 2022; 22:531. [PMID: 35303860 PMCID: PMC8932103 DOI: 10.1186/s12889-022-12930-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Childhood stunting is a major problem in Tanzania, affecting an estimated 2.7 million children under 5 years of age. The purpose of this study was to examine the factors associated with exposure to mass media (radio and television) and IPC (interpersonal communication) components integrated in a national communications campaign aiming to decrease stunting in Tanzania. Methods A cross-sectional survey was conducted among 3082 men and 4996 women dyads after the campaign. The average age of men was 34.7 years (SD = 8.9) and 28.1 years (SD = 6.9) for women. Several factors affecting exposure to the campaign were studied. Comparisons were made between radio, TV, and IPC exposure. Results Mothers who reported i) higher wealth, ii) being the primary decision-makers in the home, iii) receiving support from their husbands, iv) frequent access to radio and TV and, v) ownership of a cell phone, were more likely to report exposure to the mass media component of the communications campaign. Contrarily, the same factors were not predictors of exposure to the IPC component. Fathers who reported: i) higher wealth and education, ii) ownership of a cell phone, iii) recently listened to the radio, iv) that the mother made the decisions in the home and v) helping at home, were more likely to be exposed to the mass media component. Conclusion Significant factors affecting exposure to the communications campaign were varied but not consistent between mass media and IPC. Because of the high frequency of exposure to the campaign overall, both media and IPC components are important in a large-scale, health-related communications campaign.
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Affiliation(s)
- Ryan Moffat
- Department of Public Health, Brigham Young University, Provo, UT, USA. .,College of Dental Medicine, Roseman University, South Jordan, UT, USA.
| | - Alexis Sayer
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Kiersten DeCook
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Alise Cornia
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | | | | | | | | | - Cougar Hall
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Josh West
- Department of Public Health, Brigham Young University, Provo, UT, USA
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Ahmad RS, Sulaiman Z, Nik Hussain NH, Mohd Noor N. Working mothers' breastfeeding experience: a phenomenology qualitative approach. BMC Pregnancy Childbirth 2022; 22:85. [PMID: 35100980 PMCID: PMC8805408 DOI: 10.1186/s12884-021-04304-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background Breastfeeding practice is influenced by the mother’s attitude toward and knowledge of breastfeeding. Working mothers face many challenges and need support to maintain breastfeeding. This study aimed to explore working mothers’ breastfeeding experiences and challenges that can influenced their practices. Methods The qualitative phenomenological approach involving working mothers in Kota Bharu who fulfilled the inclusion criteria and consented to participate in the study were recruited using purposive sampling. Sixteen participants aged 24 to 46 years were interviewed using semi-structured in-depth interviews in the study. All interviews were recorded in digital audio, transcribed verbatim and analyzed using thematic analysis. Findings Three main themes emerged from the data analysis: perception of breastfeeding, challenges in breastfeeding, and support for breastfeeding. Two subthemes for perceptions were perception towards breastfeeding and towards infant formula. Challenges had two subthemes too which were related to perceived insufficient milk and breastfeeding difficulty. Where else, two subthemes for support were internal support (spouse and family) and external support (friends, employer, and healthcare staff). Conclusions Maintaining breastfeeding after return to work is challenging for working mothers and majority of them need support to continue breastfeeding practice. Support from their spouses and families’ influences working mothers’ decision to breastfeed. Employers play a role in providing a support system and facilities in the workplace for mothers to express and store breast milk. Both internal and external support are essential for mothers to overcome challenges in order to achieve success in breastfeeding. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04304-4.
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Affiliation(s)
- Rita Surianee Ahmad
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,Department of Nursing, MARA Poly-Tech College, 15050, Kota Bharu, Kelantan, Malaysia
| | - Zaharah Sulaiman
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Nik Hazlina Nik Hussain
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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Wang L, He J. Exclusive breastfeeding of full-term infants during the first 6 months after discharge from a neonatal unit in China: A cross-sectional study. Jpn J Nurs Sci 2021; 19:e12466. [PMID: 34931439 DOI: 10.1111/jjns.12466] [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: 06/21/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To elucidate breastfeeding patterns, the reasons for stopping exclusive breastfeeding, and the sociodemographic characteristics associated with exclusive breastfeeding of full-term infants during the 6 months after discharge from a neonatal unit in China. METHODS This cross-sectional study included mothers of full-term infants who were discharged from the 40-bed neonatal unit (level IIA) of a tertiary hospital in Hunan province, China between August 2019 and September 2020. Information on breastfeeding patterns was collected through telephone interviews with the mothers 6 months after their infants had been discharged from the neonatal unit. Binary logistic regression was used to determine the factors associated with exclusive breastfeeding. RESULTS This study included 489 mother-infant dyads. At 6 months after discharge, 51.5% of mothers were exclusively breastfeeding, 29.0% of mothers were partially breastfeeding, and 19.4% of mothers were not breastfeeding. The most common reason for stopping breastfeeding was "poor milk supply" (81.2%). Factors associated with exclusive breastfeeding included multiparity, exclusive breastfeeding before the hospitalization, providing breast milk to the hospitalized infant, and a high level of maternal education. CONCLUSIONS In the Chinese culture, mothers who experienced multiparity and higher-level education were more likely to breastfeed their infants to 6 months after discharge from the neonatal unit. In addition, infants who were exclusively breastfed before and during hospitalization were also more likely to be exclusively breastfed after discharge. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.
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Affiliation(s)
- Li Wang
- Nursing Department, Shenzhen University General Hospital, Shen Zhen, China
| | - Junli He
- Department of Pediatrics, Shenzhen University General Hospital, Shen Zhen, China
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Melo LCDO, Bonelli MCP, Lima RVA, Gomes-Sponholz FA, Monteiro JCDS. Anxiety and its influence on maternal breastfeeding self-efficacy. Rev Lat Am Enfermagem 2021; 29:e3485. [PMID: 34755773 PMCID: PMC8584807 DOI: 10.1590/1518-8345.5104.3485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: to identify the levels of anxiety and breastfeeding self-efficacy in
puerperal women at the intervals of 60, 120, and 180 days postpartum; and to
verify the influence of anxiety on breastfeeding self-efficacy among these
puerperal women. Method: an analytical, longitudinal and prospective study, conducted with 186
puerperal women, and which used a sociodemographic and obstetric
characterization questionnaire, the State-Trait Anxiety Inventory, and the
Breastfeeding Self-Efficacy Scale - Short Form. The analyses were performed
by means of descriptive statistics, and Fisher’s Exact Test was used. Results: most of the puerperal women presented low levels of trait anxiety (55.4%) and
of state anxiety (66.2% at 60 days, 72.8% at 120 days, and 75.5% at 180
days), and a high level of self-efficacy (77.3% at 60 days, 75.3% at 120
days, and 72.1% at 180 days of puerperium). Low levels of trait anxiety and
state anxiety were associated with high self-efficacy at 60 days (p=0.0142
and p=0.0159, respectively). Conclusion: it is necessary to pay greater attention to the mental health of puerperal
women, considering that those who presented low levels of anxiety had higher
levels of self-efficacy, a situation that can result in longer exclusive
breastfeeding.
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Affiliation(s)
- Luciana Camargo de Oliveira Melo
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Marina Cortez Pereira Bonelli
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Rosa Vanessa Alves Lima
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Juliana Cristina Dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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How do women, men, and health providers perceive interventions to influence men's engagement in maternal and newborn health? A qualitative evidence synthesis. Soc Sci Med 2021; 291:114475. [PMID: 34695645 DOI: 10.1016/j.socscimed.2021.114475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
Globally, there is growing awareness of the important contributions men can make as key stakeholders in maternal and newborn health (MNH), and increased investment in interventions designed to influence men's engagement to improve MNH outcomes. Interventions typically target men, women, couples or health providers, yet how these stakeholders perceive and experience interventions is not well understood and the fact that women may experience these interventions as disempowering has been identified as a major concern. This review aims to synthesise how women, men, and providers perceive and experience interventions designed to influence men's engagement in MNH, in order to identify perceived benefits and risks of participating in interventions, and other key factors affecting uptake of and adherence to interventions. We conducted a qualitative evidence synthesis based on a systematic search of the literature, analysing a purposive sample of 66 out of 144 included studies to enable rich synthesis. Women, men and providers report that interventions enable more and better care for women, newborns and men, and strengthen family relationships between the newborn, father and mother. At the same time, stakeholders report that poorly designed or implemented interventions carry risks of harm, including constraining some women's access to MNH services and compounding negative impacts of existing gender inequalities. Limited health system capacity to deliver men-friendly MNH services, and pervasive gender inequality, can limit the accessibility and acceptability of interventions. Sociodemographic factors, household needs, and peer networks can influence how men choose to support MNH, and may affect demand for and adherence to interventions. Overall, perceived benefits of interventions designed to influence men's engagement in MNH are compelling, reported risks of harm are likely manageable through careful implementation, and there is clear evidence of demand from women and men, and some providers, for increased opportunities and support for men to engage in MNH.
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Martin SL, Matare CR, Kayanda RA, Owoputi I, Kazoba A, Bezner Kerr R, Nnally L, Khan M, Locklear KH, Dearden KA, Dickin KL. Engaging fathers to improve complementary feeding is acceptable and feasible in the Lake Zone, Tanzania. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13144. [PMID: 34241956 PMCID: PMC8269136 DOI: 10.1111/mcn.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
In Tanzania, suboptimal complementary feeding practices contribute to high stunting rates. Fathers influence complementary feeding practices, and effective strategies are needed to engage them. The objectives of this research were to examine the acceptability and feasibility of (1) tailored complementary feeding recommendations and (2) engaging fathers in complementary feeding. We conducted trials of improved practices with 50 mothers and 40 fathers with children 6-18 months. At visit 1, mothers reported current feeding practices and fathers participated in focus group discussions. At visit 2, mothers and fathers received individual, tailored counselling and chose new practices to try. After 2 weeks, at visit 3, parents were interviewed individually about their experiences. Interview transcripts were analysed thematically. The most frequent feeding issues at visit 1 were the need to thicken porridge, increase dietary diversity, replace sugary snacks and drinks and feed responsively. After counselling, most mothers agreed to try practices to improve diets and fathers agreed to provide informational and instrumental support for complementary feeding, but few agreed to try feeding the child. At follow-up, mothers reported improved child feeding and confirmed fathers' reports of increased involvement. Most fathers purchased or provided funds for recommended foods; some helped with domestic tasks or fed children. Many participants reported improved spousal communication and cooperation. Families were able to practice recommendations to feed family foods, but high food costs and seasonal unavailability were challenges. It was feasible and acceptable to engage fathers in complementary feeding, but additional strategies are needed to address economic and environmental barriers.
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Affiliation(s)
- Stephanie L. Martin
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Cynthia R. Matare
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | - Ibukun Owoputi
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | | | | | - Maliha Khan
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kamryn H. Locklear
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
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Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13158. [PMID: 34241961 PMCID: PMC8269148 DOI: 10.1111/mcn.13158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/20/2022]
Abstract
The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.
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Affiliation(s)
- Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Juliet K. McCann
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Emily Gascoigne
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Diana Allotey
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Dadirai Fundira
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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22
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Chang YS, Li KMC, Li KYC, Beake S, Lok KYW, Bick D. Relatively speaking? Partners' and family members' views and experiences of supporting breastfeeding: a systematic review of qualitative evidence. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200033. [PMID: 33938280 PMCID: PMC8090822 DOI: 10.1098/rstb.2020.0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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Affiliation(s)
- Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Kan Yan Chloe Li
- Institute of Cardiovascular Science, University College London, London, UK
| | - Sarah Beake
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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23
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Ejie IL, Eleje GU, Chibuzor MT, Anetoh MU, Nduka IJ, Umeh IB, Ogbonna BO, Ekwunife OI. A systematic review of qualitative research on barriers and facilitators to exclusive breastfeeding practice in sub-Saharan African countries. Int Breastfeed J 2021; 16:44. [PMID: 34090461 PMCID: PMC8178897 DOI: 10.1186/s13006-021-00380-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers' perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers' perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding. METHODS A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies' quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically. RESULTS After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study's limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers' understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761. CONCLUSIONS This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.
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Affiliation(s)
- Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria. .,Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Nigeria.
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.,Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Moriam Taiwo Chibuzor
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.,Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Moore Road, Calabar, Nigeria
| | - Maureen Ugonwa Anetoh
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ifeoma Blessing Umeh
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Nigeria
| | - Brian Onyebuchi Ogbonna
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Nigeria
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24
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Gebrekidan K, Plummer V, Fooladi E, Hall H. Attitudes and experiences of employed women when combining exclusive breastfeeding and work: A qualitative study among office workers in Northern Ethiopia. MATERNAL AND CHILD NUTRITION 2021; 17:e13190. [PMID: 33830656 PMCID: PMC8476428 DOI: 10.1111/mcn.13190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Evidence from different countries shows that the level of support given to mothers who return to paid employment can significantly determine the duration of exclusive breastfeeding (EBF). However, little is known about how returning to work impacts Ethiopian women's EBF practice. The aim of this study was to explore women's attitudes and experiences of EBF when they returned to work. Mothers who had an infant of less than 12 months, working in government institutions in Tigray region, Ethiopia, were invited to participate in this study. Semi‐structured, face‐to‐face interviews were used to explore mothers' perspectives of the factors that influenced EBF when they returned to work. The interview data were transcribed verbatim and thematically analysed. Twenty mothers were interviewed from 10 organizations. Three themes were identified from their accounts: mother's knowledge, attitudes and practice towards breastfeeding; workplace context and employment conditions; and support received at home. Most participants were familiar with the benefits of EBF. Most participants reported that their colleagues had more positive attitudes towards breastfeeding than their managers. In almost all the workplaces, there was no specific designated breastfeeding space. Participants reported that close family members including husbands and mothers were supportive. Mothers' knowledge and attitude towards breastfeeding, workplace and employment conditions and support received at home were found to be the main factors determining the duration of EBF among employed women. Participants reported that the overall support given to breastfeeding women from their employers was insufficient to promote EBF.
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Affiliation(s)
- Kahsu Gebrekidan
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, Victoria, Australia.,School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Virginia Plummer
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, Victoria, Australia.,School of Health, Federation University Australia, Berwick, Victoria, Australia
| | - Ensieh Fooladi
- Monash Nursing and Midwifery, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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25
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Monteiro JCDS, Guimarães CMDS, Melo LCDO, Bonelli MCP. Breastfeeding self-efficacy in adult women and its relationship with exclusive maternal breastfeeding. Rev Lat Am Enfermagem 2020; 28:e3364. [PMID: 33027402 PMCID: PMC7529446 DOI: 10.1590/1518-8345.3652.3364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/05/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: to analyze the relationship between maternal self-efficacy to breastfeed and
sociodemographic, obstetric, and neonatal variables; between the duration of
exclusive breastfeeding and sociodemographic variables; and between the
breastfeeding self-efficacy and the duration of exclusive breastfeeding at
the intervals of 30, 60, and 180 days postpartum. Method: a longitudinal and prospective study conducted with 224 women. A
sociodemographic questionnaire, the Breastfeeding Self-Efficacy Scale –
Short Form, and a questionnaire on breastfeeding and child feeding were used
for collecting the data. Fisher’s exact test and Pearson’s correlation
coefficient test were used for analysis. Results: there was no association between breastfeeding self-efficacy and the duration
of exclusive breastfeeding identified at 30, 60, and 180 days. Self-efficacy
was associated with the type of delivery and complications in the postpartum
period. There was also an association between religion and exclusive
breastfeeding 30 and 60 days postpartum, and assistance with baby care and
exclusive breastfeeding at 60 days. Conclusion: It was identified that the type of delivery, complications in the postpartum
period, religion, and assistance with baby care corroborate to increase
maternal confidence in the ability to breastfeed.
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26
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Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days. Curr Dev Nutr 2020; 4:nzaa085. [PMID: 32607463 PMCID: PMC7311193 DOI: 10.1093/cdn/nzaa085] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
Fathers, grandmothers, and other family members' influence on maternal, infant, and young child nutrition (MIYCN) is widely recognized, yet synthesis of the effectiveness of engaging them to improve nutrition practices during the first 1000 d is lacking. We examined the impact of behavioral interventions to engage family members in MIYCN in low- and middle-income countries through a mixed-methods systematic review. We screened 5733 abstracts and included 35 peer-reviewed articles on 25 studies (16 with quantitative and 13 with qualitative data). Most quantitative studies focused on early breastfeeding, primarily engaging fathers or, less often, grandmothers. Most found positive impacts on exclusive breastfeeding rates and family members' knowledge and support. The few quantitative studies on complementary feeding, maternal nutrition, and multiple outcomes also suggested benefits. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Interventions engaging family members can increase awareness and build support for MIYCN, but more rigorous study designs are needed. This systematic review is registered at PROSPERO as CRD42018090273, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90273.
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Affiliation(s)
- Stephanie L Martin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juliet K McCann
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Emily Gascoigne
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana Allotey
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dadirai Fundira
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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27
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Kodish SR, Grey K, Matean M, Palaniappan U, Gwavuya S, Gomez C, Iuta T, Timeon E, Northrup-Lyons M, McLean J, Erasmus W. Socio-Ecological Factors That Influence Infant and Young Child Nutrition in Kiribati: A Biocultural Perspective. Nutrients 2019; 11:nu11061330. [PMID: 31200550 PMCID: PMC6627610 DOI: 10.3390/nu11061330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022] Open
Abstract
This study sought to elucidate the multi-level factors that influence behaviors underlying high childhood stunting and widespread micronutrient deficiencies in Kiribati. This two-phase formative research study had an emergent and iterative design using the socio-ecological model as the guiding theoretical framework. Phase 1 was exploratory while phase 2 was confirmatory. In phase 1, in-depth interviews, free lists, seasonal food availability calendar workshops, and household observations were conducted. In phase 2, focus group discussions, pile sorts, participatory workshops, and repeat observations of the same households were completed. Textual data were analyzed using NVivo software; ethnographic data were analyzed with Anthropac software for cultural domain analysis. We found a combination of interrelated structural, community, interpersonal, and individual-level factors contributing to the early child nutrition situation in Kiribati. Despite widespread knowledge of nutritious young child foods among community members, households make dietary decisions based not only on food availability and access, but also longstanding traditions and social norms. Diarrheal disease is the most salient young child illness, attributable to unsanitary environments and sub-optimal water, sanitation, and hygiene behaviors. This research underscores the importance of a multi-pronged approach to most effectively address the interrelated policy, community, interpersonal, and individual-level determinants of infant and young child nutrition in Kiribati.
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Affiliation(s)
- Stephen R Kodish
- Departments of Nutritional Sciences and Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA.
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | - Kelsey Grey
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | - Maryam Matean
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | | | | | - Caitlin Gomez
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
| | | | - Eretii Timeon
- Ministry of Health and Medical Services, Bikenibau, Republic of Kiribati.
| | | | - Judy McLean
- Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
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