Breastfeeding knowledge, attitude, perceived behavior, and intention among female undergraduate university students in the Middle East: the case of Lebanon and Syria

Breastfeeding: Knowledge, Perception, And Intention to Practice Among Female Students of Tertiary Institutions in Ekiti, Southwest Nigeria

INTRODUCTION

Breastfeeding is a public health practice that is critical for the survival of infants and young children. This study aimed at determining the knowledge, attitude, and future intention to breastfeed among female undergraduates in tertiary institutions in Ekiti State, Southwest Nigeria.Methodology: A prospective cross-sectional study was conducted among 1312 female students of the tertiary institutions in Ekiti State. By convenience sampling, female students were invited to participate in the study after giving verbal consent and those studying medical, nursing, and other courses allied to medicine were excluded. Internal consistency of the data obtained from this research instrument was determined using Cronbach's coefficient Alpha with a reliability value of 0.82. Data analysis was conducted using SPSS version 25. Descriptive as well as inferential statistics were computed. Results were summarized as frequencies and percentages. The differences in knowledge, attitude, and intention to practice breastfeeding as well as other responses among the participants were compared among age groups, faculties and the sources of information using Chi-square test.

RESULT

Although 93% of the respondents agreed that breast milk is important for the development of the infant's brain thereby demonstrating good knowledge; 51.6% of the respondents demonstrated poor perception to breastfeeding believing breastfeeding makes the breast to sag while only 34% of the respondents indicated their intention to breastfeed their future babies.

CONCLUSION

The intention to breastfeed among our study participants was poor. This study revealed the need to increase awareness about breastfeeding and its benefits among this huge population of future mothers.

Infant and young child feeding practices in Lebanon: a cross-sectional national study

OBJECTIVE

To assess infant and young child feeding (IYCF) practices in Lebanon and investigate their associations with socio-demographic and lifestyle factors.

DESIGN

A cross-sectional national survey was conducted in 2012-2013. In addition to a socio-demographic and lifestyle questionnaire, a 24-h dietary recall for the children was collected, with mothers as proxies. IYCF practices were assessed based on the 2021 indicators of the WHO.

SETTING

Lebanon.

PARTICIPANTS

Children aged 0-23 months and their mothers (n 469).

RESULTS

While the majority of infants were ever breastfed (87·6 %), the prevalence of exclusive breast-feeding (BF) in those under 6 months of age was 11·0 %. Early initiation of BF was 28 %. A greater child's birth order, partner's support for BF, higher parental education, maternal BF knowledge and non-smoking were associated with higher odds of meeting BF recommendations. As for complementary feeding, 92·8 % of children (6-23 months) met the minimum meal frequency indicator, 37·5 % met the minimum dietary diversity (MDD) and 34·4 % met the minimum adequate diet (MAD). The consumption of unhealthy food was observed amongst 48·9 % of children, with nearly 37 % consuming sweet beverages. Older maternal age and maternal overweight/obesity were associated with lower odds of meeting MDD and MAD, while child's age and partner's support for BF were associated with higher odds.

CONCLUSIONS

The results documented suboptimal IYCF practices amongst Lebanese children and identified a number of factors associated with these practices. Findings from this study will help guide the development of culture-specific programmes aimed at improving IYCF practices in Lebanon.

Levels and Determinants of Prenatal Breastfeeding Knowledge, Attitude, and Intention Among Pregnant Women: A Cross-Sectional Study in Northwest Ethiopia

Background

Pregnant women are a critical part of the community to assess various determinants of their future breastfeeding practice. This study aimed to assess the levels and determinants of breastfeeding knowledge, attitude, and intention among pregnant women.

Methods

A hospital-based cross-sectional study was conducted among 422 pregnant women from January 18 to February 27, 2022, at Debre Tabor Comprehensive Specialized Hospital (DTCSH) in Northwest Ethiopia. Data were collected via face-to-face interviews from participants selected by convenience sampling technique. Data analysis was made using Stata version 16.0. Multiple logistic regression analysis was used to assess the determinants of the knowledge, attitude, and intention of pregnant women, with a p-value < 0.05 considered statistically significant.

Result

About 57.8% of participants had adequate breastfeeding knowledge and only 46.9% had a positive attitude. Almost two-thirds (65.4%) of them had good intentions to breastfeed. Pregnant women attaining secondary education (AOR = 2.0; 95% CI: 1.31, 3.19), achieving college or university education (AOR = 3.13; 95% CI: 1.63, 7.41), being multiparous (AOR = 2.11; 95% CI: 1.33, 3.43), having four or more ANC visits (AOR:1.45; 95% CI: 1.21, 4.31), and having prior breastfeeding experience (AOR: 3.53; 95% CI: 2.22, 5.65) were significant predictors of adequate knowledge. Attending college or university education (AOR = 2.71;95% CI: 2.33, 5.13), being multiparous (AOR = 1.56; 95% CI: 1.32, 8.25), and having adequate knowledge (AOR = 2.02; 95% CI: 1.88,7.14) were determinants of a positive breastfeeding attitude. Whereas, advanced age (AOR = 1.44; 95% CI: 1.12, 5.59), adequate knowledge (AOR: 5.21; 95% CI: 1.51,8.04), and positive attitude (AOR = 2.41;95% CI:1.50, 4.27) were independent predictors of good breastfeeding intention.

Conclusion

The breastfeeding knowledge and attitude of pregnant women were generally suboptimal. Their overall breastfeeding intention was also unsatisfactory. This highlights the need to develop culture-specific interventions aimed at improving breastfeeding knowledge, attitudes, and intention to enhance the appropriate breastfeeding practice of their future children.

Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates

Background

Breastfeeding (BF) is considered the ultimate method of infant feeding for at least the first 6 months of life. Exclusive breastfeeding (EBF) is one of the most effective interventions to improve child survival. The main objective of this study was to assess the prevalence and duration of exclusive breastfeeding and the associated factors among women in Dubai and Sharjah, UAE.

Methods

A cross-sectional study was conducted in four hospitals and four healthcare centers in Dubai and Sharjah between September 2017 and December 2017. Hospitals and centers are governmental and provide maternal and child health services. A convenience sample of 858 Arab and Emirati mothers with children under the age of 2 years participated in the study. Face-to-face interviews were conducted by using structured questionnaires. The study was approved by the University Ethical Committee and the UAE Ministry of Health before data collection. Descriptive statistics were computed to describe all the questionnaire items. The chi-square test was used to compare the study's categorical variables. A binary logistic regression analysis was used to predict the relationship between BF and its associated factors. Statistical tests with P-values < 0.05 were considered statistically significant.

Results

The mean age of the participating mothers was 30.6 (SD 5.5) years. Results showed that the prevalence of exclusive breastfeeding among the study participants was 24.4% (31.1% in Sharjah and 22% in Dubai; P = 0.003). The binary logistic regression reported that mother's and father's education, skin-to-skin period, number of children, mothers' health, and place of living were significantly associated with exclusive breastfeeding (P < 0.05). The results reported a significant association between EB and duration of breastfeeding (OR = 6.9, P = 0.002), husband education (OR = 2.1, P = 0.015), mother education (OR = 1.3, P = 0.027), number of children (OR = 7.9, P = 0.045), having any health problem (OR = 1.2, P = 0.045), and living place (OR = 1.4, P = 0.033), and a non-significant positive effect of family size and family income. Furthermore, the result reported a significant association between mixed breastfeeding and duration of breastfeeding (OR = 0.1, P = 0.000), skin-to-skin period (OR = 0.3, P = 0.002), underweight (OR = 4.7, P = 0.034), last infant's sex (OR = 1.6, P = 0.010), having maid at home (OR = 2.1, P = 0.000), number of children (OR = 0.2, P = 0.013), and living place (OR =1.1, P = 0.014), and a non-significant association with family size and family income.

Conclusions

Therefore, a health promotion program for exclusive breastfeeding during antenatal health visits, together with initiating health policies in maternal hospitals to encourage the initiation of breastfeeding during the first hour of birth and the introduction of skin-to-skin contact during the first 5 min of birth are highly recommended.

Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar

Background

Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention.

Methods

Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk.

Results

Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68).

Conclusions

Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00456-x.

Predicting Risk for Early Breastfeeding Cessation in Israel

OBJECTIVES

This study aimed to 1) Examine factors associated with cessation of exclusive breastfeeding in Israel and 2) Develop predictive models to identify women at risk for early exclusive breastfeeding cessation.

METHODS

The study used data from longitudinal national representative infant nutrition survey in Israel (n = 2119 participants). Logistic regression was used to identify risk factors and build predictive models.

RESULTS

The rate of exclusive breastfeeding cessation increased from 45.4% at 2 months to 85.7% at 6 months. Five factors were significantly associated with higher odds of exclusive breastfeeding cessation at 2 months: being a primapara, low educational level, lack of previous breastfeeding experience, negative attitude towards birth, and lack of intention to breastfeed. Six factors were significantly associated with higher odds of exclusive breastfeeding cessation at 6 months: younger age, being in a relationship with a partner, lower religiosity level, cesarean delivery, not taking folic acid during pregnancy, and negative attitude towards birth. Both 2 and 6-months models had good predictive performance (C-statistic of .72 and .68, accordingly).

CONCLUSIONS FOR PRACTICE

This nationwide study successfully identified several predictors of exclusive breastfeeding cessation and created breastfeeding cessation prediction tools for two time periods (2 and 6 months). The resulting tools can be applied to identify women at risk for stopping exclusive breastfeeding in hospitals or at community clinics. Further studies should examine practical aspects of applying these tools in practice and explore whether applying those tools can lead to higher exclusive breastfeeding rates.

Traditional practices in post-partum care among Indonesian and Filipino mothers: a comparative study

This study was conducted to assess the traditional practices in post-partum care among Indonesian and Filipino mothers to propose a program to improve maternal and child health. The study utilized a descriptive research design for Indonesian mother respondents (n=110) and Filipino mother-respondents (n=119) conveniently selected. Traditional practices on post-partum care focused on hygienic care, behavioral precautions, breastfeeding, baby care; dietary modifications; and physical activities. Descriptive statistics (frequency and percentage), weighted mean, and independent t-test were used to describe and analyze quantitative information. Four dimensions, including hygienic care (p-value 0.038); breastfeeding and baby care (p-value 0.000); dietary modifications (p-value 0.000); and physical activities (p-value 0.000), showed a statistically significant difference in the assessment of mother respondents on their traditional practices in post-partum care. Meanwhile, the dimension on behavioral precautions (p-value 0.250) yielded statistically no significant difference on the assessment of mother respondents on their traditional practices in post-partum care. Four dimensions, including hygienic care (p-value 0.038); breastfeeding and baby care (p-value 0.000); dietary modifications (p-value 0.000); and physical activities (p-value 0.000), showed a statistically significant difference in the assessment of mother respondents on their traditional practices in post-partum care. Meanwhile, the dimension on behavioral precautions (p-value 0.250) yielded statistically no significant difference on the assessment of mother respondents on their traditional practices in post-partum care]

Effects of a 'Baby-Friendly Hospital Initiative' on exclusive breastfeeding rates at a private hospital in Lebanon: an interrupted time series analysis

Background

Exclusive breastfeeding (EBF) through six months of age has been scientifically validated as having a wide range of benefits, but remains infrequent in many countries. The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is one approach to improve EBF rates.

Methods

This study documents the implementation of BFHI at Clemenceau Medical Center (CMC), a private hospital in Lebanon, and analyzes data on EBF practices among CMC’s patients before, during, and after the implementation period. The process of launching the BFHI at CMC is discussed from the perspective of key stakeholders using the SQUIRE guidelines for reporting on quality improvement initiatives. As an objective measure of the program’s impact, 2,002 live births from July 2015 to February 2018 were included in an interrupted time series analysis measuring the rates of EBF at discharge prior to, during, and following the bundle of BFHI interventions.

Results

The steps necessary to bring CMC in line with the BFHI standards were implemented during the period between November 2015 and February 2016. These steps can be grouped into three phases: updates to hospital policies and infrastructure (Phase 1); changes to healthcare staff practices (Phase 2); and improvements in patient education (Phase 3). The baseline percentage of EBF was 2.4 % of all live births. Following the BFHI intervention, the observed monthly change in EBF in the “Follow-Up” period (i.e., the 24 months following Phases 1–3) was significantly increased relative to the baseline period (+ 2.0 % points per month, p = 0.006). Overall, the observed rate of EBF at hospital discharge increased from 2.4 to 49.0 % of all live births from the first to the final month of recorded data.

Conclusions

Meeting the BFHI standards is a complex process for a health facility, requiring changes to policies, practices, and infrastructure. Despite many challenges, the results of the interrupted time series analysis indicate that the BFHI reforms were successful in increasing the EBF rate among CMC’s patients and sustaining that rate over time. These results further support the importance of the hospital environment and health provider practices in breastfeeding promotion, ultimately improving the health, growth, and development of newborns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03816-3.

Path Model Validation of Breastfeeding Intention Among Pregnant Women

OBJECTIVE

To validate a blended health belief model and integrated behavioral model of selected modifiable psychosocial constructs during pregnancy to seek the best-fit path model for breastfeeding intention.

DESIGN

A nonexperimental, cross-sectional study.

SETTING

A virtual online market research sample aggregator.

PARTICIPANTS

Women (N = 300) between 18 and 45 years of age in their second or third trimesters of pregnancy participated in the study in February 2018.

METHODS

Based on the health belief model and the integrated behavioral model, we proposed a theoretical framework, including self-efficacy for breastfeeding, knowledge, perceived benefits, perceived barriers, attitude toward breastfeeding, patient-provider interaction, and motivation to breastfeed, to predict breastfeeding intention. We administered a 98-item questionnaire modified from preexisting instruments. We conducted descriptive, bivariate, and regression analyses to help with the formation of the path model.

RESULTS

The best-fit path model with all significant paths and effect directions showed that intention to breastfeed is directly influenced by motivation to breastfeed, attitudes toward breastfeeding, and self-efficacy for breastfeeding, which together accounted for 56% (R²) of the variance in intention. We also identified indirect effects from knowledge about breastfeeding, patient-provider interaction, perceived benefits, and perceived barriers and their interrelationships with effect directions.

CONCLUSION

Through our findings, we contribute to the emerging body of evidence that shows the significant variables and their effect directions for breastfeeding intention. Incorporating these findings may provide support and evidence for clinical and community interventions focusing on modifiable psychosocial constructs during pregnancy to promote breastfeeding and further investigations using health behavior theories.

Exploring the breastfeeding knowledge level and its influencing factors of pregnant women with gestational diabetes mellitus

Background

Studies reveal that promoting the breastfeeding knowledge level help to improve breastfeeding behaviors. Promoting breastfeeding knowledge is a simple and economical way to increase breastfeeding rates. However, there are no studies focus on the level of breastfeeding knowledge and factors influencing the knowledge in women with gestational diabetes mellitus (GDM), which is defined as any degree of glucose tolerance impairment first diagnosed during pregnancy. Thus, the objectives of this study were to investigate the breastfeeding knowledge level of GDM pregnant women and explore factors influencing the knowledge level.

Methods

Cross-sectional survey and convenience sampling were conducted in this study. The sociodemographic characteristics, caregivers in pregnancy, knowledge source, breastfeeding status and breast status information of participants were collected. Breastfeeding Knowledge Scale was used to assess the breastfeeding knowledge level of pregnant women with GDM. Multiple linear regression was used to analyze the influence factors of breastfeeding knowledge level in this study.

Results

A total of 226 questionnaires were issued and finally 212 valid questionnaires were collected. Some misconceptions still existed (e.g. ‘breastfeeding cannot prevent your baby from being overweight’ and ‘it is advisable to breastfeed 3-4 times per day within 2-3 days after delivery’), although women with GDM had a good score of breastfeeding knowledge (mean score: 103.5 ± 10.4). Multiple linear regression analysis found that gestational age, family per capita monthly income, educational level, knowledge source were the independent protective factors for breastfeeding knowledge and minority nationality was the independent risk factor. The educational level had the greatest influence on the breastfeeding knowledge level of GDM pregnant women (β = 0.210, t = 2.978, P = 0.003).

Conclusion

GDM pregnant women with insufficient gestational age, low educational level, low family per capita monthly income and single access to knowledge should be included in the focus of health education on breastfeeding. In-depth and systematic health education should be conducted for pregnant women with GDM to improve their breastfeeding rate.

Cultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil

OBJECTIVES

to translate and culturally adapt the Infant Feeding Intentions Scale for pregnant women in Brazil.

METHODS

methodological study that included stages of translation, synthesis, face and content validation, back translation and semantic assessment. In the face and content and semantic validation stages, we used the Content Validity Index for individual items and for the overall scale for clarity and representativeness.

RESULTS

nine (100.0%) experts participated in face and content validation, and the average index obtained was 85.0% for representativeness. In the semantic assessment, performed with 31 (100.0%) pregnant women, the tool was considered clear, obtaining an average index of 91.0%.

CONCLUSIONS

the Brazilian version of the scale was considered representative and clear. After assessing psychometric properties, the scale is expected to be valid and reliable to assess maternal intention to breastfeed exclusively until the infant's six months of life in different Brazilian settings.

Knowledge, attitude, motivation and planning of breastfeeding: a cross-sectional study among Jordanian women

BACKGROUND

In Jordan, the rate of exclusive breastfeeding is declining. The trend variation in breastfeeding practice is determined by different factors including antenatal women's attitude and planning which are affected by their awareness and the support they receive. This study aims to assess knowledge, attitude, support, and planning of breastfeeding among Jordanian women.

METHODS

A face-to-face cross-sectional semi-structured questionnaire survey was conducted among healthy women in the antenatal clinic and postpartum ward at three hospitals in Northern Jordan during the period August 2019 to December 2019. Data were collected about demographic characteristics, women's knowledge and attitude towards breastfeeding, antenatal and postnatal support and counseling, and feeding planning. Customized scales were utilized to assess knowledge and attitude. Factors associated with planning to breastfeed were reported.

RESULTS

660 women completed the survey questionnaire. The majority were 20 to 35 years of age, 10% were primiparous, and 30% were employed. 78% were knowledgeable about breastfeeding benefits and aware of WHO recommendations. 72% had a positive attitude towards breastfeeding. More than half received support from their husbands to breastfeed their infants, while less than 20% received any counseling from their obstetric providers. 97% reported their intention to breastfeed, and more than half indicated their willingness to breastfeed exclusively. With multivariable logistic regression modelling, predictors of EBF planning include: primiparity (AOR 1.79; 95% CI 1.1, 3.25), positive attitude (AOR 1.80; 95% CI 1.05, 3.1) and positive husband's support (AOR 1.92; 95% CI 1.18, 3.15). Barriers include women's employment (AOR 0.43; 95% CI 0.26, 0.70) and low birthweight (AOR 0.46; 95% CI 0.25, 0.84).

CONCLUSION

Jordanian women are highly knowledgeable about breastfeeding benefits, and they exhibit a positive attitude towards breastfeeding resulting in a very high percentage intending to breastfeed their infants. Limited counseling about breastfeeding is a major gap in antenatal care. As intentions might not reflect the actual practice after delivery, gaps and barriers affecting the determinants of successful breastfeeding should be identified, and corrective tools should be implemented accordingly. Allocating a specific time for antenatal or postnatal counseling and support is expected to promote breastfeeding practice in our population.

Validation of the Arabic version of the breastfeeding behavior questionnaire among Lebanese women

BACKGROUND

The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabic-speaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months.

METHODS

The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women's BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery.

RESULTS

The BBQ-A had a good internal consistency reliability (Cronbach's alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between - 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months.

CONCLUSIONS

The BBQ-A is a reliable and valid instrument to assess women's perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.

Adaptation and validation of the Iowa infant feeding attitude scale and the breastfeeding knowledge questionnaire for use in an Ethiopian setting

Background

Validated instruments to assess breastfeeding knowledge and attitude are non-existent in Africa including Ethiopia. We aimed to adapt and validate the Breastfeeding Knowledge Questionnaire (BFKQ) and the Iowa Infant Feeding Attitude Scale (IIFAS) for use in Afan Oromo (AO), the most widely spoken language in Ethiopia.

Methods

After forward-backward translation into Afan Oromo, the instruments were reviewed for content validity by a panel of a nutritionist and pediatricians, and pretested on a sample of 30 mothers. Then, a cross-sectional study involving 468 pregnant women in their second and third trimester was conducted between May and August 2017 in the Manna district, Southwest Ethiopia, using the final versions of the adapted questionnaires. We used exploratory and confirmatory factor analysis to assess the construct validity, receiver operating characteristic (ROC) curves to determine the predictive validity and Cronbach’s alpha coefficients to assess internal consistency.

Results

Using exploratory factor analysis (EFA), nine domains containing 34 items were extracted from the BFKQ-AO. A confirmatory factor analysis of the constructs from EFA confirmed construct validity of the instrument (χ2/df = 2.11, RMSEA = 0.049, CFI = 0.845, TLI = 0.823). In factor analysis of the IIFAS, the first factor explained 19.7% of the total variance and the factor loadings and scree plot test suggested unidimensionality of the tool. Cronbach’s alpha was 0.79 for the BFKQ-AO and 0.72 for IIFAS-AO suggesting an acceptable internal consistency of both instruments. For the sensitivity and specificity in predicting intention of breastfeeding for ≥24 months, the area under the curve (AUC) was 82% for IIFAS score and 79% for BFKQ score.

Conclusions

Here we present the first study that reported the use of the BFKQ and the IIFAS in Ethiopia. Our results showed that both BFKQ-AO and IIFAS-AO can be reliable and valid tools for measuring maternal breastfeeding knowledge and attitude in the study population, showing the potential for adapting these tools for application in a wider Ethiopian context.

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long-term by targeting children and adolescents' knowledge, attitudes, skills, and intentions. Breastfeeding rates in Lebanon are suboptimal. Psychosocial drivers of breastfeeding intention among the youth are unknown. We administered a survey to 658 high school students (448 females; 210 males) at two large Lebanese schools to understand intentions, intention drivers, and views on SBBE as means to guide SBBE programme design on the basis of the theory of planned behaviour. We collected information on demographics, intention to breastfeed/support wife to breastfeed future. Intention was predicted by attitude related to breastfeeding health outcomes and family normative beliefs-χ2 (25) = 115, P < .001 for males, and χ2 (39.3) = 186, P < .001 for females. Among females, intention was also positively associated with being breastfed, higher socio-economic status, and being more accepting of public breastfeeding. Seventy-eight per cent of students felt they were not learning enough about breastfeeding in school but were interested in SBBE through didactic teaching methods and interactive experiences. Findings indicate that breastfeeding intention among adolescent students is not merely influenced by the extent of knowledge but by more complicated psychosocial drivers that may differ by gender. Our findings also suggest a misalignment exists between what schools are providing with what students feel they need, thereby opening up a potential space for intervention.

Violent conflict and breastfeeding: the case of Iraq

BACKGROUND

This study explores the relationship between armed conflict and breastfeeding practices of Iraqi mothers. To date, the relationship between violent conflict and breastfeeding is surprisingly understudied. Especially in the Middle East, which is conflict-prone and has a young population, research on war and household behavior is critical for promoting recovery and sustainable development.

METHODS

This study employs a unique pairing of the Iraq Body Count Database and the 2006 and 2011 Multiple Indicator Cluster Surveys for Iraq. We use probit models to explore the association between armed conflict and several breastfeeding outcomes - whether a child was ever breastfed, whether a child was breastfed within 1 h after birth, whether a child is currently breastfed, and whether an infant under 6 months of age is exclusively breastfed. Our proxies for conflict intensity are the average rate of conflict-related casualties across the 3 years prior to survey administration and the rate of casualties averaged across the 2 years prior to the birth of the child, in the governorate in which the family resides. We employ a number of other independent variables important for breastfeeding status, including health controls and characteristics of the household, child and mother. We also use a Cox proportional hazards model to study the association between conflict and breastfeeding duration. We complement this analysis with various robustness checks, including disaggregation by year, controls for household wealth and an analysis of breastmilk substitutes and their potential for an interaction with household wealth.

RESULTS

We find in our main results that increases in conflict-related casualties are associated with a significant decline in the probability that a child was ever breastfed and a decline in the probability that a child is currently breastfeeding. There is no significant association with exclusive breastfeeding or with initiation of breastfeeding within 1 h after birth. This result is robust to alternative measures of conflict, although some coefficients from estimation based on the 2006 subsample are positive and not significant, and reverse causation is a potential source of bias in interpreting cross-sectional feeding patterns. Results on breastfeeding duration are mixed. Our results also suggest an increase in the use of breastfeeding substitutes like formula concurrent to higher levels of conflict among wealthier households.

CONCLUSION

The results are informative in the context of designing policy aimed at stabilizing the long-term health and productivity of populations in conflict areas. Infant formula provided with the objective of offering temporary relief creates risks, including reducing the probability and duration of breastfeeding. Attention to the supply of health care and to support systems for women, especially skilled breastfeeding support and targeted support to infants dependent on formula, are matters of the utmost urgency during and after conflict periods.

Breastfeeding exposure is associated with better knowledge of and attitudes toward BF in Kuwaiti women

Objectives

Breastfeeding (BF) has many benefits for both infants and mothers. However, despite evidence in support of BF, its prevalence has remained low in Kuwait. The purpose of this study was to (1) assess and describe BF attitudes and knowledge among women at a college campus; (2) evaluate BF exposures and sociodemographic factors associated with attitudes toward BF; (3) determine the association between BF knowledge and attitudes.

Materials and methods

This survey was a cross-sectional descriptive study conducted from February to April 2016. A convenience sample of 330 women (students, faculty and staff) from the College of Life Sciences (CLS) at Kuwait University participated in the survey.

Results

Most of the participants respected women who breast fed (81.8%). Some participants believed that BF a baby is painful (43.3%), makes the breasts sag (35.8%), and restricts the mothers’ freedom (51.5%). Additionally, 47.6% of the participants reported that they would feel embarrassed if they saw a woman BF her baby. Acceptability of BF in public was low and most participants preferred BF only around friends and family (52.4%). A statistically significant positive association was observed between BF knowledge and attitudes (R²=6.5%, p<0.001); however, the relationship was not independent and was also associated with nationality and having been breast fed as a baby (R²=10.3%, p=0.021).

Conclusion

BF knowledge is important to encourage positive BF attitudes, and both are enforced with family values and practice across generations.

Assessment of Antibiotic and Pesticides Residues in Breast Milk of Syrian Refugee Lactating Mothers

Occupational exposures and current diet are both sources of environmental contaminants that can be transferred in the mother’s body. These chemicals can definitely penetrate to the developing foetus and the nursing infant from contaminated breast milk during the lactation period. Nowadays, one of the special interests is the exposure of new-borns to toxic chemicals such as pesticides and antibiotics reported in human milk due to their potential harms, especially developmental deficits in early childhood. The aim of our current study was to assess the occurrence of pesticide residues and antibiotic residues contamination in breast milk collected from Syrian refugee lactating mothers residing in North Lebanon Camps. A total of 120 breast milk samples (40 in triplicate) were collected from camps in Akkar, North Lebanon using an electrical pump. A survey was administrated to determine socio-demographic characteristics, dietary and smoking habits and medical history of participating lactating mothers. The milk samples were analysed for the presence of antibiotic residues and pesticide residues using liquid and gas chromatography tandem mass spectroscopy (LC-MS/MS) and Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS). This study reported the absence of antibiotic residues in 96.66% of our samples (n = 120) and the presence of pesticides residues in only 5% of our total breast milk sample. Our results considered the breast milk collected from Syrian refugee lactating mothers as safe from chemical contamination. It is worth conducting more studies on other Syrian refugee camps to test the effect of camp living conditions on breast milk safety.

Knowledge, Attitude, Exposure, and Future Intentions toward Exclusive Breastfeeding among Universiti Sains Malaysia Final Year Medical and Dental Students

BACKGROUND

Breastmilk is the best nourishment for an infant for the first 6 months of life. Health professionals like medical doctors and dentists can help promote and support exclusive breastfeeding. We aimed to assess knowledge, attitudes, exposure, and future intentions toward exclusive breastfeeding among final year medical and dental students at Universiti Sains Malaysia, Kelantan, Malaysia.

METHODS

A total of 162 students participated in this cross-sectional study that was conducted between May and September of 2015. Self-administered questionnaires were used to collect the variables of interest.

RESULTS

Most students knew exclusive breastfeeding is recommended for the first 6 months of life (98.1%). However, some students incorrectly thought formula milk can be given if the infant appears hungry after having been breastfed (61.7%). Additionally, some incorrectly thought expressed breastmilk can be warmed on direct heat (47.5%) and left-over expressed milk can be re-stored (60.5%). Most students agreed that exclusive breastfeeding is easier to practice than formula feeding and that it is the best choice for working mothers. Most students (93.2%) intend to breastfeed their children, and this intention was significantly associated with their experience being breastfed as infants and attitudes toward exclusive breastfeeding.

CONCLUSION

Generally, final year medical and dental students have favorable attitudes and future intentions toward exclusive breastfeeding, although some of them lacked knowledge about certain important aspects of the practice. Past experience of being exclusively breastfed and a more positive attitude toward the practice were associated with their future intentions to practice exclusive breastfeeding.

Breastfeeding knowledge, attitudes, intentions, and perception of support from educational institutions among nursing students and students from other faculties: A descriptive cross-sectional study

BACKGROUND

Nursing education aims to promote positive health practices among the general population as well as among nurses themselves. Breastfeeding is one of these important health practices. However, to date there is little evidence regarding the extent to which nursing education affects nursing students' attitudes, knowledge, intentions, and their perception of institutional support regarding breastfeeding.

OBJECTIVES

To compare breastfeeding attitudes and knowledge among nursing students and students from other faculties, as well as their perception of their academic institution's support for breastfeeding, and to explore the association between these factors and students' intention to breastfeed during the course of their studies.

DESIGN

This study was a descriptive cross-sectional study.

SETTINGS

The study was conducted at a large university in central Israel.

PARTICIPANTS

One hundred female students from the faculty of nursing and 100 female students from other faculties, of childbearing age, who were either pregnant or mothers.

METHODS

The students completed a questionnaire regarding their breastfeeding knowledge, intentions, attitudes, and their perception of their academic institution's support for breastfeeding.

RESULTS

Nursing students' level of breastfeeding knowledge was very high, and higher than that among students from other faculties. However, both groups had similar moderately positive overall scores for attitudes towards breastfeeding. In addition, both groups expressed similar moderate intentions to breastfeed during the course of their studies. Students' perception of their academic faculty as supportive of breastfeeding, their breastfeeding attitudes, and breastfeeding knowledge, were found to predict their intention to breastfeed during the course of their studies.

CONCLUSIONS

Nursing programs should place more emphasis on improving nursing students' attitudes towards breastfeeding. In order to promote breastfeeding among students during their studies, it is important to ensure a pro-breastfeeding environment on campus.

Validation of the Arabic Version of the Infant Feeding Intentions Scale Among Lebanese Women

BACKGROUND

The Infant Feeding Intentions (IFI) scale was shown to reliably measure maternal intentions to initiate breastfeeding and continue exclusive breastfeeding until 1, 3, or 6 months in English and Spanish but not in Arab contexts. Research aim: This study aimed to validate an Arabic version of the IFI scale (IFI-A) and examine its ability to predict exclusive breastfeeding at 1, 3, or 6 months in pregnant Lebanese women.

METHODS

The internal consistency reliability and construct validity of the IFI-A scale were tested on 50 pregnant women (Group 1), whereas its predictive ability was tested on 196 pregnant women (Group 2), who were surveyed monthly about their infants' nutrition method until 6 months.

RESULTS

The IFI-A scale's Cronbach's alpha internal consistency reliability is .82. Its corrected item-total correlations ranged from .26 for Item 2 ("at least give breastfeeding a try") to .86 for Item 4 ("will be exclusively breastfeeding at 3 months"). Exploratory factor analysis revealed that it is unidimensional. IFI-A scores correlated significantly with exclusive breastfeeding duration in Group 1 ( r = .624; p = .001) and with participants' breastfeeding attitude ( r = .390; p < .001) and previous breastfeeding duration ( r = .237; p = .011) in Group 2, thus confirming its external construct validity. In adjusted analysis, the IFI-A scale predicted exclusive breastfeeding at 3 months, albeit weakly (odds ratio = 1.16; 95% confidence interval [0.99, 1.36]), but not at 1 or 6 months.

CONCLUSION

The IFI-A scale is a reliable and valid tool to assess maternal feeding intentions and predict exclusive breastfeeding at 3 months in the Arab context. Further studies are needed in other Arab contexts to confirm our findings.

Female College Students Knowledge, Attitude and Future Intention towards Breastfeeding: Implications for Advocacy

INTRODUCTION

Breastfeeding is important for promoting child's health. Since, breastfeeding decisions are made before pregnancy and are strongly influenced by women's knowledge and attitude, it is important to identify knowledge gaps in youth girls.

AIM

To assess the knowledge, attitude and future intention regarding infant feeding among female college students in Puducherry, India.

MATERIALS AND METHODS

This descriptive study was done among 307 college going female students. Their knowledge, attitude and future intention was assessed using structured questions and Likert's scale. Data were summarized as percentages with 95% confidence interval. Responses to Likert's scale were analyzed using consensus index.

RESULTS

Around 98% (95% CI: 96.5%, 99.6%) and 86.3% (95% CI: 82.5%, 90.2%) knew that breast milk and colostrum respectively is good for the child. However, students had poor knowledge about exclusive breastfeeding, the age of starting supplementation, recommended duration of breastfeeding. Noteworthy, 15% and 38% of them thought that breastfeeding spoils the mother's beauty and interferes with mother's employment respectively. Around 98% (95% CI: 97.0%, 100.0%) wanted to breastfeed their child in future. A high proportion of students, 20.5% (95% CI: 16.0%, 25.0%) wanted to give formula feed before 6 months. Knowledge and future intention to breastfeed was better among 'arts and science' students than engineering students.

CONCLUSION

The knowledge and attitude of female college students on breastfeeding is good. Almost all students wanted to breastfeed their children in future. However, the study has identified knowledge gaps and misconceptions which need to be stressed during the health education activity to promote optimal breastfeeding practices.

Adaptation and Validation of the Arabic Version of the Infant Breastfeeding Knowledge Questionnaire among Lebanese Women

BACKGROUND

Valid instruments that can reliably assess maternal breastfeeding knowledge in Arabic-speaking populations are nonexistent. The availability of such an instrument is essential for investigators working in this field.

OBJECTIVE

This study aimed to describe the adaptation and validation of the Arabic Breastfeeding Knowledge Questionnaire (BFK-A) from the original 20-item English version.

METHODS

A translated version of the 20-item BFK was validated among 417 Lebanese women after pilot testing for clarity, comprehension, length, and cultural appropriateness. Exploratory factor analysis was run to examine dimensionality of the instrument and Kuder-Richardson-20 (KR-20) was used to assess its internal consistency.

RESULTS

The BFK-A is a unidimensional scale with acceptable internal consistency reliability (KR-20 = 0.652) after the exclusion of 4 items. Higher breastfeeding knowledge levels were strongly and statistically significantly associated with higher mean scores for the validated Arabic Iowa Infant Feeding Attitude Scale ( P < .001), thus confirming its construct validity.

CONCLUSION

The Arabic 16-item BFK-A has an acceptable reliability, similar to the original instrument. Further studies are encouraged to confirm the validity of the 16-item BFK-A among other Arab populations. There is also a need to develop more reliable instruments to use in lactation research in this context.