What do Kramer's Baby-Friendly Hospital Initiative PROBIT studies tell us? A review of a decade of research

Breastfeeding experiences of patients in baby-friendly certified hospital settings: protocol for a scoping review

INTRODUCTION

The Baby-friendly Hospital Initiative is a global programme that is meant to support breastfeeding within organisations. Most of the current literature is focused on implementation and uptake of the programme; however, little is known about the patient experience of breastfeeding within these settings. By exploring this current gap in the literature, we may discover important contextual elements of the breastfeeding experience. The objective of this protocol is to provide a framework for a scoping review where we aim to understand the extent and type of evidence in relation to the patient experience of breastfeeding in Baby-friendly Hospital Initiative (BFHI)-certified settings.

METHODS AND ANALYSIS

The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The databases to be searched for relevant literature include MEDLINE, Embase, PsycINFO, CINAHL and Scopus in April 2023. A grey literature scan will include reviewing documents from professional organisations/associations. For all sources of evidence that meet the inclusion criteria, data will be extracted and presented in a table format. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Participants in this review will include any individual who delivered their baby in a BFHI-certified setting. Exploring the patient experience will involve reviewing their subjective perceptions of events related to breastfeeding. These events must occur in a BFHI-certified hospital, and therefore, home births and other outpatient settings will be excluded.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review protocol or the final review. Knowledge gained from this research will be disseminated through the primary author's PhD dissertation work, as well as manuscript publications and conference presentations.

Feeding Infants: Choice-Specific Considerations, Parental Obligation, and Pragmatic Satisficing

Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard's work critically engages with two distinct views of parental obligation that might ground such an obligation-based on maximal benefit and avoidance of significant harm-to reject an obligation to breastfeed. While agreeing with Woollard's substantive conclusion, this paper (drawing on philosophical discussion of the 'right to rear') argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one's child, but from what we call 'choice-specific' obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation-the Dual Interest view, and the Best Custodian view-to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. Finally, we argue that not only is there no general obligation to breastfeed children, but that it is often morally right not to do so. Since much advice from health institutions on this issue implies that exclusive breastfeeding on demand is the best option for all families, our argument drives the feeding debate forward by showing that this advice often misrepresents parents' moral obligations in potentially harmful ways.

Evidence for human milk as a biological system and recommendations for study design-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 4

Human milk contains all of the essential nutrients required by the infant within a complex matrix that enhances the bioavailability of many of those nutrients. In addition, human milk is a source of bioactive components, living cells and microbes that facilitate the transition to life outside the womb. Our ability to fully appreciate the importance of this matrix relies on the recognition of short- and long-term health benefits and, as highlighted in previous sections of this supplement, its ecology (i.e., interactions among the lactating parent and breastfed infant as well as within the context of the human milk matrix itself). Designing and interpreting studies to address this complexity depends on the availability of new tools and technologies that account for such complexity. Past efforts have often compared human milk to infant formula, which has provided some insight into the bioactivity of human milk, as a whole, or of individual milk components supplemented with formula. However, this experimental approach cannot capture the contributions of the individual components to the human milk ecology, the interaction between these components within the human milk matrix, or the significance of the matrix itself to enhance human milk bioactivity on outcomes of interest. This paper presents approaches to explore human milk as a biological system and the functional implications of that system and its components. Specifically, we discuss study design and data collection considerations and how emerging analytical technologies, bioinformatics, and systems biology approaches could be applied to advance our understanding of this critical aspect of human biology.

Motivational interviewing to promote interconception health: A scoping review of evidence from clinical trials

BACKGROUND

Promoting interconception health can improve birth outcomes and long-term women's health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement.

OBJECTIVE

This scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions.

METHODS

We searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features.

RESULTS

There were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes.

DISCUSSION

MI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion.

PRACTICAL VALUE

MI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.

Human milk-sharing practices and infant-feeding behaviours: A comparison of donors and recipients

Human milk sharing (HMS) is growing in popularity as an infant-feeding strategy in the United States. HMS families are a hidden population because HMS is a nonnormative and stigmatized behaviour. Thus, gaining access to HMS participants is challenging, and research on this topic remains limited. In particular, little is known about the broader infant-feeding behaviours of HMS parents. This study aimed to describe and compare the infant-feeding behaviours and HMS practices among a network of HMS donors and recipients. A detailed online survey was distributed to HMS parents in the Washington, DC region. Bivariate analyses were used to summarize the data by donor/recipient status when possible. Group differences were tested using analysis of variance for continuous variables and χ² tests for categorical variables. Donors and recipients did not differ in their sociodemographic characteristics. Recipients were significantly more likely than donors to have experienced complications of labour and delivery, traumatic birth, postpartum depression or a negative breastfeeding experience. Donors and recipients did not differ significantly in their duration of lactation or HM-feeding. Interestingly, 30% of recipients ever produced excess milk and 21% of donors ever had difficulty producing enough milk for their child. Compared with donors, recipients faced numerous maternal health challenges, but were still able to achieve a long duration of HM-feeding. HMS recipients represent a vulnerable group who may benefit from additional psychosocial and lactation support to improve their health and breastfeeding outcomes. Additional research is needed to investigate the associations between HMS participation, infant-feeding behaviours and lactation outcomes.

Motherhood in Europe: An Examination of Parental Leave Regulations and Breastfeeding Policy Influences on Breastfeeding Initiation and Duration

This study examines how European variation in breastfeeding initiation and duration rates is related to the presence of baby-friendly hospitals, the international code of marketing of breast-milk substitutes, and different constellations of maternal, paternal, and parental leave. We use Eurobarometer data (2005) to compare initiation and duration levels across 21 European countries within a multilevel regression framework. We find that countries play a significant role in determining breastfeeding through their different social policies. Breastfeeding practices across different leave regulation models differ substantially. We conclude that ongoing changes in paid maternity and parental leave length combined with uptake flexibility and paternal involvement help determine breastfeeding rates and should put infant feeding issues on governmental policy agendas across European countries.

Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities

Breastfeeding and human milk (HM) are critically important to maternal, infant and population health. This paper summarizes the proceedings of a workshop that convened a multidisciplinary panel of researchers to identify key priorities and anticipated breakthroughs in breastfeeding and HM research, discuss perceived barriers and challenges to achieving these breakthroughs and propose a constructive action plan to maximize the impact of future research in this field. Priority research areas identified were as follows: (1) addressing low breastfeeding rates and inequities using mixed methods, community partnerships and implementation science approaches; (2) improving awareness of evidence-based benefits, challenges and complexities of breastfeeding and HM among health practitioners and the public; (3) identifying differential impacts of alternative modes of HM feeding including expressed/pumped milk, donor milk and shared milk; and (4) developing a mechanistic understanding of the health effects of breastfeeding and the contributors to HM composition and variability. Key barriers and challenges included (1) overcoming methodological limitations of epidemiological breastfeeding research and mechanistic HM research; (2) counteracting 'breastfeeding denialism' arising from negative personal breastfeeding experiences; (3) distinguishing and aligning research and advocacy efforts; and (4) managing real and perceived conflicts of interest. To advance research on breastfeeding and HM and maximize the reach and impact of this research, larger investments are needed, interdisciplinary collaboration is essential, and the scientific community must engage families and other stakeholders in research planning and knowledge translation.

Effects of baby-friendly practices on breastfeeding duration in China: a case-control study

BACKGROUND

The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months.

METHODS

Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses.

RESULTS

Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included "breastfeeding within one hour after birth" (74.29% vs. 59.09%), "breastfeeding on demand" (86.48% vs. 75.00%), and "never use a pacifier" (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563).

CONCLUSIONS

These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.

Exposure to baby-friendly hospital practices and mothers' achievement of their planned duration of breastfeeding

BACKGROUND

Both breastfeeding intentions and exposure to baby-friendly hospital practices were found to be associated with a longer duration of breastfeeding. This study aims to examine the effect of exposure to baby-friendly hospital practices on mothers' achievement of their planned duration of breastfeeding.

METHODS

A total of 1011 mother-newborn pairs from the postnatal units of four public hospitals in Hong Kong were recruited. Sociodemographic data and breastfeeding intention data were collected via self-report questionnaires during the postnatal hospitalization and exposure to Baby-Friendly hospital practices were assessed through hospital records and maternal self-report. Breastfeeding status after hospital discharge was assessed through telephone follow-up for up to 12 months postnatal, or until participants were no longer breastfeeding.

RESULTS

Only 55% (n = 552) of study participants achieved their intended duration of breastfeeding. Participants with higher socioeconomic status, previous breastfeeding experience, and those who had lived in Hong Kong for less than 5 years, were more likely to achieve their planned duration of breastfeeding. Among baby-friendly hospital practices, feeding only breast milk during the hospitalization and providing information about breastfeeding support on discharge were associated with participants' achieving their individual breastfeeding intentions. After adjustment, when compared with women who experienced onebaby-friendly practice, participants who experienced six baby-friendly hospital practices were significantly more likely to achieve their planned duration of breastfeeding (adjusted odds ratio = 8.45, 95% confidence interval 3.03-23.6).

CONCLUSIONS

Nearly half of participants did not achieve their planned breastfeeding duration. Exposure to baby-friendly hospital practices, especially in-hospital exclusive breastfeeding and providing breastfeeding support information upon hospital discharge may help more mothers to achieve their individual breastfeeding goals.

Breastfeeding and the Risk of Infant Illness in Asia: A Review

Infancy remains the most vulnerable period of human life for death, illness, and establishing a lifetime trajectory of growth and health. It is estimated that there are 5.3 million deaths under five years of age worldwide and approximately 800,000 lives could be saved by improving breastfeeding rates and duration. In Asia, an estimated 300,000-350,000 child deaths could be prevented with optimal breastfeeding and the majority would be under 12 months of age. We present a systematic review of studies of infection and breastfeeding in infants in Asia and further review interactions of selected infectious diseases and breastfeeding. Initially, 2459 records of possible interest were identified, 153 full text papers were reviewed in detail, and 13 papers describing diarrhoeal disease and/or acute respiratory tract infection were selected for inclusion in the review. Additional papers were selected to discuss specific diseases and their relationship to breastfeeding. The review found that a variety of methods were used with differing definitions of breastfeeding and diseases. Overall, breastfeeding when compared to the use of infant formula, is associated with significantly lower rates of diarrhoeal disease and lower respiratory tract infection, with a reduction of 50% or more to be expected, especially in infants under six months of age. The relationship between breastfeeding and specific diseases including measles and HTLV1 were reviewed. Breastfeeding reduces some disease rates, but there remain a few conditions where breastfeeding may be contra-indicated.

Knowledge and attitudes towards breastfeeding practices: A cross-sectional survey of postnatal mothers in China

OBJECTIVE

To examine the mothers' knowledge and attitudes toward breastfeeding and highlight barriers to exclusive breastfeeding in Chinese postpartum mothers.

DESIGN

Cross sectional survey SETTING: Maternity wards of two large, multi-service teaching hospitals, Wuhan, China.

PARTICIPANTS

324 postnatal mothers completed a structured questionnaire during their stay at hospital from October 2016 to January 2017.

MEASUREMENTS AND FINDINGS

Descriptive and inferential statistics revealed that most mothers showed neutral attitude on breastfeeding and neutral knowledge level as well. The average score for the total Iowa Infant Feeding Attitude Scale (IIFAS) was 56.55±4.77 M±SD, and 10.83±2.77, M±SD for the knowledge section. The mothers who had poor knowledge were less likely to initiate breastfeeding within an hour after birth.

CONCLUSIONS

The results of this study are applicable to nurses and nurse midwives to assist in identification of women who may be at-risk to not initiate breastfeeding. Maternal positive attitude and good knowledge play key roles in the process of breastfeeding. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counselling, especially for new mothers, to improve maternal attitudes and knowledge toward breastfeeding practices.

[Maintenance of exclusive breastfeeding after three months postpartum: An experience in a health department of a Valencian Community]

AIMS

To investigate the prevalence of EBF at 3-months postpartum, and the early factors for discontinuation.

DESIGN

Observational, retrospective study.

LOCATION

Health department of La Ribera, Valencia, Spain.

PARTICIPANTS

Newborns between December 2012 to January 2017.

METHODS

Pregnant women were interviewed at postpartum and at 3 months regarding variables associated with breastfeeding initiation and continuation, matched with socio-demographic and obstetric-neonatal information.

MAIN MEASUREMENTS

Prevalence of breastfeeding at discharge and exclusive breastfeeding at 3 months. Reasons for interrupt exclusive breastfeeding. Chi-square determination between qualitative variables.

FINDINGS

One thousand three hundred and thirty-eighth women were recruited. EBF at discharge was 68.2% (913) and at 3 months 46.7% (625). EBF duration was 68.7±32.7 days (95% CI: 66.9-71.2). We found statistically significant differences between the type of breastfeeding and the variables, year of study, country of origin and parity (P<0.001, P=0.005 and P=0.05 respectively). Hypogalactia (21.8%) and lower than recommended increase in newborn weight gain (14.9%) were most frequent factors for discontinuation.

CONCLUSION

The prevalence of EBF at 3 months is low compared to other similar studies, although we see an upward trend. Belief in hypogalactia influenced the maintenance of exclusive breastfeeding.

Organizational Factors Associated With Quality Perinatal Care

Perinatal care has been recognized as an integral part of ensuring quality health care in hospitals, and the focus on perinatal care quality is increasing. The previous hospital literature has focused much attention on measuring and improving quality of care generally, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting. The perinatal literature is limited in addressing the association between organizational factors and perinatal quality. Using chart audit data for more than 10 000 maternity patients, we used multiple regression analysis to examine the association of organizational factors and perinatal quality of care. Findings show that ownership, setting (location), and hospital policy on infant feeding were statistically significant. Findings suggest that it is important that hospital boards and leaders develop and implement organizational policies to enhance perinatal quality of care.

ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Effect of breastfeeding education and support intervention (BFESI) versus routine care on timely initiation and exclusive breastfeeding in Southwest Ethiopia: study protocol for a cluster randomized controlled trial

BACKGROUND

Infant mortality rates are still high in Ethiopia. Breastfeeding is regarded as the simplest and least expensive strategy for reduction of infant mortality rates. Community-based educational and support interventions provided prenatally and postnatally are effective in increasing breastfeeding rates. However, such interventions are not widely implemented in Ethiopia. This study aims to assess the effect of breastfeeding education and support on timely initiation and duration of exclusive breastfeeding.

METHODS

A cluster-randomized controlled trial at the community level will be conducted to compare the effect of breastfeeding education and support versus routine care. The intervention will be provided by Women Development Army leaders who are already in the country's health system using a 40-h WHO breastfeeding counseling course, "Infant and Young Child Feeding Counseling: an integrated course" and the "Training of Trainers Manual for Counseling on Maternal, Infant and Young Child Nutrition" in the local language. Culturally appropriate operational packages of information will be developed for them. Using preset criteria at least 432 pregnant women in their third trimester will be recruited from 36 zones. Visits in the intervention arm include two prenatal visits and 8 postnatal visits. Supervisory visits will be conducted monthly to each intervention zone. Data will be entered into Epi-data version 3.1 and analyzed using STATA version 13.0. All analysis will be done by intention to treat analysis. We will fit mixed-effects linear regression models for the continuous outcomes and mixed-effects linear probability models for the binary outcomes with study zone as random intercept to estimate study arm difference (intervention vs. routine education) adjusted for baseline value of the outcome and additional relevant covariates. The protocol was developed in collaboration with the Jimma Zone and Mana district Health office. Ethical clearance was obtained from the Institutional Review Board of University of Oslo and Jimma University. This study is partly funded by NORAD's NORHED programme.

DISCUSSION

We expect that the trial will generate findings that can inform breastfeeding policies and practices in Ethiopia.

TRIAL REGISTRATION

ClinicalTrials.gov NCT 03030651 January 25, 2017 version 3 dated 16 July 2018.

The Baby-Friendly Hospital Initiative: increasing breastfeeding and decreasing infant mortality in Brazil

Abstract Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from the II Breastfeeding Prevalence Survey of 2008. Initially, the effect of BFHI on breastfeeding in the first hour of life, exclusive breastfeeding, and any breastfeeding based on the prevalence of the outcomes among infants born in BFHI or non-BFHI was calculated. Second, the population attributable fraction of nonbreastfeeding was estimated for late neonatal mortality, mortality by all causes and infant mortality by infections, for BFHI and non-BFHI, and the number of potentially avoidable deaths if all children were born in BFH. Results: reduction of 4.2% of late neonatal deaths due to the increase in BF prevalence in the first hour, as provided by BFHI. BFHI potentially contributed with 3.5% of all-cause deaths and 4.2% of deaths from infection by BF promotion in infants below 6 months. Conclusions: the reduction of mortality in children between 7 and 180 days in 2008 potentially attributable to BFHI through the promotion of BF indicators reinforces the importance of strengthening and expanding this initiative in Brazil to ultimately enhance child survival.

The uptake and implementation of the Baby Friendly Health Initiative in Australia

PROBLEM

Despite evidence that implementation of the Initiative has been effective in increasing breastfeeding rates and duration of breastfeeding worldwide; the uptake is low with only 70 Baby Friendly accredited maternity facilities across Australia (approximately 23% of facilities).

BACKGROUND

The Ten Steps to Successful Breastfeeding and International Code of Marketing of Breastmilk Substitutes shaped the foundation for the Initiative to implement practices that protect, promote and support breastfeeding. There is evidence that implementation of the Initiative is impacted by individual and organisational culture, organisational support, and education. Organisational change is also identified as playing an important role in the successful implementation of the Initiative. Despite policy and guideline support for the Initiative at national and state levels in Australia the uptake of the Initiative is low.

AIM

The aim of this research was to explore health practitioners' perspectives about the uptake and implementation of the Initiative in Australia.

METHODS

Semi-structured, face-to-face, telephone and Skype interviews were conducted with 12 health practitioners. Thematic analysis was used to analyse data.

RESULTS

Participants identified that the uptake and implementation of the Initiative in Australia is complex. This complexity was related to six themes: (1) policy and guideline support for the Initiative, (2) leadership support to implement the Initiative, (3) improving breastfeeding and Initiative-related knowledge, (4) improving communication between stakeholders regarding the Initiative, (5) accreditation and reaccreditation processes, and (6) implementation complexity.

CONCLUSION

Using organisational change theories as a guide to implementation of the Initiative may be useful for facilities intending to become accredited.

Baby-friendly hospital practices are associated with duration of full breastfeeding in primiparous but not multiparous Iranian women

There is evidence that the Baby-Friendly Hospital Initiative (BFHI) results in improved breastfeeding outcomes in Western countries, but little is known of its impact in Middle-Eastern countries. This study investigated the impact of BFHI practices on duration of full breastfeeding in a cohort of 700 Iranian mothers recruited between June 2014 and March 2015 from maternity hospitals in Shiraz and followed-up prospectively for 6 months. At baseline, mothers self-reported exposure to 7 of the BFHI Ten Steps to Successful Breastfeeding (Steps 3 to 9). Data on breastfeeding outcomes were collected at baseline, 1, 3, 4, and 6 months postpartum. Cox regression analysis was conducted to determine the impact of individual and cumulative BFHI Steps on the duration of full breastfeeding, defined as the number of weeks since discharge that an infant received only breast milk and no complementary formula or food. Mothers reported experiencing on average 3.9 (SD 1.13, range 1 to 7) Steps, and only 28% of infants were fully breastfed at 6 months. There was a protective inverse relationship for primiparous (p for trend = .022) but not multiparous mothers (p for trend = .069), between the number of Steps a woman was exposed to and the likelihood of her discontinuing full breastfeeding within 6 months postpartum. Greater exposure to BFHI practices potentially could increase primiparous mothers' chances of fully breastfeeding to 6 months. Continual monitoring of the BFHI Steps and repeated education of healthcare staff are required to ensure that Iranian mothers receive adequate breastfeeding support.

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature

There is no doubt regarding the multiple benefits of breastfeeding for infants and society in general. Therefore, the World Health Organization (WHO) in a conjoint effort with United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" in 1992, which became the backbone of the Baby Friendly Hospital Initiative (BFHI). Following this development, many hospitals and countries intensified their position towards creating a "breastfeeding oriented" practice. Over the past two decades, the interest increased in the BFHI and the Ten Steps. However, alongside the implementation of the initiative, extensive research continues to evaluate the benefits and dangers of the suggested practices. Hence, it is our intention to make a critical evaluation of the current BFHI and the Ten Steps recommendations in consideration of the importance of providing an evidence-based breastfeeding supported environment for our mothers and infants.

Examining Early Childhood Health Outcomes of Children Born Late Preterm in Urban Manitoba

Objective The late preterm population [34-36 weeks gestational age (GA)] is known to incur increased morbidity in the infancy stage compared to the population born at term (39-41 weeks GA). This study aimed to examine the health of these children during their early childhood years, with specific attention to the role of socioeconomic status. Methods A retrospective cohort study was conducted using data from the Manitoba Centre for Health Policy, including all live-born children born at 34-36 and 39-41 weeks GA in urban Manitoba between 2000 and 2005 (n = 28,100). Multivariable logistic regression was used to examine the association of GA with early childhood morbidity after controlling for maternal, child and family level variables. Results The late preterm population was found to have significantly greater adjusted odds of lower respiratory tract infections in the preschool years (aOR = 1.59 [1.24, 2.04]) and asthma at school age (aOR = 1.33 [1.18, 1.47]) compared to the population born at term. The groups also differed in health care utilization at ages 4 (aOR = 1.19 [1.06,1.34]) and 7 years (aOR = 1.24 [1.09, 1.42]). Additional variables associated with poor outcomes suggest that social deprivation and GA simultaneously have a negative impact on early childhood development. Conclusions for Practice Adjustment for predictors of poor early childhood development, including socioeconomic status, were found to attenuate but not eliminate health differences between children born late preterm and children born at term. Poorer health outcomes that extend into childhood have implications for practice at the population level and suggest a need for further follow-up post discharge.

Effectiveness of Baby Friendly Community Initiative (BFCI) on complementary feeding in Koibatek, Kenya: a randomized control study

Background

Appropriate infant and young child nutrition is critical for proper growth and development. In order to promote optimal nutrition at an early age, the World Health Organization (WHO) and UNICEF have developed the Baby Friendly Hospital Initiative (BFHI) to address poor breastfeeding practices in maternity wards. However, impact is limited in less developed countries like Kenya, where more than half of all births are home deliveries. Therefore, Kenya has explored the adoption of Baby Friendly Community Initiative (BFCI) in its rural settings. In contrast to the BFHI, the BFCI supports breastfeeding and optimal infant feeding in community. BFCI has been implemented in Koibatek, in rural Kenya. This study aimed at assessing the effectiveness of BFCI on complementary feeding practices of children aged 6–23 months, by comparing intervention and control groups.

Methods

This was a randomized control study design that included 270 mother-infant pairs enrolled in the Baby Friendly Community Initiative (BFCI) project in Koibatek. Evaluation was carried out using structured questionnaires.

Results

A statistically significantly higher proportion of children in the intervention group compared to the control group attained minimum dietary diversity (77% vs. 58%; p = 0.001), minimum meal frequency (96% vs. 89%; p = 0.046) and minimum acceptable diet (77% vs. 61%; p = 0.005). The odds of attaining minimum dietary diversity, minimum meal frequency and minimum acceptable diet were statistically significantly higher for the intervention group compared to control group (OR: 4.95; 95%CI 2.44–10.03, p = < 0.001; OR: 14.84; 95%CI 2.75–79.9, p = 0.002; OR: 4.61; 95%CI 2.17–9.78, p = < 0.001 respectively).

Conclusion

The BFCI intervention was successful in improving complementary feeding practices. Strengthening and prioritizing BFCI interventions could have a significant impact on child health outcomes in rural Kenya.

Trial registration

ISRCTN03467700. Registration 24 September 2014. Retrospectively registered.

Affect of Early Skin-to-Skin Mother-Infant Contact in the Maintenance of Exclusive Breastfeeding: Experience in a Health Department in Spain

BACKGROUND

Breastfeeding has been shown to result in extensive physical and psychological benefits for both the mother and the newborn. However, the rate and duration of exclusive breastfeeding (EBF) remains low worldwide. Mother-infant skin-to-skin contact (SSC) immediately after birth has demonstrated results that support the argument for breastfeeding continuation. Research aim: This study aimed to investigate the prevalence of EBF 3 months postpartum and the effect of early SSC in maintaining optimal EBF practices for mothers and their healthy newborns.

METHODS

We conducted an observational, retrospective study in Spain from 2013 to 2015. Pregnant women were interviewed immediately postpartum and again at 3 months postpartum regarding variables associated with breastfeeding initiation and continuation.

RESULTS

There were 1,071 women recruited. Early SSC was performed in 92% of vaginal births but only 57% of urgent cesarean births. Of women breastfeeding at discharge, 69.5% performed SSC with their newborn. We found that 68.6% of women were exclusively breastfeeding by discharge and 46.7% by 3 months postpartum. Type of feeding at discharge, country of origin, and parity were found to be associated with each other ( p = .003, p = .001, respectively). Early SSC was also significantly associated with type of feeding at discharge, 1 month, 2 months, and 3 months postpartum ( p < .001). Hypogalactia (19.8%) was the most frequently reported factor for breastfeeding discontinuation.

CONCLUSION

Breastfeeding promotion interventions are likely to improve breastfeeding rates at 3 months postpartum. Social and economic factors should be taken into account when such programs are planned to be implemented.

Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial

BACKGROUND

Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.

METHODS

We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant's first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.

RESULTS

A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718).

CONCLUSIONS

EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.

TRIAL REGISTRATION

ISRCTN ISRCTN83692672 . Registered 11 November 2012. Retrospectively registered.

Pathways from parental educational attainment to adolescent blood pressure

OBJECTIVES

Lower parental education is associated with higher adolescent blood pressure (BP). We examined the contribution of modifiable risk factors from infancy to adolescence that could potentially explain the link between parental education and SBP and DBP in the offspring.

METHODS

In a prospective Chinese birth cohort, 'Children of 1997' of 5604 adolescents (68% follow-up), we analyzed the relation between parental educational attainment and sex-specific, age-specific and height-specific BP z-scores at ∼13 years. Using mediation analysis, we examined the contribution of household income at birth (both absolute income and relative income deprivation), exposures during infancy (breastfeeding and early life second-hand smoking), lifestyles during childhood (diet, physical activity and screen-time), weight or BMI status during fetal, infancy, childhood and puberty, pubertal stage as well as parental BMI.

RESULTS

We found that adolescent BMI, but not birth weight or infant growth or childhood BMI, mediated the inverse association of parental education with adolescent SBP (proportion mediated: 24%), followed by maternal BMI (proportion mediated: 18%). Factors explaining the link between parental education and DBP were less clear. Absolute income, breastfeeding, childhood diet and physical activity, pubertal stage and paternal BMI did not mediate the association between parental education and adolescent BP.

CONCLUSION

Low parental education is a risk factor for high SBP and, to a lesser extent, DBP in adolescents. Important mediators of this relation include adolescent and maternal body weight.

Breastfeeding Is Associated With Reduced Obesity in Hispanic 2- to 5-Year-Olds Served by WIC

OBJECTIVE

To examine the relationship between breastfeeding (BF) and odds of childhood obesity in a large, primarily Hispanic Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population.

SETTING

A large urban WIC program in California.

PARTICIPANTS

Infants enrolled in WIC born between 2004 and 2007 and observed to age 5 years (N = 39,801; 88.6% Hispanic).

INTERVENTION

Level of BF: fully BF, fully formula feeding, or combination feeding.

MAIN OUTCOME MEASURE

Obesity at age 2-5 years, measured by body mass index (BMI) ≥ 95th percentile.

ANALYSIS

Logistic regression analyses to evaluate the association between initiation, duration, and exclusivity of BF and odds of obesity at age 2-5 years, controlling for ethnicity, preferred language, family size, poverty level, and maternal BMI.

RESULTS

Infants exclusively formula fed at birth were significantly more likely than fully breastfed infants to be obese at age 2-5 years (χ² [2, N = 39,801] = 123.31; P < .001). For every additional month of any BF, obesity risk at age 2-5 years decreased by 1%. Every additional month of full BF conferred a 3% decrease in obesity risk. Ethnicity, preferred language, family size, poverty level, and maternal BMI were also significantly related to obesity risk.

CONCLUSIONS AND IMPLICATIONS

Breastfeeding may have a role in the attenuation of obesity in early childhood among Hispanic children. The BF promotion and support offered at WIC may have a significant role in reducing rates of early childhood obesity.

Ethical Challenges in Infant Feeding Research

Infants have a complex set of nutrient requirements to meet the demands of their high metabolic rate, growth, and immunological and cognitive development. Infant nutrition lays the foundation for health throughout life. While infant feeding research is essential, it must be conducted to the highest ethical standards. The objective of this paper is to discuss the implications of developments in infant nutrition for the ethics of infant feeding research and the implications for obtaining informed consent. A search was undertaken of the papers in the medical literature using the PubMed, Science Direct, Web of Knowledge, Proquest, and CINAHL databases. From a total of 9303 papers identified, the full text of 87 articles that contained discussion of issues in consent in infant feeding trials were obtained and read and after further screening 42 papers were included in the results and discussion. Recent developments in infant nutrition of significance to ethics assessment include the improved survival of low birth weight infants, increasing evidence of the value of breastfeeding and evidence of the lifelong importance of infant feeding and development in the first 1000 days of life in chronic disease epidemiology. Informed consent is a difficult issue, but should always include information on the value of preserving breastfeeding options. Project monitoring should be cognisant of the long term implications of growth rates and early life nutrition.

The Impact in the United States of the Baby-Friendly Hospital Initiative on Early Infant Health and Breastfeeding Outcomes

Studies were examined to evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breastfeeding and early infant health outcomes in U.S.

POPULATIONS

Using the Social Ecological Model as a guiding theoretical framework, results were categorized into four interrelated multilevel factors: (1) maternal/infant dyad factors, (2) provider factors, (3) hospital organizational factors, and (4) policy/systems factors. Results from the review support the BFHI's success in facilitating successful breastfeeding initiation and exclusivity. Breastfeeding duration also appears to increase when mothers have increased exposure to Baby-Friendly practices, but deficiencies in breastfeeding tracking mechanisms have limited reliable breastfeeding duration data. Of the 10 steps of the BFHI, step 3, prenatal education and step 10, postnatal breastfeeding support are the most difficult steps to implement; however, those steps have the potential to significantly impact maternal breastfeeding decisions. The underlying mechanisms by which Baby-Friendly practices contribute to maternal breastfeeding decisions remain unclear; thus, studies are needed to examine mothers' experiences and perceptions of Baby-Friendly practices. Additionally, studies are needed to investigate the impact of the BFHI for women living in rural areas and in southeastern regions of the United States. Finally, studies are needed to examine early infant health outcomes related to the BFHI, especially for late premature infants (34-36 weeks) who are most vulnerable to poor outcomes and are in need of specialized breastfeeding support. Results from future qualitative and quantitative explorations could clarify how the delivery of Baby-Friendly practices leads to successful breastfeeding and infant health outcomes.

Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula

BACKGROUND

The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps.

OBJECTIVES

To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates.

METHODS

We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report.

RESULTS

After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95).

CONCLUSION

After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.

Is baby-friendly breastfeeding support in maternity hospitals associated with breastfeeding satisfaction among Japanese mothers?

While the World Health Organization's Baby-Friendly Hospital Initiative has increased breastfeeding duration and exclusivity, a survey found that only 8.5 % of maternity hospitals in 31 developed countries could be designated baby-friendly. Baby-friendly breastfeeding support is sometimes criticized as mother unfriendly. This study examined whether baby-friendly breastfeeding support was associated with breastfeeding satisfaction, duration, and exclusivity among Japanese mothers. In this cross-sectional study, 601 breastfeeding Japanese mothers completed questionnaires at their infants' 4-month health checkups at two wards in Yokohama, Japan; 363 were included in the analysis. Baby-friendly breastfeeding support was measured based on the WHO's "Ten Steps to Successful Breastfeeding." We measured satisfaction using two subscales of the Japanese version of the Maternal Breastfeeding Evaluation Scale. The association of baby-friendly support with maternal satisfaction was assessed using multiple linear regression, while the prevalence ratios (PRs) for breastfeeding were estimated using Poisson regression. Mothers were stratified by prepartum exclusive breastfeeding intention (yes, n = 256; no, n = 107). Mothers who experienced early skin-to-skin contact with their infants were more likely to report breastfeeding satisfaction than those who did not. Among mothers without exclusive breastfeeding intention, those who were encouraged to feed on demand were more likely to be breastfeeding without formula at 1 month (PR 2.66 [95 % CI 1.32, 5.36]) and to perceive breastfeeding as beneficial for their baby (regression coefficient = 3.14 [95 % CI 0.11, 6.17]) than those who were not so encouraged. Breastfeeding satisfaction was a useful measure of breastfeeding outcome. Early skin-to-skin contact and encouragement to feed on demand in the hospital facilitate breastfeeding satisfaction.

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis

Background

Despite the crucial need to develop targeted and effective approaches for obesity prevention in children most at risk, the pathways explaining socioeconomic disparity in children’s obesity prevalence remain poorly understood.

Methods

We conducted a systematic review of the literature that investigated causes of weight gain in children aged 0–5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries. Major electronic databases were searched from inception until December 2015. Key words identified studies addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and child weight in disadvantaged samples.

Results

A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity precluded identification of independent effects of each of these risk factors.

Conclusions

This review has highlighted significant gaps in our mechanistic understanding of the relative importance of different aspects of parent and child behaviours in disadvantaged population groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2801-y) contains supplementary material, which is available to authorized users.

Potential effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.

Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial

BACKGROUND

Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya.

METHODS

The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health.

DISCUSSION

Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative.

TRIAL REGISTRATION

ISRCTN03467700 ; Date of Registration: 24 September 2014.

Breastfeeding practices in relation to country of origin among women living in Denmark: a population-based study

The objective of this study was to describe breastfeeding practices and to compare the risk of suboptimal breastfeeding of women living in Denmark according to country of origin, and further to examine how socio-economic position and duration of stay in the country affected this risk. Information on breastfeeding of 42,420 infants born 2002–2009 and living in eighteen selected Danish municipalities was collected from the Danish Health Visitor’s Child Health Database. The data was linked with data on maternal socio-demographic information from Danish population-covering registries. Suboptimal breastfeeding was defined as <4 months of full breastfeeding as described by the Danish Health and Medicines Authority. We used logistic regression to model the crude associations between suboptimal breastfeeding and country of origin, and taking maternal age and parity, and a variety of parental socio-economic measures into account. Suboptimal breastfeeding was more frequent among non-Western migrant women than among women of Danish origin. Women who were descendants of Turkish and Pakistani immigrants had a higher risk of suboptimal breastfeeding as compared to the group of women who had migrated from the same countries, suggesting that acculturation did not favor breastfeeding. For all but the group of women who had migrated from Pakistan, adjustment for socio-demographic indicators (age, parity, education, attachment to labour market, and income) eliminated the increased risk of suboptimal breastfeeding. There was no evidence for differences in the breastfeeding support provided at hospital level according to migrant status. Suboptimal breastfeeding was more frequent among women who were non-Nordic migrants and descendants of migrants than among women with Danish origin.

Breast feeding practices as cultural interventions for early childhood caries in Cree communities

Background

Breastfeeding is a gift from mother to child and has a wide range of positive health, social and cultural impacts on infants. The link between bottle feeding and the prevalence of early childhood caries (ECC) is well documented. In Aboriginal communities, the higher rates of ECC are linked with low rates of breast feeding and inappropriate infant feeding of high sugar content liquids.

Methods

The Baby Teeth Talk Study (BTT) is one project that is exploring the use of four interventions (motivational interviewing, anticipatory guidance, fluoride varnish and dental care to expectant mothers) for reducing the prevalence of ECC in infants within Aboriginal communities. This research explored cultural based practices through individual interviews and focus groups with older First Nations women in the community.

Results

Participants in a First Nations community identified cultural based practices that have also been used to promote healthy infant feeding and good oral health. A wide range of themes related to oral health and infant feeding emerged. However, this paper focusses on three themes including: breastfeeding attitudes, social support for mothers and birthing and supporting healthy infant feeding through community programs.

Conclusions

The importance of understanding cultural health traditions is essential for those working in oral public health capacities to ensure there is community acceptance of the interventions.

Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial

BACKGROUND

Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya.

METHODS/DESIGN

The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government's health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015.

DISCUSSION

Interventions aimed at promoting optimal breastfeeding and complementary feeding practices are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates. This study will inform policy and practice in Kenya and similar settings regarding delivery mechanisms for such high-impact interventions, particularly among urban poor populations.

TRIAL REGISTRATION

ISRCTN83692672.

ABM Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Infant feeding in America: enough to break a mother's heart?

Cardiovascular disease is a leading cause of death of women around the world. Diet, exercise, smoking cessation, and blood pressure control are all recognized as key elements of preventing cardiovascular disease. Infant feeding has received less attention, but the studies reviewed here indicate that lactation may also play an important role in determining women's future risk of heart disease. A growing body of literature indicates that mothers who prematurely discontinue lactation face increased risk of visceral adiposity, hypertension, hyperlipidemia, diabetes, and subclinical cardiovascular disease, as well as cardiovascular morbidity and mortality. Breastfeeding is not always easy, but neither is dieting, exercise, smoking cessation, or treating hypertension. In order to effectively fight heart disease, efforts are needed to promote all aspects of a healthy lifestyle, which for women includes breastfeeding their babies.

Breastfeeding and adolescent blood pressure: evidence from Hong Kong's "Children of 1997" Birth Cohort

Observationally, breastfeeding is associated with lower blood pressure in Western developed settings, whereas little association exists in developing settings. However, postnatal characteristics (e.g., breast milk substitutes, infection rates, underweight, and pubertal timing) differ between these settings. We examined the association of breastfeeding with blood pressure at ∼13 years, using multivariable linear regression, in 5,247 term births in 1997 from a population-representative Hong Kong Chinese birth cohort where socioeconomic patterning of breastfeeding differs from that of Western and developing settings but standard of living, social infrastructure, and postnatal characteristics are similar to those of Western settings. Higher education is associated with short-term breastfeeding but recent migration with longer-term breastfeeding. Compared with never breastfeeding, exclusive breastfeeding for ≥3 months was not associated with blood pressure (systolic mean difference = 0.82 mm Hg, 95% confidence interval (CI): -0.46, 2.11 and diastolic mean difference = 0.49 mm Hg, 95% CI: -0.22, 1.21), nor was partial breastfeeding for any length of time or exclusive breastfeeding for <3 months (systolic mean difference = 0.01 mm Hg, 95% CI: -0.64, 0.66 and diastolic mean difference = 0.16 mm Hg, 95% CI: -0.20, 0.52), adjusted for socioeconomic position and infant characteristics. Lack of association in a non-Western developed setting further suggests that observations concerning breastfeeding and blood pressure vary with setting, thereby casting doubt on causality.

Establishing successful breastfeeding in the newborn period

The first days after delivery of a newborn infant are critical for breastfeeding establishment. Successful initiation and continuation-especially of exclusive breastfeeding-have become public health priorities, but it is fraught with many individual- and systems-level barriers. In this article, we review how hospital newborn services can be constructed or restructured to support the breastfeeding mother-infant dyad so that they can achieve high levels of breastfeeding success. Important positive and negative factors from the prenatal period, and the preparation for hospital discharge are also discussed.