Infant feeding pattern and weaning practices in Kuwait

Risk factors for self-reported insufficient milk during the first 6 months of life: A systematic review

The objective of this systematic review was to identify multifactorial risk factors for self-reported insufficient milk (SRIM) and delayed onset of lactation (DOL). The review protocol was registered a priori in PROSPERO (ID# CDR42021240413). Of the 120 studies included (98 on SRIM, 18 on DOL, and 4 both), 37 (31%) studies were conducted in North America, followed by 26 (21.6%) in Europe, 25 (21%) in East Asia, and Pacific, 15 (12.5%) in Latin America and the Caribbean, 7 (6%) in the Middle East and North Africa, 5 (4%) in South Asia, 3 (2.5%) in Sub-Saharan Africa, and 2 (1.7%) included multiple countries. A total of 79 studies were from high-income countries, 30 from upper-middle-income, 10 from low-middle-income countries, and one study was conducted in a high-income and an upper-middle-income country. Findings indicated that DOL increased the risk of SRIM. Protective factors identified for DOL and SRIM were hospital practices, such as timely breastfeeding (BF) initiation, avoiding in-hospital commercial milk formula supplementation, and BF counselling/support. By contrast, maternal overweight/obesity, caesarean section, and poor maternal physical and mental health were risk factors for DOL and SRIM. SRIM was associated with primiparity, the mother's interpretation of the baby's fussiness or crying, and low maternal BF self-efficacy. Biomedical factors including epidural anaesthesia and prolonged stage II labour were associated with DOL. Thus, to protect against SRIM and DOL it is key to prevent unnecessary caesarean sections, implement the Baby-Friendly Ten Steps at maternity facilities, and provide BF counselling that includes baby behaviours.

A study to identify the most common reasons to wean among breastfeeding mothers in UAE

Background:

Despite the great benefits of breastfeeding for the mother and the child, many mothers face a lot of challenges and issues during lactation, which might lead to early weaning.

Aim:

The aim of this study was to assess the factors that can lead to early weaning and to identify the most common reasons to early weaning among breastfeeding mothers.

Materials and Methods:

This was a cross-sectional, questionnaire-based survey study. Eight hundred and fifty questionnaires were distributed to lactating mothers, but only 820 were returned making the response rate of 96.5%. Breastfeeding mothers in Ajman and Sharjah, United Arab Emirates (UAE) participated in the study.

Statistical Analysis:

The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics were used to summarize the data concerning the demographic characteristics. Categorical variables (such as nationality and educational level) were described by using frequency, percentages, bar chart, and pie chart.

Results:

The results revealed that 29% of respondents stopped breastfeeding for some reason. The main reasons stated by the participants were low milk supply (25.8%) and pain, congestion, and abscess (19.22%) followed by new pregnancy (17.5%), which were the most identified reasons for early discontinuation of breastfeeding.

Conclusion:

Our study indicated that the misconception of weaning because of a new pregnancy has declined in the UAE compared to a study conducted 3 years ago. A positive improvement was also observed in terms of weaning due to personal desire compared to previous years among mothers as they became more aware of the benefits of breastfeeding.

Factors influencing complementary and weaning practices among women in rural communities of Sokoto state, Nigeria

Introduction

When breast milk alone is no longer sufficient to meet a child's nutritional needs, foods other than breast milk are introduced gradually into the baby's diet, first to complement breast feeding and progressively to replace it and get the child used to adult diet. This study aimed to assess the factors influencing complementary and weaning practices among women in rural communities of Sokoto state, Nigeria.

Methods

It was a cross-sectional study. Using a multi-staged sampling technique, 296 mothers of children 6-24 months were recruited. Data was collected using a pretested structured questionnaire and analyzed using IBM SPSS version 20. Chi square test was used to test associations between categorical variables. Binary logistic and multinomial regression was used to compute the determinants of complementary and weaning practices. The level of significance was set at p < 0.05. Ethical approval was obtained from the State Ethical Committee.

Results

Timely introduction of complementary feeds was commenced in 54% of the children. Only 6.2% weaned their children at 6 months; 90.5% weaned their children gradually and 63.5% bottle fed. Factors influencing complementary and weaning practices was found to be child's age; maternal age and family setting.

Conclusion

The respect of World Health Organization (WHO) recommendations on complementary and weaning practices was suboptimal. It was also evident from this study that complementary and weaning practices were influenced by maternal and house-hold factors. It is therefore important to develop interventions aimed at bridging the gap between these practices in rural settings and WHO recommendations.

Timing and Determinants of the Introduction of Complementary Foods in Kuwait: Results of a Prospective Cohort Study

BACKGROUND

The early introduction of complementary foods is common in Middle Eastern countries but little is known about the determinants of this practice in this region.

OBJECTIVES

This prospective cohort study conducted from October 2007 to October 2008 investigated the determinants of the very early (before 17 weeks) introduction of complementary foods in Kuwait and compared rates of this practice against rates reported in the mid-1990s.

METHODS

A total of 373 women were recruited from maternity hospitals in Kuwait City and followed to 26 weeks postpartum. Data on complementary feeding practices were available from 303 women. Multivariate logistic regression was used to estimate the association of very early introduction of complementary foods with infant sex and maternal characteristics including age, years of education, employment intentions at 6 months postpartum, parity, prepregnancy body mass index, and prepregnancy smoking status.

RESULTS

All infants had received complementary foods by 26 weeks of age, with 30.4% receiving complementary foods before 17 weeks of age. Women born in other Arabic countries were less likely to introduce complementary foods before 17 weeks (adjusted odds ratio [adj OR] = 0.40; 95% confidence interval [CI], 0.22-0.73) than women born in Kuwait. Women who were exclusively formula feeding at 6 weeks postpartum were less likely to introduce complementary foods before 17 weeks (adj OR = 0.40; 95% CI, 0.23-0.71) than women who were still breastfeeding.

CONCLUSION

Compared to the mid-1990s, fewer infants in Kuwait were receiving complementary foods before 17 weeks. Nevertheless, all infants had received complementary foods by 6 months of age.

Food system sustainability and vulnerability: food acquisition during the military occupation of Kuwait

OBJECTIVE

To document food acquisition experiences during Iraqi military occupation in Kuwait.

DESIGN

Retrospective cross-sectional study.

SETTING

Urban areas in Kuwait during occupation.

SUBJECTS

Those living in Kuwait during the period of occupation, and aged between 15 to 50 years at the time of occupation, recruited by snowball sampling. A total of 390 completed questionnaires (response rate 78%, 202 female and 188 male) were returned.

RESULTS

During the occupation, food became increasingly difficult to acquire. Two food systems emerged: (i) an underground Kuwaiti network linked to foods recovered from local food cooperatives and (ii) a black market supplied by food imported through Iraq or stolen locally. Food shortages led to reductions in meal size and frequency. Some respondents (47·7%) reported not having sufficient income to purchase food and 22·1% had to sell capital items to purchase food. There was a significant increase (P<0·01) in home production, with 23·1% of people growing vegetables and 39·0% raising animals to supplement food needs. Reduction in food wastage also emerged as a significant self-reported behaviour change. Respondents reported deterioration in the quality and availability of fish, milk, and fruit in particular. Despite a decrease in opportunities for physical activity, most respondents reported that they lost weight during the occupation.

CONCLUSIONS

Although the Kuwaiti population fell by about 90 % and domestic food production increased during the 7-month occupation, the local population continued to rely heavily on imported food to meet population needs. The high prevalence of self-reported weight loss indicates the inadequacies of this food supply. High apparent food security in systems which significantly exceed the ecological carrying capacity of the local environment and rely on mass food importation remains vulnerable.

Determinants of breastfeeding initiation among mothers in Kuwait

BACKGROUND

Exclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding.

METHODS

A sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.

RESULTS

In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery.

CONCLUSIONS

The reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.

A systematic review of maternal obesity and breastfeeding intention, initiation and duration

Background

Breastfeeding behaviour is multifactorial, and a wide range of socio-cultural and physiological variables impact on a woman's decision and ability to breastfeed successfully. An association has been reported between maternal obesity and low breastfeeding rates. This is of public health concern because obesity is rising in women of reproductive age and the apparent association with increased artificial feeding will lead to a greater risk of obesity in children. The aim of this paper is to examine the relationship between maternal overweight and obesity and breastfeeding intention and initiation and duration.

Methods

A systematic review was conducted in January and February 2007, using the following databases: Medline, CINAHL and the Australian Breastfeeding Association's Lactation Resource Centre. Studies which have examined maternal obesity and infant feeding intention, initiation, duration and delayed onset of lactation were tabulated and summarised.

Results

Studies have found that obese women plan to breastfeed for a shorter period than normal weight women and are less likely to initiate breastfeeding. Of the four studies that examined onset of lactation, three reported a significant relationship between obesity and delayed lactogenesis. Fifteen studies, conducted in the USA, Australia, Denmark, Kuwait and Russia, have examined maternal obesity and duration of breastfeeding. The majority of large studies found that obese women breastfed for a shorter duration than normal weight women, even after adjusting for possible confounding factors.

Conclusion

There is evidence from epidemiological studies that overweight and obese women are less likely to breastfeed than normal weight women. The reasons may be biological or they may be psychological, behavioral and/or cultural. We urgently need qualitative studies from women's perspective to help us understand women in this situation and their infant feeding decisions and behaviour.

Selection of reference foods for a scale of standards for use in assessing the transitional process from milk to solid food in infants and pre-school children

OBJECTIVE

This paper describes the development of a reliable scale of standards for use in evaluating the progress of the transition from milk to solid food in infants and preschool children. The maturation of chewing and swallowing behavior in infants and young children, which enables processing of solid food, varies, and a scale would assist not only in the instruction of mothers and nurses but also in preventing delay in the introduction of solid food.

DESIGN

A range of 159 reference foods were selected on the basis of intake during the period of transition from liquid to solid food. These foods were listed in our previous study, Validity and reliability were tested to create a scale.

METHODOLOGY

Foods were selected on the basis of 50% of the subjects studied being able to eat them, and on the food groups classified by cluster analyses using the Varclus procedure of SAS. Validity, of the scale was tested by using Pearson's correlation coefficient between the scale score of selected food items and the total score of all 159 food items. The total score of 159 food items was calculated using the general linear models (GLM) procedure of SAS. Reliability was tested using Cronbach's coefficient alpha.

SETTING

Public health centers in Aomori, Tokyo, Saitama, Nagano, and Okinawa (Japan).

SUBJECT

Five hundred and eighty healthy mothers and children from 2 to 46 months were randomly selected and 470 (81.0%) completed the study. To avoid regional bias, subjects were drawn from northern to southern prefectures in Japan, namely Aomori, Tokyo, Saitama, Nagano, and Okinawa.

RESULTS

Twenty food items were selected. By analyzing the score correlation using Pearson's correlation coefficient (R =0.97, P <0.001) and GLM (R2 =0.95, P <0.001), it was confirmed that these 20 food items adequately represented the original 159. The reliability was also found to be sufficient (Cronbach's coefficient alpha=0.96).

CONCLUSIONS

The findings demonstrate that a scale of standards for measuring progress in chewing ability can be created using 20 food items. Such a standard will provide a useful basis against which to assess delay of solid food introduction in childhood.

SPONSORSHIP

Grant-in-Aid for Scientific Research, provided by the Japanese Ministry of Education, Science and Culture, Project No. 07838030.

Marital fertility in Lebanon: a study based on the population and housing survey

This study tested the general economic theory of fertility within the contextual setting of the Lebanese society, by using the 1996 Population and Housing Database Survey. The theory argues that the household's demand for a child is closely related to different services and utilities ascribed to that child. It also claims that fertility as such is income-inelastic, but becomes positively associated with the household's income when the notion of child-quality is added to the model. Findings confirm the baseline inverse association between an index of the household's socioeconomic status (HSES) and the cumulative fertility level. However, when women's education was added to the model, an interaction was observed whereby the illiterate subgroup--unlike the educated--was at higher risk of having a large number of children with improvement in their economic conditions. A similar interaction was found between women's and husband's education. It was concluded that in response to higher socioeconomic status, illiterate women end up supplying an excess number of children, an effect mediated by the shortening of lactation period, which is in turn triggered by a higher access to breast milk substitutes. On the other hand, their educated husbands demand 'child quantity' since this educational gap grants them more power to decide their family size. In contrast, educated women demand child 'quality' as they expect both material and opportunity costs of having a child to coincide with the norms and values of their social class. Their lower supply of births with increased economic well-being is primarily attributed to a higher use of modern contraceptive methods. Other factors investigated in this study included the potential effect of family structure on fertility, and control was done on a number of other sociocultural and demographic variables, such as women's work status, husband's occupation, age at marriage and area of residence.

Efeito da prática de alimentação infantil e de fatores associados sobre a ocorrência da cárie dental em pré-escolares de 18 a 48 meses

Este estudo foi realizado objetivando estudar o efeito das práticas de alimentação infantil e de fatores associados sobre a ocorrência de cárie dental. Para isso, determinou-se o ceo-d e o ceo-s em 156 crianças de 18 a 48 meses e foi aplicado às mães um questionário incluindo perguntas sobre a ocupação do pai, nível educacional da mãe, higiene bucal, época de erupção do dente e sobre práticas de alimentação infantil. Os dados obtidos foram analisados através dos testes X2 e Mann-Whitney U. A média do ceo-s foi 3,4 com 40% das crianças livres de cáries, sendo que 36 e 24% tinham um ceo-d maior que 0 e 4, respectivamente. Notou-se que 72% das crianças eram alimentadas ao seio, 17% apenas com mamadeira e 10% pelos dois meios. Das crianças alimentadas apenas com mamadeira 70% apresentaram cárie. A cárie de mamadeira foi observada em 20% das crianças, sendo que 77% destas tinham sido alimentadas por mais de 12 meses. As crianças, cujos pais eram profissionais com terceiro grau de escolaridade, tiveram significativamente menos cárie do que aquelas de pais com nível técnico ou pais operários. A prevalência de cárie na faixa etária estudada foi relativamente alta. As crianças com cárie de mamadeira tenderam a manter seus hábitos de aleitamento por mais de 12 meses, sendo que o uso de mamadeira açucarada estava presente em 100% dos casos.

Back to nature? Historical and cross-cultural perspectives on barriers to optimal breastfeeding

This article examines the discrepancy between the recommendations of international authorities concerning breastfeeding and the practices of a significant proportion of women all over the world who discontinue breastfeeding because of the reported insufficiency of their milk. Our review of the evidence on the insufficient milk syndrome suggests that the phenomenon is inextricably linked to the construction of family, gender and motherhood at different historical times and in different parts of the world, and that the prevention of early discontinuation of breastfeeding requires a better understanding of these issues in their historical and cultural context.