Perceptions of caregivers about health and nutritional problems and feeding practices of infants: a qualitative study on exclusive breast-feeding in Kwale, Kenya

Evidence-based complementary feeding recipe book for Kenyan caregivers: A novel approach

The Kenyan Ministry of Health (MOH) and a consortium of nutritionists, researchers and communication, and design specialists developed a novel approach to create an evidence-based recipe book promoting complementary feeding (CF) in Kenya. The ADAPT approach includes five steps: applied research (A), dialogue with stakeholders (D), adapted behaviour change communication (BCC) theories (A), purpose-driven visual communication (P), and tailoring to priority audiences (T). Through this approach, the recipe book addresses key knowledge gaps using behaviour change theories and visual communication best practice to increase accessibility, acceptability, retention and motivation for behaviour change. The book addresses barriers to CF identified through formative applied research. Dialogue with stakeholders helped ensure cultural appropriateness and the book's alignment with MOH recommendations and key messages. The book uses behaviour change theories to approach the reader in a respectful way that motivates behaviour change. The use of consistent, purpose-driven visuals helps ensure key messages are easily understood and accessible to all caregivers regardless of literacy level. The book's tone and content are tailored to its audiences' attributes, needs and preferences. This five-step process inspired the development of ADAPT, a novel approach that integrates behaviour change and visual communication for greater impact. This paper outlines how the consortium used the ADAPT approach to develop an evidence-based book that thoughtfully and holistically addresses a wide range of barriers, provides practical solutions and increases self-efficacy around CF. It offers a blueprint for public health practitioners from any field who are interested in using visual behaviour change communication to promote healthy behaviour.

Protecting both infant and mother: perceptions of infant feeding practices in rural Haiti

Background

Global recommendations for optimal breastfeeding include early initiation, exclusivity for six months, and continued breastfeeding for two years and beyond. Although breastfeeding is near universal in Haiti, gaps in optimal practices persist. Determinants of breastfeeding practices are complex, and a contextualized understanding is needed to strengthen breastfeeding support interventions. We conducted a qualitative study to explore mothers’ perceptions of factors influencing breastfeeding practices in rural Haiti.

Methods

Focus group discussions were held in eight rural communes participating in a nutrition project. Study participants (n=86) were recruited from mothers’ support groups. A moderator facilitated the focus groups in Haitian Creole using a question guide to elicit observations about community breastfeeding practices related to early initiation, colostrum feeding, complementary foods and beverages, and breastfeeding cessation. Focus groups were recorded, and three observers took notes which were compiled into a single report of key points and validated by participants following each session. Quotes representing the key points were selected from the audio recordings, translated into English and analyzed to identify explanatory themes.

Results

Participants described breastfeeding for 12-18 months as the norm in study areas, with early and frequent use of additional foods and beverages. Three explanatory themes were identified, related to concerns for (i) infant well-being, including digestive health, nutritional needs and contentment; (ii) transmission of negative maternal emotional and physical states through breast milk; and (iii) maternal well-being, including effects on breastfeeding practices of maternal illness, hunger, stress, and competing time pressures. Underlying all these concerns is the context of rural poverty and the cultural meanings of breastfeeding.

Conclusions

Findings suggest that practices which compromise global breastfeeding recommendations may persist because of their perceived value in addressing concerns for infant and maternal well-being in the challenging context of rural poverty, food insecurity and poor health. Multi-sectoral interventions are needed to mitigate these underlying contributors and create an enabling environment for early, exclusive and continued breastfeeding.

Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment

BACKGROUND

Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited.

PURPOSE

To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school.

METHODS

A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis.

RESULTS

Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care.

IMPLICATIONS FOR PRACTICE

There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality.

IMPLICATIONS FOR RESEARCH

Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

Community-based new born care practice and its associated factors among women who give birth at home in Ethiopia: cross-sectional study

BACKGROUND

In Ethiopia, perinatal mortality rate was 33 per 1000 pregnancies and 64.4% of this death was occurred within the first 7 days of neonatal life. Moreover, more than 2.1% of new born babies were died within their first seven days of life in Ethiopia. Majority of neonatal deaths are preventable by applying an effective and lifesaving interventions. However, little is known about newborn care practice at the community level.

METHODS

A community-based cross-sectional study design was used. Multi-stage sampling techniques were used to get a total of 540 mothers who gave birth at home within the past six months from their kebeles in Ethiopia. Data was collected by using face-to-face interview with structured questionnaires. Then the data was coded, cleaned, and entered into Epidemiological data version 3.1 and exported to statistical package for social science version 23.0 for analyses. Bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio at 95% confidence interval with P-Value 0.05% was computed.

RESULTS

A total of 540 women were participated with a response rate of 98.3%. Only 208 (44%) of the women had good practice towards essential newborn care. Head of households [AOR (95%CI) 2.7417 (1.80-4.25)], type of birth attendant [AOR (95%CI) 3.962 (3.329-7.171)] and bad obstetrical history [AOR (95%CI) 3.151 (2.209-4.969)] were significantly associated with maternal newborn care practice.

CONCLUSION

Less than half of the mothers had good newborn care practice. In this study, head of household, type of birth attendant, and bad obstetrical history were significantly associated with maternal newborn care practice. Therefore, Ministry of Women and Woreda women and Child offices needs to promote the socioeconomic empowerment of women to increase the practice of essential newborn care practices.

A systematic review of hot weather impacts on infant feeding practices in low-and middle-income countries

BACKGROUND

Increased rates of exclusive breastfeeding could significantly improve infant survival in low- and middle-income countries. There is a concern that increased hot weather due to climate change may increase rates of supplemental feeding due to infants requiring fluids, or the perception that infants are dehydrated.

OBJECTIVE

To understand how hot weather conditions may impact infant feeding practices by identifying and appraising evidence that exclusively breastfed infants can maintain hydration levels under hot weather conditions, and by examining available literature on infant feeding practices in hot weather.

METHODS

Systematic review of published studies that met inclusion criteria in MEDLINE, EMBASE, Global Health and Web of Science databases. The quality of included studies was appraised against predetermined criteria and relevant data extracted to produce a narrative synthesis of results.

RESULTS

Eighteen studies were identified. There is no evidence among studies of infant hydration that infants under the age of 6months require supplementary food or fluids in hot weather conditions. In some settings, healthcare providers and relatives continue to advise water supplementation in hot weather or during the warm seasons. Cultural practices, socio-economic status, and other locally specific factors also affect infant feeding practices and may be affected by weather and seasonal changes themselves.

CONCLUSION

Interventions to discourage water/other fluid supplementation in breastfeeding infants below 6 months are needed, especially in low-middle income countries. Families and healthcare providers should be advised that exclusive breastfeeding (EBF) is recommended even in hot conditions.

Factors impacting on childhood nutrition: The experience of mothers in a rural Ghanaian community

Despite globally recommended infant and young child feeding (IYCF) practices, inadequate Child feeding remains a global challenge and the root cause of undernutrition. Most mothers who primarily feed children in most developing settings appear to have received information on the IYCF practices. We explored mothers' limitations to provide children optimally in a rural Ghanaian community. We interviewed 42 family members, including parents and grandparents of thirty-two children under five years, from fifteen households using an ethnographic fieldwork approach. We observed and participated in food preparation and child feeding and interviewed religious leader, diviners. Households' decision-making arrangements, mothers, emerging roles and inconsistency of fathers' roles, competing sources of knowledge poverty, food insecurity and the nature of the community's social interactions and policing of women's child feeding practices are issues mothers have to navigate to feed children in the study community. Cultural custodians should be given child nutrition and providing information. Mothers should be empowered to manage child feeding and emerging roles.

Relatively speaking? Partners' and family members' views and experiences of supporting breastfeeding: a systematic review of qualitative evidence

This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Effects of comprehensive care on complications, oxygenation indexes and guardian's psychological mood of children with neonatal respiratory distress syndrome

OBJECTIVE

To observe the effects of comprehensive care on complications, oxygenation indexes of children with neonatal respiratory distress syndrome (NRDS), as well as their guardian's psychological mood.

METHODS

Totally 205 cases of children with NRDS admitted to our hospital from February 2018 to December 2019 were recruited and divided into two groups according to different nursing interventions. Cases receiving comprehensive care were included in the research group (RG, n=108), and cases receiving routine care were included in the control group (CG, n=97). The curative effect, improvement of clinical symptoms, complications during nursing process, improvement of oxygenation indexes, degree of lung injury, improvement of physiological health were observed and compared, as well as the improvement of parents' psychological mood and their satisfaction with this nursing intervention.

RESULTS

After care, RG had significantly better improvement of clinical indexes than that in CG, with notably lower PaCO₂ and higher PaO₂ and SaO₂. Besides, children in RG showed remarkably lower Murray score and APACHE-II score, and the patients of children in RG also had lower SAS and SDS scores. The overall response rate (ORR) of children in RG was evidently higher than that in CG, the incidence of total complications in RG was evidently lower than that in CG, and the nursing satisfaction of parents in RG was evidently higher than that in CG.

CONCLUSION

Comprehensive care is effective for children with NRDS, which can improve oxygenation indexes and lung injury, reduce the incidence of complications, and improve the psychological mood of parents.

Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya

Background

Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers.

Methods

Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis.

Results

Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity.

Conclusions

There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.

Longitudinal interrelationship between HIV viral suppression, maternal weight change, breastfeeding, and length in HIV-exposed and uninfected infants participating in the Kabeho study in Kigali, Rwanda

PURPOSE

The health of infants that are HIV-exposed and -uninfected (HEU) is a major public health concern as HIV becomes a chronic condition. We investigate the interrelationship between maternal viral suppression, maternal weight status, breastfeeding, and infants that are HEU.

METHODS

The Kabeho study followed 502 HEU infants in Kigali, Rwanda, for 24 months from 2013 to 2014. We use a structural equation modeling approach to investigate the dynamic relationships between viral suppression, maternal weight change, breastfeeding, and infant length-for-age z-score (LAZ) as defined by the WHO.

RESULTS

Older mothers are more likely to be virally suppressed and to breastfeed. Viral suppression and the mother being on antiretroviral treatment for longer were related to lower infant LAZ at three months. A more positive maternal weight change was related to higher infant LAZ at the end of each period. At 12 months, a higher infant LAZ was related to increased probability of continued breastfeeding. At 18 months, continued breastfeeding was related to lower LAZ, and food shortages were related to higher LAZ.

CONCLUSION

There is a complex interrelationship between viral suppression, maternal weight change, breastfeeding, and infant LAZ. These relationships demonstrate the link between maternal and infant health in the context of HIV.

Improvement of Dietary Diversity and Attitude toward Recommended Feeding through Novel Community Based Nutritional Education Program in Coastal Kenya-An Intervention Study

Community-based nutritional intervention to improve the practice of dietary diversity and child nutrition by community health workers (CHWs) involving Nyumba Kumi as small neighborhood units (SNUs) in communities has not yet been explored. This study was conducted in two villages in rural Kenya between 2018 and 2019. In total, 662 participants (control vs. intervention: n = 339 vs. n = 323) were recruited. The intervention group received education on maternal and child nutrition and follow-up consultations. The custom-tailored educational guidelines were made based on Infant and Young Child Feeding and the mother and child health booklet. The educational effects on household caregivers’ feeding practice attitude and child nutritional status were analyzed using multiple linear regression. After the intervention, a total of 368 household caregivers (187 vs. 181) and 180 children (113 vs. 67) were analyzed separately. Between the groups, no significant difference was found in their background characteristics. This study successfully improved the dietary diversity score (β = 0.54; p < 0.01) and attitude score (β = 0.29; p < 0.01). The results revealed that the interventions using CHWs and SNUs were useful to improve dietary diversity and caregivers’ attitudes toward recommended feeding. This research has the potential to be successfully applied in other regions where child undernutrition remains.

Child feeding in rural northern Ghana: Carer's perceptions of food and their children's diets

A child's diet should be composed of appropriate nutrients to achieve optimal nutritional status, and though there is a substantial evidence base for child feeding recommendations, developing countries continue to face challenges regarding optimal child feeding. This paper describes an ethnographic study undertaken in rural northern Ghana to explore community perceptions of what ‘counts’ as food for children and the impact this had on the nutrients they received. Fifteen households with children under 5 years were purposively selected. In‐depth interviews were held with 25 mothers, 7 fathers and 8 grandparents within these households as well as 2 diviners. Participant observations were also undertaken. Findings show that satiety rather than nutrition was the key consideration in adult choices about a child's diet. The community regarded carbohydrate‐based meals as food, but considered protein, vitamins and mineral‐based foods as nonessential elements of a child's diet, and important sources of these nutrients were regarded as treats.

Mothers' experiences of exclusive breastfeeding in a postdischarge home setting

Re‐establishment and maintenance of exclusive breastfeeding (EBF) is recommended by the World Health Organization for the nutritional rehabilitation of malnourished infants under 6 months; however, there is no explicit guidance on how this should be achieved. The IBAMI study—a pilot study conducted in Kilifi, Kenya—implemented these recommendations using an intervention for hospitalized infants and their mothers that included ward‐based breastfeeding peer supporters. This paper explores how the challenges of maintaining EBF are recontextualized after infant hospitalization for malnutrition. Four weeks after discharge, semistructured interviews on experiences of trying to maintain EBF in a postdischarge home setting were conducted with a total of 20 mothers. Although most stated the aspiration of maintaining EBF for 6 months, a range of challenges were reported and not all had successfully maintained EBF post discharge. Reported challenges include the stress of household chores, food insecurity, technical difficulties and social stigma of expressing breast milk, pressure from neighbours and family members to introduce mixed feeding, and needing more community‐based awareness and support. Most of these challenges were specific to the home setting and were not easily surmountable, despite the breastfeeding practices mothers had learned in the ward. Indeed, in some cases, challenges were exacerbated by the overmedicalized nature of the breastfeeding practices taught in the ward. In order to aid the transition from ward to home, there may be a need to further translate ward‐based education and promotional messaging for EBF into a community setting, targeting other caregivers as well.

Prenatal infant feeding intentions and actual feeding practices during the first six months postpartum in rural Rwanda: a qualitative, longitudinal cohort study

Background

Exclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0–1 month to 81% among those aged 4–5 months. Little is known about what influences mothers’ breastfeeding practices. This study aimed to gain insights into expectant mothers’ prenatal feeding intentions, the underlying reasons, actual practices after birth, and factors facilitating or impeding EBF for the first 6 months of a child’s life in Muhanga District, Rwanda.

Methods

This qualitative longitudinal study, conducted between December 2016 and October 2017 as part of a larger study, recruited a purposive sample of 39 pregnant women attending prenatal consultations during their last trimester in two rural health centers. Women were interviewed during pregnancy, within the first week after birth and at 4 and 6 months postpartum to explore intentions, actual practices, critical transition points, and facilitating or impeding factors. Interviews were recorded, transcribed verbatim, and analyzed thematically.

Results

Of the 39 participants, 38 intended to breastfeed within the first hour after birth, and 32 intended to breastfeed exclusively for the first 6 months. In practice, 34 initiated breastfeeding within the first hour, and 12 breastfed exclusively for 6 months. Impeding factors include perceived breastmilk insufficiency, pressure from family members, past experiences, mothers’ concerns over their infants’ health, mothers’ heavy workload, poverty and food insecurity. Factors facilitating early initiation and EBF include mothers’ awareness of EBF’s advantages, confidence in their breastfeeding ability, and support from health professionals and family members.

Conclusion

Despite participants’ intentions about breastfeeding, there was a gap between intentions and actual practices. An interplay of barriers at individual, group and societal levels impeded women from EBF for the first 6 months. EBF promotion interventions should consider supporting and equipping breastfeeding mothers with skills to deal with perceived breastmilk insufficiency and to recognize the true signs of baby hunger cues. Furthermore, important influential family and community members should be targeted to support mothers to breastfeed. Interventions that consider addressing the issue of poverty-driven food insecurity should not be overlooked either.

Exclusive breastfeeding in first-time mothers in rural Kenya: a longitudinal observational study of feeding patterns in the first six months of life

BACKGROUND

Exclusive breastfeeding up to 6 months of age is recommended by the World Health Organization as the optimal mode of infant feeding, providing adequate nutrition for the baby and protection against infectious diseases. Breastfeeding can be adversely affected by individual, cultural and socio-economic factors. The study aimed to explore barriers of exclusive breastfeeding in the first 6 months of life among first-time mothers in rural Kenya.

METHODS

An observational longitudinal design aimed to provide rich data on breastfeeding behaviour. Twenty pregnant first-time mothers were recruited through antenatal clinics and snowballing. Mothers were visited nine times at home from late pregnancy, at 1 week and 2 weeks post-delivery, then monthly until the baby was aged 6 months. Visits were conducted between November 2016 and April 2018. At the first visit, participants were asked about breastfeeding intentions and infant feeding education received. At each postnatal visit, direct observation of breastfeeding, a recorded semi-structured interview on feeding, mother's and baby's health was performed. Interviews were transcribed, checked, content was grouped into categories and analyzed using a qualitative descriptive approach.

RESULTS

Most participants were adolescent (75%) and unmarried (65%). All 20 mothers intended to and did breastfeed, however additional fluids and semi-solids were commonly given. Only two mothers exclusively breastfed from birth up to 6 months of age. Prelacteal feeds, home remedies and traditional medicine were given by over a third of mothers in the first week of life. Concern over babies' bowel habits and persistent crying perceived as abdominal colic led to several mothers receiving advice to give gripe water and traditional remedies. Early introduction of maize porridge from 3 months of age because of perceived hunger of the child was recommended by other family members. Breastfeeding observation showed persistent problems with positioning and attachment of infants.

CONCLUSIONS

Exclusive breastfeeding from birth to 6 months was uncommon. Prioritization of capacity to detect mothers with breastfeeding problems and provide breastfeeding education and support is necessary, particularly during the antenatal and early postnatal period. It is important to engage with other women resident in the household who may offer conflicting feeding advice.

'This sickness is not hospital sickness': a qualitative study of the evil eye as a source of neonatal illness in Ghana

Previous research has described the evil eye as a source of illness for pregnant women and their newborns. This study sought to explore the perceptions of the evil eye among mothers whose newborns had experienced a life-threatening complication across three regions of Ghana. As part of a larger, quantitative study, trained research assistants identified pregnant and newly delivered women (and their newborns) who had survived a life-threatening complication at three tertiary care hospitals in southern Ghana to participate in open-ended, qualitative interviews about their experiences in March-August 2015. All interviews were audio-recorded and transcribed verbatim into English and analysis using the constant comparative method of theme generation. A total of 37 mothers were interviewed, 20 about neonatal illnesses and 17 about maternal illnesses. Six of the 20 mothers interviewed about their newborn's illnesses spoke at length about the evil eye being a potential cause of newborn illness. The evil eye was described in a variety of terms, but commonalities included a person looking at a pregnant woman, her newborn baby, the baby's clothes and even the mother's food, causing harm, even unintentionally. Prevention required mothers covering themselves while pregnant and keeping the baby away from others until it was old enough to ward off the evil eye. Treatment required traditional medicine, yet some indicated that allopathic medicine could help. The evil eye appears to serve a social control mechanism, encouraging pregnant women to dress modestly, stay indoors as much as possible and behave appropriately. The evil eye is a pervasive, universally understood phenomenon across three regions of Ghana, even amongst a hospitalized population receiving allopathic health care for life-threatening complications of childbirth. Understanding the role of the evil eye in newborn illness attribution is important for clinicians, researchers and programmatic staff to effectively address barriers to care seeking.

Integrated review of healthcare provider postnatal newborn care recommendations in Sub-Saharan Africa

AIMS

To (1) identify formal and informal healthcare provider knowledge and counselling on newborn care recommendations; (2) identify care guidelines used; and (3) determine healthcare provider training regarding recommendations.

BACKGROUND

In sub-Saharan Africa, many newborn deaths occur in the community between days two to 42 of life.

INTRODUCTION

Formal and informal healthcare providers, including nurses and community health workers, counsel newborn caregivers but little is known about their recommendations.

METHODS

Integrative review of studies conducted 2000-2018 after search of PubMed, CINAHL, Embase, and African healthcare journals. Study quality was assessed and findings synthesized.

FINDINGS

Twelve qualitative, quantitative, or mixed-methods studies (quality good to poor) from seven countries were included. Eleven reported on one to three recommendations; one study reported on eight recommendations. Knowledge or counselling on feeding, cord care, recognizing illness, referrals, informal treatment, home visits, immunizations, follow-up examinations, thermal care, low birthweight, and bed net usage were reported. Formal healthcare providers gave recommendations in only two studies. Four studies documented use of guidelines. Six studies reported on training.

DISCUSSION

Studies were primarily descriptive, limiting quality. Feeding and cord care recommendations were prioritized. Care guidelines were underutilized. Additional training on recommendations is needed. These findings regarding healthcare providers align with other regions with high neonatal mortality.

CONCLUSION

Research is needed to improve and sustain knowledge, counselling, and guideline usage among providers to address neonatal mortality.

IMPLICATIONS FOR NURSING

The unique role of nurses to promote newborn health appears under-researched. Nurse professionalization and specialization may contribute to sustained knowledge of and counselling on newborn recommendations.

IMPLICATIONS FOR HEALTH POLICY

As countries adopt universal health care, policies that enable formal providers to encourage maternal-newborn engagement in newborn health promotion before transition to the community are needed. Collaboration between formal and informal providers may improve dissemination of recommendations and contribute to gains in newborn health.

Perspectives on maternal, infant, and young child nutrition and family planning: Considerations for rollout of integrated services in Mara and Kagera, Tanzania

In Lake Zone, Tanzania, low contraceptive prevalence, closely spaced births, and child stunting are common. Synergies exist between postpartum family planning (PPFP) and maternal, infant, and young child nutrition (MIYCN), yet health services are often provided in silos. This qualitative formative research study aimed to identify barriers and facilitating factors for optimal nutrition and PPFP practices in Mara and Kagera, Tanzania. Results informed the program design of an integrated nutrition and family planning (FP) implementation approach. The study involved in‐depth interviews with mothers of infants under 1 year (n = 24), grandmothers (n = 12), health providers (n = 6), and traditional birth attendants (n = 12), and 14 focus group discussions with community health workers, fathers, and community leaders. Findings reveal that breastfeeding initiation was often delayed, and prelacteal feeding was common. Respondents linked insufficient breast milk to inadequate maternal nutrition—in terms of the quality of the diet and small quantities of food consumed by mothers. Breast milk insufficiency was addressed through early introduction of foods and liquids. Mothers believed that breastfeeding prevents pregnancy, regardless of the frequency or duration of breastfeeding, yet were generally not aware of the lactational amenorrhea method (LAM) of FP. Joint decision‐making on FP was viewed as important, and women often discussed it with their partner. Future programming should address misconceptions about return to fecundity1 knowledge gaps and concerns about FP methods including LAM; and perceptions regarding insufficient breast milk and early introduction of foods which are impediments to optimal MIYCN and FP practices.

A qualitative exploration of the sociocultural determinants of exclusive breastfeeding practices among rural mothers, North West Nigeria

Background

Suboptimal breastfeeding is responsible for 96% of deaths among children under 12 months of age in developing countries. However, the exclusive breastfeeding rate in Nigeria from birth to 6 months is just 23%. The study explored the sociocultural factors that influence exclusive breastfeeding among rural mothers.

Methods

The social constructionism-interpretivist epistemological approach underpinned this qualitative study. Semi-structured interviews were conducted with 20 mothers aged 18–39 years, purposefully sampled from two Local Government Areas in Katsina State, Nigeria. Thematic content approach was utilised for analysis.

Results

Three major themes were developed from the analysis: (1) Breastfeeding initiation – the determinants of how soon a mother initiated breastfeeding included traditional new-born care practices, the birth attendant and place of delivery. (2) Exclusive breastfeeding - motivation to sustain exclusive breastfeeding was influenced by the conflict between the obligation to perform traditional rites, the mother’s awareness and family support. (3) Decision-making about infant feeding – the husband, grandmother, traditional birth attendant and the health workers all influenced participants’ decisions around infant feeding. Despite awareness of the benefits of exclusive breastfeeding among most mothers interviewed, they expressed concerns that they may not win their family’s support if their views were contrary to those held by other family members.

Conclusion

While mothers have limited powers to make decisions, the key role that grandmothers and husbands have in decisions about breastfeeding demonstrates the need to engage the support of partners and relatives through community-driven policies and integrated interventions that address social and cultural barriers throughout the prenatal and postnatal period.

Getting schooled: teachers' views on school-based breastfeeding education in Lebanon

Background

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long term by instilling in young people a base of evidence-informed knowledge, skills, and attitudes that primes them to make informed decisions about infant feeding and to become positive change agents. Breastfeeding rates in Lebanon remain suboptimal, and breastfeeding misconceptions along with social pressures to use infant formula are known contributing barriers. We conducted this study with pre-K-12 teachers to understand the SBBE landscape as well as the supports and constraints for SBBE at two large Lebanese schools.

Methods

We conducted a survey with 193 teachers during the 2017-2018 academic school year to collect information about demographics, breastfeeding history, breastfeeding teaching practices, attitudes towards SBBE such as attitude towards educating both boys and girls about breastfeeding, and views on potential constraints to successful SBBE implementation. Descriptive statistics and thematic analysis were used. Binary multiple logistic regression was used to ascertain the effects of teacher characteristics on likelihood to support SBBE.

Results

While limited SBBE is currently taking place with only eight (4%) teachers reporting teaching about breastfeeding, 133 (69%) reported students should learn about breastfeeding in school. A multiple regression model [χ2(4) = 19.71, p = 0.001] showed teachers were more likely to support SBBE if they/their partners had ever breastfed, if they taught biology, or if they believed that schools should educate both boys and girls about breastfeeding in a society where discussing breastfeeding in public is a taboo. One hundred and ten (60%) teachers reported several concerns to SBBE implementation which included limited uptake by students who might not find SBBE valuable to them and resistance from parents due to cultural barriers. In order to effectively expand SBBE in these schools, 71 SBBE supporters (59.2% of respondents; 13 with missing data) suggested supporting local teachers to deliver SBBE, and 48 (40%) suggested mandating SBBE.

Conclusions

Teachers held generally positive views on SBBE, which provides a fertile ground for growing SBBE in their schools. Future steps need to include engaging parents, students, and school principals to further understand the social constrains to SBBE before program design.

Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka's slums: a mixed method study

Background

Despite the substantial impact on child and maternal health, breastfeeding practices for infants remain at the suboptimum level in Bangladesh. Yet the understanding of why these practices are suboptimal, especially surrounding urban slum dwelling mothers, is unclear. The purpose of this study was to assess early infant feeding practices, examine associations with maternal factors, and uncover the facilitators and barriers to early feeding practices in selected slums of Dhaka, Bangladesh.

Methods

A mixed method study was conducted from June to September 2016 using both quantitative and qualitative methods among mothers with children under the age of 6 months. The survey included 342 mother-infant pairs and 18 in-depth interviews were conducted. Univariate and multiple logistic regression was used to determine status of early infant feeding practices and factors associated with exclusive breastfeeding (EBF) within the previous 24 h. Transcripts were coded to uncover the facilitators and barriers surrounding early infant feeding practices.

Results

Sixty four percent (220/342) of mothers initiated breastfeeding within 1 h, 96.5% (330/342) reported feeding colostrum, and 36.3% (124/342) infants were EBF in the last 24 h. After adjusting for child gender, maternal age, education, diet and household income; infant’s age (adjusted odds ratio (AOR) for 61–120 days 6.42; 95% CI 3.42, 12.1; AOR for 121–180 days 45.6; 95% CI 18.33, 113.45), prelacteal feeding (AOR 2.53; 95% CI 1.14, 4.58), lack of planning for EBF during pregnancy (AOR 4.06; 95% CI 1.09, 15.12) and infants delivered by cesarean section (AOR 2.76; 95% CI 1.34, 5.67) were negatively associated with EBF. During the 18 interviews, eight mothers reported a cesarean delivery and none of these mothers initiated breastfeeding within 1 h or exclusively breastfed. Moreover, all eight mothers gave their infants prelacteal feeds.

Conclusions

The status of early infant feeding practices in Dhaka’s slums was poor. The negative impact of cesarean section on all early infant feeding practices was evident in both quantitative and qualitative analysis.

Effect of VAPE about mother and infant health on knowledge among primary caregivers of patients with postpartum psychiatric illness:- A pre-experimental study

Post partum psychiatric illnesses are quiet common nowadays, which can interfere with postnatal care of both mother and infant. The present study was a one group pre-test - post-test design, adopted with an aim to enhance the knowledge on mother infant health among primary caregivers of mothers with postpartum psychiatric illnesses conducted in the mother-baby unit, NIMHANS, Bengaluru. Twenty five subjects who met the inclusion criteria were recruited through convenience sampling. After the pilot study, data was collected with a researcher developed tool. The Video Assisted Psycho-Education [VAPE] consisted of three sessions lasting for thirty minutes, taken over three consecutive days following the pre-test. Post-test was done immediately after the last session. Effectiveness of the intervention was established by McNemar test, Paired t-test and Wilcoxon Sign Ranks test. Analysis revealed statistically significant (p<0.001) increase in the post-test mean knowledge scores following the VAPE sessions. There was no statistically significant association between the pre-intervention knowledge score and the socio-demographic variables of the study subjects. The study findings revealed that the VAPE programme was effective in increasing the knowledge of the primary caregivers on mother infant health.

Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study

Background: Early feeding patterns may affect the growth of HIV-exposed children and thus their subsequent health and cognition.Objective: We assessed the association of infant feeding (IF) mode with length-for-age z score (LAZ) and stunting from age 2 d to 18 mo in HIV-exposed African children within a controlled randomized trial, which evaluated triple antiretrovirals initiated during pregnancy and continued for 6 mo postpartum to prevent HIV transmission.Methods: HIV-infected pregnant women with CD4⁺ counts of 200-500 cells/mm³ from Burkina Faso, Kenya, and South Africa were advised to exclusively breastfeed for up to 6 mo or to formula-feed from birth. Factors associated with LAZ were investigated in all uninfected children by using mixed-effects linear models; those associated with stunting (LAZ <-2) at 6 or 12 mo were assessed in multiple logistic regression after exclusion of children stunted at age 2 d. Independent variables were IF mode: formula feeding (FF), exclusive breastfeeding (EBF) <3 mo, or EBF ≥3 mo (reference); sex; trial arm; maternal characteristics; and site.Results: Among 728 children, FF was associated with a greater increase in LAZ from 2 d to 6 mo (+0.07 z score/mo, P < 0.001). Between 6 and 18 mo, FF and EBF <3 mo were both associated with greater mean LAZ than was EBF ≥3 mo (+0.52 z scores and +0.43 z scores, respectively, P < 0.001). Among children not stunted at 2 d, FF was independently associated with a reduced risk of stunting at 6 mo (OR: 0.24; 95% CI: 0.07, 0.81; P = 0.021), whereas EBF <3 mo was not (OR: 0.49; 95% CI: 0.22, 1.10; P = 0.09).Conclusions: In this observational study of HIV-exposed uninfected infants, growth in length in the first 6 mo of life was faster in formula-fed infants than in exclusively breastfed infants. The plausibility of residual confounding and reverse causality is discussed. This trial was registered at www.controlled-trials.com as ISRCTN71468401.

"When you give birth you will not be without your mother" A mixed methods study of advice on breastfeeding for first-time mothers in rural coastal Kenya

Background

Exclusive breastfeeding for the first 6 months of life is currently recommended by the World Health Organization, but mixed feeding earlier than this commonly occurs in rural coastal Kenya. Mothers may receive conflicting advice on breastfeeding from various sources including health workers, relatives and community members. We aimed to find out how first-time mothers learn to breastfeed, who advises them on infant feeding and what advice they obtain in case of any breastfeeding problems.

Methods

To identify advisers, a questionnaire on socio-demographic status, place of delivery, household members, education and help received on breastfeeding, breastfeeding problems, name of advisers and their relationship to the mothers was administered to 50 new first-time mothers in Jaribuni, Kilifi (population approximately 18,000). Summary statistics were obtained using frequencies, medians and interquartile ranges (IQR). Focus group discussions (FGDs) were held amongst 4 groups of mothers who had answered questionnaires; 4 groups of their named advisers; and 1 group of community health workers in order to explore breastfeeding practices, problems and advice given. FGDs were analysed by thematic framework analysis.

Results

First-time mothers were young (median age 18, IQR 17–21, range 14–26 years) and 42 % were single. Living in extended families was the norm and married women lived with their husband’s family. All had a female family member or neighbour helping with childcare in the perinatal period. The main advisers on breastfeeding were their mother or older female members of their husband’s family. Married first-time mothers felt obliged to follow their mother-in-law’s advice to maintain good relationships and show respect within the household. Breastfeeding problems were reported by 80 % of respondents. Nipple pain (56 %) was the most reported problem, then breast engorgement (48 %) and insufficient milk supply (38 %). Most problems were treated at home without consultation with health workers. Concerns were raised about co-sleeping, breastfeeding whilst lying down, and insufficient milk supply. Advisers would like more information on breastfeeding in order to help mothers.

Conclusions

Interventions to increase knowledge of, and facilitate optimal breastfeeding practices in first-time mothers should include those family members who advise and assist with childcare around the time of delivery.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0069-6) contains supplementary material, which is available to authorized users.

Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya

Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In‐depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro‐level policies and interventions that consider the ecological setting are needed.