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Basbous M, Yehya N, Salti N, Tamim H, Nabulsi M. Cost-benefit analysis of a multicomponent breastfeeding promotion and support intervention in a developing country. PLoS One 2024; 19:e0295194. [PMID: 39028742 PMCID: PMC11259277 DOI: 10.1371/journal.pone.0295194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/27/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Studies on breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life. METHODS This is a cost-benefit analysis of data generated from a randomized controlled trial that investigated whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data of 339 participants on sociodemographics, mother and infant health, infant nutrition, direct and indirect costs of the intervention were used to assess the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months as primary outcome. Secondary outcomes included overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models explored the effect of the intervention on the overall infant nutrition cost and mother-infant health costs. Similar regression models investigated the association between cost variables and infant nutrition types (exclusive breastfeeding, mixed feeding, artificial milk). Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p-value below 0.05. RESULTS The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient at one year (incremental net benefits of 374 USD; BCR = 2.44), and two years (incremental net benefits of 472 USD; BCR = 2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (p = 0.045). Stratified analyses by the infant nutrition type revealed that infants who were on Exclusive/Predominant, or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years (p<0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (p<0.05) but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants (p = 0.001), they were similar in infants on Mixed Feeding or Artificial Milk. CONCLUSIONS Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.
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Affiliation(s)
- Maya Basbous
- The Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine Yehya
- Department of Public Affairs and Marketing, UC Davis, Davis, CA, United States of America
| | - Nisreen Salti
- Department of Economics, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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Rodríguez-Gallego I, Corrales-Gutierrez I, Gomez-Baya D, Leon-Larios F. Effectiveness of a Postpartum Breastfeeding Support Group Intervention in Promoting Exclusive Breastfeeding and Perceived Self-Efficacy: A Multicentre Randomized Clinical Trial. Nutrients 2024; 16:988. [PMID: 38613021 PMCID: PMC11013075 DOI: 10.3390/nu16070988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
There are numerous recognized benefits of breastfeeding; however, sociocultural, individual, and environmental factors influence its initiation and continuation, sometimes leading to breastfeeding rates that are lower than recommended by international guidelines. The aim of this study was to evaluate the effectiveness of a group intervention led by midwives supporting breastfeeding during the postpartum period in promoting exclusive breastfeeding, as well as to assess the impact of this intervention on perceived self-efficacy. This was a non-blind, multicentric, cluster-randomized controlled trial. Recruitment started October 2021, concluding May 2023. A total of 382 women from Andalusia (Spain) participated in the study. The results showed that at 4 months postpartum there was a higher prevalence of breastfeeding in the intervention group compared to formula feeding (p = 0.01), as well as a higher prevalence of exclusive breastfeeding (p = 0.03), and also at 6 months (p = 0.01). Perceived self-efficacy was similar in both groups for the first two months after delivery, which then remained stable until 4 months and decreased slightly at 6 months in both groups (p = 0.99). The intervention improved the average scores of perceived self-efficacy and indirectly caused higher rates of exclusive breastfeeding (p = 0.005). In conclusion, the midwife-led group intervention supporting breastfeeding proved to be effective at maintaining exclusive breastfeeding at 6 months postpartum and also at increasing perceived self-efficacy.
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Affiliation(s)
- Isabel Rodríguez-Gallego
- Foetal Medicine, Genetics and Reproduction Unit, Virgen del Rocío University Hospital, 41013 Seville, Spain;
- Red Cross Nursing University Centre, University of Seville, 41009 Seville, Spain
| | - Isabel Corrales-Gutierrez
- Surgery Department, Faculty of Medicine, University of Seville, 41009 Seville, Spain
- Foetal Medicine Unit, Virgen Macarena University Hospital, 41009 Seville, Spain
| | - Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, Universidad de Huelva, 21007 Huelva, Spain
| | - Fatima Leon-Larios
- Nursing Department, School of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
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Claudia Lopes A, Lousada M. Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal. BMC Public Health 2024; 24:394. [PMID: 38321425 PMCID: PMC10848452 DOI: 10.1186/s12889-024-17849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon. METHODS A sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding. RESULTS Only 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers' breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers' breastfeeding attitudes, beliefs, and practices. CONCLUSIONS The findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.
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Affiliation(s)
- Ana Claudia Lopes
- Center for Health Technology and Services Research (CINTESIS.UA@RISE), University of Aveiro, Aveiro, Portugal
| | - Marisa Lousada
- Center for Health Technology and Services Research (CINTESIS.UA@RISE), University of Aveiro, Aveiro, Portugal
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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Rodríguez-Gallego I, Vila-Candel R, Corrales-Gutierrez I, Gomez-Baya D, Leon-Larios F. Evaluation of the Impact of a Midwife-Led Breastfeeding Group Intervention on Prevention of Postpartum Depression: A Multicentre Randomised Clinical Trial. Nutrients 2024; 16:227. [PMID: 38257120 PMCID: PMC10821517 DOI: 10.3390/nu16020227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Postpartum depression is a significant health issue affecting both mothers and newborns during the postpartum period. Group support interventions during this period have proven effective in helping women cope with depression and improving breastfeeding rates. This study aimed to assess the effectiveness of a midwife-led breastfeeding support group intervention on breastfeeding rates, postpartum depression and general self-efficacy. This was a multicentric cluster randomised controlled trial with control and intervention groups and was not blinded. It was conducted in Andalusia (southern Spain) from October 2021 to May 2023. A total of 382 women participated in the study. The results showed a significant difference in exclusive breastfeeding rates at 4 months postpartum between the groups (control 50% vs. intervention 69.9%; p < 0.001). Additionally, there was a lower mean score on the Edinburgh Postnatal Depression Scale in the intervention group (12.49 ± 3.6 vs. 13.39 ± 4.0; p = 0.044). Similarly, higher scores of general self-efficacy were observed among breastfeeding women at 2 and 4 months postpartum (77.73 ± 14.81; p = 0.002 and 76.46 ± 15.26; p < 0.001, respectively). In conclusion, midwife-led breastfeeding support groups enhanced self-efficacy, prolonged breastfeeding and reduced postpartum depression 4 months after giving birth.
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Affiliation(s)
- Isabel Rodríguez-Gallego
- Foetal Medicine, Genetics and Reproduction Unit, Virgen del Rocío University Hospital, 41009 Seville, Spain;
- Red Cross Nursing University Centre, University of Seville, 41013 Seville, Spain
| | - Rafael Vila-Candel
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain
- La Ribera Primary Health Department, 46600 Alzira, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
| | - Isabel Corrales-Gutierrez
- Surgery Department, Faculty of Medicine, University of Seville, 41009 Seville, Spain
- Foetal Medicine Unit, Virgen Macarena University Hospital, 41009 Seville, Spain
| | - Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, Universidad de Huelva, 21007 Huelva, Spain;
| | - Fatima Leon-Larios
- Nursing Department, School of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
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Basbous M, Yehya N, Salti N, Tamim H, Nabulsi M. Cost-benefit analysis of a multicomponent breastfeeding promotion and support intervention in a developing country. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.17.23298704. [PMID: 38014286 PMCID: PMC10680883 DOI: 10.1101/2023.11.17.23298704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life. Methods This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models investigated the effect of the multicomponent intervention (independent variable) on the overall infant nutrition cost and the overall mother-infant health costs (as dependent variables), adjusting for monthly income and number of children (confounders) at different time points in the first two years. Similar regression models investigated the association between infant nutrition type (exclusive breastfeeding, mixed feeding, artificial milk) and infant nutrition costs and infant-mother health costs. Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p-value below 0.05. Results The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient by the end of the first year (incremental net benefits of 374 USD; BCR=2.44), and by the end of the second year (incremental net benefits of 472 USD; BCR=2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (p=0.045). Stratified analyses by the type of infant nutrition revealed that infants who were on Exclusive/Predominant, or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years (p<0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (p<0.05), but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants (p=0.001), they were similar in infants on Mixed Feeding or Artificial Milk. Conclusions Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.
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Affiliation(s)
- Maya Basbous
- The Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut-Lebanon
| | - Nadine Yehya
- Department of Public Affairs and Marketing, UC Davis, USA
| | - Nisreen Salti
- Department of Economics, Faculty of Arts and Sciences, American University of Beirut, Beirut-Lebanon
| | - Hani Tamim
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut-Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut-Lebanon
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Strong G, Gober M, Walker M. Speaking the Same Language: A Call for Standardized Lactation Terminology in the United States. J Hum Lact 2023; 39:121-131. [PMID: 36511175 DOI: 10.1177/08903344221131041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Genae Strong
- Loewenberg College of Nursing, University of Memphis, Memphis, TN, USA
| | - Merrilee Gober
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
| | - Marsha Walker
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Ibrahim C, Kammouni Z, Barake M, Kassir M, Al-Jawaldeh A, Matta J, Sacre Y, Hanna-Wakim L, Haddad J, Hoteit M. Pediatric Health Risk Assessment for Exposure to Aluminum from Infant Formulas and Children under the Age of Five's Food Products among Arab Infants: Experience from Lebanon. Foods 2022; 11:foods11162503. [PMID: 36010503 PMCID: PMC9407326 DOI: 10.3390/foods11162503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic dietary aluminum (Al) exposure can have various negative effects on health. The aim of our study is to (1) assess the contamination level of Al in infant formulas (n = 41) and baby food products (n = 76) available in the Lebanese market, and to (2) evaluate the margin of exposure of Al through the consumption of these foods among children under the age of five in Lebanon. Flame atomic absorption spectrometry (FAAS) was used to evaluate all of the samples. Al levels in all tested children’s food items were below the limit of detection. The highest Al level was detected in cornflakes (0.361 ± 0.049 mg/kg) and pureed foods (0.362 ± 0.079 mg/kg). Among infants aged 0−23 months, the average Al exposure due to the daily intake of infant formulas and baby foods was 0.01 and 0.0104 mg/kg BW/day for males and females, respectively. Babies aged 8−10 and 3−5 months had the highest and lowest levels of Al exposure, respectively. Additionally, the toxicological contribution of Al exposure determined for several age groups to a provisional tolerated weekly intake (PTWI) set by JECFA was <6% and <7% for males and females, respectively. The total Al exposure through the consumption of infant formulas and complementary foods among all ages in both males and females was below the values of weekly tolerable intakes (2 mg/kg/BW/W) set by JECFA. However, the values of hazard quotient (HQ) exceeded 1 in both male and female Lebanese infants. As a result, the risk of infants being exposed to Al in baby foods needs to be continuously considered.
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Affiliation(s)
- Carla Ibrahim
- Doctoral School of Sciences and Technology (DSST), Lebanese University, Hadath 6573, Lebanon
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Zeinab Kammouni
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon
| | - Maryam Barake
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon
| | - Mounir Kassir
- Platform for Research and Analysis in Environmental Sciences, Doctoral School of Science and Technology (DSST), Lebanese University, Beirut 6573, Lebanon
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt
| | - Joseph Matta
- Department of Nutrition, Faculty of Pharmacy, Saint-Joseph University of Beirut, Medical Sciences Campus, Damascus Road, P.O. Box 11-5076, Riad Solh, Beirut 1107 2180, Lebanon
- Industrial Research Institute, Lebanese University Campus, Hadath 6573, Lebanon
| | - Yonna Sacre
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Lara Hanna-Wakim
- Department of Agricultural and Food Engineering, School of Engineering, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Joyce Haddad
- Directorate of Preventive Healthcare, Ministry of Public Health, Beirut 6573, Lebanon
| | - Maha Hoteit
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
- Correspondence:
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Radwan H, Fakhry R, Metheny N, Baniissa W, Faris MAIE, Obaid RS, Al Marzooqi S, Al Ghazal H, ElHalik M, Dennis CL. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J 2021; 16:79. [PMID: 34641934 PMCID: PMC8507212 DOI: 10.1186/s13006-021-00428-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors. METHODS Using a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes. RESULTS Almost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum. CONCLUSION This study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.
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Affiliation(s)
- Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Randa Fakhry
- Department of Nursing, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nick Metheny
- School of Nursing and Health Studies, University of Miami, Miami, USA
| | - Wegdan Baniissa
- Department of Nursing, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Moez Al Islam E Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Suad Al Marzooqi
- Department of Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hessa Al Ghazal
- Sharjah Child-Friendly Office, Sharjah, United Arab Emirates
| | - Mahmoud ElHalik
- Department of Neonatology, Latifa Women and Children Hospital, Dubai, United Arab Emirates
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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Clermont A, Gemayel JE, Hammoud R, Wang J, Beciu H, Sinno M, Berends W, Rosenblum N, Bienstock JL, Byrnes K, Samuels R. Effects of a 'Baby-Friendly Hospital Initiative' on exclusive breastfeeding rates at a private hospital in Lebanon: an interrupted time series analysis. BMC Pregnancy Childbirth 2021; 21:385. [PMID: 34011312 PMCID: PMC8132377 DOI: 10.1186/s12884-021-03816-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Adrienne Clermont
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Josianne El Gemayel
- Department of Obstetrics and Gynecology, Clemenceau Medical Center, Clemenceau St, Beirut, Lebanon
| | - Rola Hammoud
- Department of Quality Management, Clemenceau Medical Center, Clemenceau St, Beirut, Lebanon
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mona Sinno
- Department of Obstetrics and Gynecology, Clemenceau Medical Center, Clemenceau St, Beirut, Lebanon
| | - Wilma Berends
- Johns Hopkins Medicine International, Baltimore, MD, USA
| | - Nadine Rosenblum
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica L Bienstock
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristen Byrnes
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger Samuels
- Johns Hopkins Medicine International, Baltimore, MD, USA. .,Department of Medicine, Division of Pulmonary/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Dagla M, Mrvoljak-Theodoropoulou I, Vogiatzoglou M, Giamalidou A, Tsolaridou E, Mavrou M, Dagla C, Antoniou E. Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041988. [PMID: 33670797 PMCID: PMC7922856 DOI: 10.3390/ijerph18041988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Background: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. Methods: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014–January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. Results: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). Conclusions: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.
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Affiliation(s)
- Maria Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
- Correspondence: ; Tel.: +30-210-932-4415
| | - Irina Mrvoljak-Theodoropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Marilena Vogiatzoglou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Anastasia Giamalidou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Eleni Tsolaridou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Marianna Mavrou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Calliope Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Evangelia Antoniou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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Elaridi J, Dimassi H, Estephan M, Hassan HF. Determination of Aluminum, Chromium, and Barium Concentrations in Infant Formula Marketed in Lebanon. J Food Prot 2020; 83:1738-1744. [PMID: 32971540 DOI: 10.4315/jfp-20-003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022]
Abstract
ABSTRACT Infant formula is a major nutritional component for many infants and toddlers. However, the presence of contaminants, such as toxic metals, may pose increased health risks to infants. An investigation of the total concentrations of the metals aluminum (Al), barium (Ba), and chromium (Cr) in infant formulae marketed in Lebanon was performed. Powdered dairy and nondairy infant formula samples were collected from all commercially available brands (n = 39) in the Lebanese market on two production dates (78 samples in total) and analyzed for these three metals with inductively coupled plasma mass spectrometry. All brands contained detectable concentrations of Al and Ba, Cr was detected in 95% of brands. Mean (±standard deviation) concentrations of the metals were estimated as 1.54 ± 1.43 (Al), 0.256 ± 0.593 (Ba), and 0.168 ± 0.143 (Cr) (μg/g). The concentration ranges in the powdered formula were 0.080 to 7.93 (Al), 0.038 to 5.35 (Ba), and 0.041 to 0.348 (Cr) μg/g. A significant difference in the mean concentrations of Al, Ba, and Cr for the two production dates of a single brand was observed in 92, 59, and 83% of samples, respectively. The mean concentration of Al in the soy-based formula was significantly higher than that of aluminum in milk-based and corn-based formulas (P = 0.018). Cr concentrations in the continuation special formulations were significantly higher than those in the beginner formulations (P = 0.008). Our study provides the first publicly available information on metal contamination in infant formulas in Lebanon and reveals the need for frequent monitoring and surveillance of these products intended for infant consumption. HIGHLIGHTS
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Affiliation(s)
- Jomana Elaridi
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon (ORCID: https://orcid.org/0000-0003-4215-6815 [H.F.H.])
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Maria Estephan
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon (ORCID: https://orcid.org/0000-0003-4215-6815 [H.F.H.])
| | - Hussein F Hassan
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon (ORCID: https://orcid.org/0000-0003-4215-6815 [H.F.H.])
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Rodríguez-Gallego I, Leon-Larios F, Ruiz-Ferrón C, Lomas-Campos MDLM. Evaluation of the impact of breastfeeding support groups in primary health CENTRES in Andalusia, Spain: a study protocol for a cluster randomized controlled trial (GALMA project). BMC Public Health 2020; 20:1129. [PMID: 32682408 PMCID: PMC7368689 DOI: 10.1186/s12889-020-09244-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2003, the World Health Organization recommended exclusive breastfeeding (EB) during the newborn's first 6 months of life and, if possible, during the first 2 years. However, EB rates resist these recommendations. In developed countries, only 1 out of 3 babies is breastfed during its first 6 months of life, and great differences between areas and countries can be observed. Only 35% of the newborns receive breastfeeding at 3-4 months of age. There are diverse strategies described in the literature that have proven their efficiency in improving breastfeeding rates. It has also been proven that professional support is an effective tool to extend any kind of breastfeeding; besides, it has been observed that mother-to-mother support also increases breastfeeding initiation, sustainment, and exclusive duration. The overall aim of the study is to assess the impact of the support groups on the sustainment of exclusive breastfeeding until 6 months after birth. METHODS/DESIGN This study is a cluster-random multicentric clinical trial with a control group and an intervention group, without blinding because it is impossible to mask the intervention. A randomization by centres of primary health (clusters) will be carried out. The women allocated to the intervention or control group will be randomized with a simple randomization sampling. The participants' breastfeeding rate will be followed up at the first 10 days, and at 2, 4, and 6 months of their newborn's life. DISCUSSION There is a need to assess the impact of mother support groups on exclusive breastfeeding. This study aims to analyse the outcomes related to the support received and to identify what should the structure of these groups be; in other words, to describe factors related to a better breastfeeding experience in order to help women increase breastfeeding rates. TRIAL REGISTRATION The trial is prospectively recorded at the ISRCTN registry (Trial ID: ISRCTN17263529 ). Date recorded: 17/06/2020.
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Affiliation(s)
- Isabel Rodríguez-Gallego
- Virgen del Rocío University Hospital (Seville), Centro Universitario de Enfermería Cruz Roja, University of Seville, Sevilla, Spain
| | - Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain.
| | - Cecilia Ruiz-Ferrón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain
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Lokonon JHF, Hounkpatin WA, Idohou-Dossou N. Participation in the "nutrition at the Centre" project through women's group improved exclusive breastfeeding practices, as measured by the deuterium oxide dose-to-mother technique. Int Breastfeed J 2020; 15:58. [PMID: 32590987 PMCID: PMC7318378 DOI: 10.1186/s13006-020-00302-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background Evidence of interventions that are effective in improving exclusive breastfeeding (EBF) practices is needed to help countries revise their strategies. To assess whether mothers who had participated in the Nutrition at the Centre (N@C) project effectively demonstrated better EBF practices than did those who did not participate, we documented the processes of this nutritional intervention in Benin. Methods This study was a cross-sectional design comparing the intervention group, namely, the Village Saving and Loan Association (VSLA-N@C), to the control group. The N@C project was an educational intervention based on behavioural and social changes related to nutrition. Through VSLA groups installed in communities, mothers were connected to the project; had weekly discussions around the process, benefits and challenges linked to EBF, and advocated during Breastfeeding Week celebrations. The study participants were mothers with children aged 4–5.5 months from the VSLA-N@C group (n = 53) and mothers (n = 50) from non-intervention areas who served as controls. With the deuterium oxide dose-to-mother technique, we quantified human milk intake (HMI) and non-milk oral intake (NMOI) and compared both groups using Student’s t-test. A child is considered to be exclusively breastfed if the NMOI is less than 86.6 g/day. Multivariate regression logistics adjusted for VSLA membership, mothers’ body mass index, and children’s age, weight-for-age and weight-for-length, thus enabling us to measure differences in EBF rates. Results Children of mothers from the VSLA-N@C group consumed significantly more human milk than those of mothers in the control group (900.2 ± 152.5 g/day vs 842.2 ± 188.6 g/day, P = 0.044). Children in the VSLA-N@C group had significantly less non-milk oral intake than did those in the control group (difference: 148.2 g/day, P = 0.000). Therefore, the EBF rate was significantly higher in the VSLA group (38% vs 8%, P < 0.0001), and mothers in VSLAs were 14 times more likely to practise EBF than were those in the control group (adjusted odds ratio [AOR] = 13.9, 95% CI 1.9–116.5, P = 0.015). Conclusion The EBF rate was significantly higher in the group of mothers who participated in the VSLA-N@C project than in those who did not receive the intervention. The N@C model could be promoted as a strategy for increasing EBF practices in poor and rural contexts, where it is possible to organize mothers into VSLA groups to discuss the process, benefits and challenges of EBF.
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Affiliation(s)
- Jaures H F Lokonon
- School of Nutrition, Food Sciences and Technologies, Faculty of Agronomics Sciences, University of Abomey-Calavi, Abomey-Calavi, Republic of Benin
| | - Waliou Amoussa Hounkpatin
- School of Nutrition, Food Sciences and Technologies, Faculty of Agronomics Sciences, University of Abomey-Calavi, Abomey-Calavi, Republic of Benin.
| | - Nicole Idohou-Dossou
- Laboratory of Nutrition, Department of Animal Biology, Faculty of Sciences and Techniques, University Cheikh Anta Diop, Dakar, Senegal
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Charafeddine L, Masri S, Shamsedine L, Ghandour L, Tamim H, El Khoury N, Hachem Z, Nabulsi M. Validation of the Arabic version of the breastfeeding behavior questionnaire among Lebanese women. Int Breastfeed J 2020; 15:54. [PMID: 32517707 PMCID: PMC7282113 DOI: 10.1186/s13006-020-00296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Shamsedine
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Nathalie El Khoury
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Zahraa Hachem
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
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Lassi ZS, Kedzior SGE, Bhutta ZA. Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries. Cochrane Database Syst Rev 2019; 2019:CD007647. [PMID: 31686427 PMCID: PMC6828589 DOI: 10.1002/14651858.cd007647.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems. OBJECTIVES To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables. MAIN RESULTS We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33. AUTHORS' CONCLUSIONS This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.
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Affiliation(s)
- Zohra S Lassi
- University of AdelaideRobinson Research InstituteAdelaideAustraliaAustralia
| | - Sophie GE Kedzior
- Robinson Research Institute, University of AdelaideFaculty of Health and Medical SciencesAdelaideAustralia
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoCanada
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Kabakian-Khasholian T, Nimer H, Ayash S, Nasser F, Nabulsi M. Experiences with peer support for breastfeeding in Beirut, Lebanon: A qualitative study. PLoS One 2019; 14:e0223687. [PMID: 31644569 PMCID: PMC6808323 DOI: 10.1371/journal.pone.0223687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/25/2019] [Indexed: 11/18/2022] Open
Abstract
Background Despite the beneficial effects of peer support on breastfeeding, research on the process of peer support is scarce. In Lebanon, exclusive breastfeeding is only 15% in infants below six months. A multidisciplinary team launched a multi-component breastfeeding support intervention, with peer support, and professional lactation support provided by International Board Certified Lactation Consultants (IBCLs) to target this decline. Aim To describe the experiences of breastfeeding mothers and peer support providers with the process of breastfeeding support, and the influence of the intervention on their social support system. Methods Using a qualitative methodology, a purposive sample of breastfeeding and support mothers was accessed from among those who completed their six months interview in the trial taking place in two hospitals in Beirut, Lebanon. Data were collected from 43 participants using in-depth interviews and following the data saturation principle. All interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted, guided by the principles of grounded theory. Results Breastfeeding mothers were satisfied with their breastfeeding experience, and extremely appreciative of the support provided by their peers and the IBCLCs. They experienced these forms of support differently. Peer support was perceived to be important in encouraging breastfeeding continuation, whereas IBCLC support was influential in problem solving. Conclusion These findings can improve our understanding of the peer and professional lactation support process within the social context, and the realities of breastfeeding mothers, and help facilitate the scaling up of interventions in similar contexts.
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Affiliation(s)
- Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hana Nimer
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Soumaya Ayash
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatima Nasser
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
- * E-mail:
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Nabulsi M, Tamim H, Shamsedine L, Charafeddine L, Yehya N, Kabakian-Khasholian T, Masri S, Nasser F, Ayash S, Ghanem D. A multi-component intervention to support breastfeeding in Lebanon: A randomized clinical trial. PLoS One 2019; 14:e0218467. [PMID: 31199849 PMCID: PMC6568407 DOI: 10.1371/journal.pone.0218467] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/31/2019] [Indexed: 12/04/2022] Open
Abstract
Background Effective evidence-based breastfeeding support interventions can bolster breastfeeding practices. This study investigated the effect of a multi-component breastfeeding support intervention delivered in hospital and home settings on six-month exclusive breastfeeding (EBF) relative to standard care. Methods This is a parallel group, randomized clinical trial, in which 362 healthy pregnant women with singleton pregnancy were randomly allocated to a multi-component intervention that included antenatal breastfeeding education, professional, and peer support, delivered in hospital and home settings for six months (experimental, n = 174), or to standard care (control, n = 188). The primary outcome was six-month EBF rate. Secondary outcomes were exclusive and any breastfeeding rates at one and three months, maternal breastfeeding knowledge, attitude, and behavior at six months, and satisfaction with the intervention. Results The crude six-month EBF rate was similar in both groups (35.2% vs. 28.1% in the experimental and control groups, respectively, p = 0·16). In adjusted analysis, six-month exclusivity was twice as likely in the experimental group relative to standard care (OR = 2.02; 95%CI: 1.20 to 3.39); whereas the odds for any breastfeeding were similar. Participants compliant with all three components were six times more likely to practice EBF for six months relative to standard care (OR = 6.63; 95% CI: 3.03 to 14.51). Breastfeeding knowledge of the experimental group, at six months, was significantly improved compared to the control. No changes were observed in breastfeeding attitude or behavior. Conclusions Combining education with peer and professional breastfeeding support improved six-month breastfeeding exclusivity and knowledge.
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Affiliation(s)
- Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- * E-mail:
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Shamsedine
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine Yehya
- Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatima Nasser
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Soumaya Ayash
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Mattar L, Hobeika M, Zeidan RK, Salameh P, Issa C. Determinants of Exclusive and Mixed Breastfeeding Durations and Risk of Recurrent Illnesses in Toddlers Attending Day Care Programs Across Lebanon. J Pediatr Nurs 2019; 45:e24-e34. [PMID: 30655117 DOI: 10.1016/j.pedn.2018.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Breastfeeding rates continue to decrease in Lebanon. Studies addressing the relationship between breastfeeding duration and health outcomes in Middle Eastern countries are scarce. This study is the first in Lebanon to have investigated the determinants of both exclusive and mixed breastfeeding durations and the relationship with health in infants and toddlers. DESIGN AND METHODS Our sample of 1051 toddlers is nationwide and representative of all toddlers enrolled in daycare centers, and aged between 12 and 36 months. RESULTS Median of exclusive breastfeeding duration was 15 days and mean age of formula introduction was 2.03 (±3.22) months. Exclusive breastfeeding was initiated at a mean age of 10.56 (±27.12) hours and half of the toddlers (51.6%) were exposed to formula milk since day one following birth. Determinants of both exclusive and total breastfeeding durations were related to several parents' socio-demographic and behavioral factors. A longer duration of exclusive breastfeeding was associated with a lower frequency of pediatrician visits, antibiotic prescriptions, absence from daycare, and a lower risk of otitis, colic and UTI occurrence, after adjusting for cofounders. Similarly, a longer duration of total breastfeeding was associated with less antibiotic prescriptions and a lower risk of otitis. CONCLUSIONS Our study highlights the health benefits of extending exclusive breastfeeding duration. It is urgent to address alarmingly low breastfeeding rates in Lebanon. Policy implementation and enforcement along with raising awareness and creating a supportive environment for breastfeeding mothers should involve the various stakeholders in order to succeed in increasing breastfeeding rates and duration.
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Affiliation(s)
- Lama Mattar
- Nutrition Division, Natural Sciences Department, Lebanese American University, Beirut, Lebanon
| | - Maria Hobeika
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | | | - Pascale Salameh
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | - Carine Issa
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon.
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Ke J, Ouyang YQ, Redding SR. Family-Centered Breastfeeding Education to Promote Primiparas' Exclusive Breastfeeding in China. J Hum Lact 2018; 34:365-378. [PMID: 29161530 DOI: 10.1177/0890334417737293] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few breastfeeding education programs focus on primiparas and the importance of family members on exclusive breastfeeding in China. Research aim: This study aimed to explore the influence of a family-centered breastfeeding education program in promoting exclusive breastfeeding up to 6 months postpartum and to improve women's attitude and knowledge, family members' knowledge, and family support. METHODS This was a two-group quasi-experimental design with multiple comparisons. Participants ( N = 59) were randomized to either the intervention ( n = 29) or the control ( n = 30) group. The intervention group received two prenatal breastfeeding education lectures that included important family members, three home visits, eight telephone calls, text or video/audio support, and quality online resources during lactation. The control group received in-hospital care and follow-up by community nurses after discharge. RESULTS Compared with the control group, the intervention group was more likely to exclusively breastfeed in the first 6 months, odds ratio = 0.44, 95% confidence interval [0.20, 0.98]. The mean knowledge level of the intervention group improved more across time ( p < .05) and was higher than the control group ( p < .05). Perceived family support within the intervention group was significantly higher than the control group from 1 to 6 months ( p < .05). CONCLUSION The breastfeeding education program is an effective strategy to promote exclusive breastfeeding in China.
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Affiliation(s)
- Jian Ke
- 1 School of Health Sciences, Wuhan University, Wuhan, China
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Kim SK, Park S, Oh J, Kim J, Ahn S. Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2018; 80:94-105. [PMID: 29407349 DOI: 10.1016/j.ijnurstu.2018.01.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/24/2017] [Accepted: 01/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that mothers practice exclusive breastfeeding (EBF) of their infants for 6 months. Various breastfeeding support interventions have been developed to encourage mothers to maintain breastfeeding practices. Research aim: This study aims to review how effectively breastfeeding support interventions enable mothers to practice EBF for 6 months and to suggest the best intervention strategies. METHODS Six databases were searched, including MEDLINE, EMBASE, Cochrane, CINAHL, PsycINFO, and KoreaMed. The authors independently extracted data from journals written in English or Korean and published between January 2000 and August 2017. Randomized controlled trials (RCTs) reporting EBF until 6 months were screened. RESULTS A total of 27 RCTs were reviewed, and 36,051 mothers were included. The effectiveness of breastfeeding support interventions to promote EBF for 6 months was significant (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 1.81-3.76). A further subgroup analysis of intervention effects shows that a baby friendly hospital initiative (BFHI) intervention (OR = 5.21; 95% CI: 2.15-12.61), a combined intervention (OR = 3.56; 95% CI: 1.74-7.26), a professional provider led intervention (OR = 2.76; 95% CI: 1.76-4.33), having a protocol available for the provider training program (OR = 2.87; 95% CI: 1.89-4.37) and implementation during both the prenatal and postnatal periods (OR = 3.32; 95% CI: 1.83-6.03) increased the rate of EBF for 6 months. CONCLUSION We suggest considering a multicomponent intervention as the primary strategy and implementing BFHI interventions within hospitals. Evidence indicates that intervention effectiveness increases when a protocol is available for provider training, when interventions are conducted from the pre- to postnatal period, when the hospital and community are connected, and when healthcare professionals are involved.
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Affiliation(s)
| | - Seyeon Park
- Chungnam National University, Daejeon, South Korea
| | - Jiwon Oh
- Chungnam National University, Daejeon, South Korea
| | - Jisoon Kim
- Chungnam National University, Daejeon, South Korea
| | - Sukhee Ahn
- Chungnam National University, Daejeon, South Korea.
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Alberdi G, O'Sullivan EJ, Scully H, Kelly N, Kincaid R, Murtagh R, Murray S, McGuinness D, Clive A, Brosnan M, Sheehy L, Dunn E, McAuliffe FM. A feasibility study of a multidimensional breastfeeding-support intervention in Ireland. Midwifery 2017; 58:86-92. [PMID: 29324318 DOI: 10.1016/j.midw.2017.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/26/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breastfeeding is the optimum mode of infant feeding. Despite this, most global populations do not achieve the World Health Organisation's recommendation of exclusive breast milk for the first 6 months of life. Irish breastfeeding rates are among the lowest in Europe, necessitating a well-designed breastfeeding-support intervention. AIM To evaluate the feasibility and acceptability of a multidimensional breastfeeding intervention in a rural and an urban maternity setting in Ireland. DESIGN A feasibility study of a breastfeeding-support intervention. SETTING Participants were recruited from The National Maternity Hospital (Dublin, urban) and Wexford General Hospital (Wexford, rural). Questionnaires were completed antenatally, at 6 weeks postpartum and at 3 months postpartum to assess acceptability of the intervention and determine breastfeeding status. PARTICIPANTS Pregnant women were recruited in the 3rd trimester, alongside a support partner. INTERVENTION The intervention consisted of an antenatal class (including the physiology and practical approaches to breastfeeding), a one-to-one breastfeeding consultation with a lactation consultant after birth, access to a breastfeeding helpline, online resources, and a postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant. RESULTS One hundred women from The National Maternity Hospital, Dublin and 27 women from Wexford General Hospital were recruited. The antenatal class was attended by 77 women in Dublin and 23 in Wexford; thus, 100 women participated in the intervention. Seventy-six women had a one-to-one postnatal consultation with a lactation consultant in Dublin and 23 in Wexford. Fifty and 45 women in Dublin, and 15 and 15 in Wexford responded to the 6-week and 3-month questionnaires, respectively. At 3 months postpartum, 70% of respondents from Dublin and 60% from Wexford were breastfeeding. Mothers perceived the one-to-one consultation with the lactation consultant during postnatal hospitalization as the most helpful part of the intervention. Inclusion of a support partner was universally viewed positively as a means to support the mother's decision to initiate and continue breastfeeding. CONCLUSION This multidimensional intervention is well-accepted and feasible to carry out within an Irish cohort, in both urban and rural areas. Data from this feasibility study will be used to design a randomized controlled trial of a breastfeeding-support intervention.
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Affiliation(s)
- Goiuri Alberdi
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland.
| | | | - Helena Scully
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland.
| | - Niamh Kelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland.
| | | | | | | | | | | | - Mary Brosnan
- The National Maternity Hospital, Dublin 2, Ireland.
| | | | | | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland; The National Maternity Hospital, Dublin 2, Ireland.
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Yehya N, Tamim H, Shamsedine L, Ayash S, Abdel Khalek L, Abou Ezzi A, Nabulsi M. Validation of the Arabic Version of the Infant Feeding Intentions Scale Among Lebanese Women. J Hum Lact 2017; 33:383-389. [PMID: 28099043 DOI: 10.1177/0890334416680790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Nadine Yehya
- 1 Suliman Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- 2 Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Lama Shamsedine
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Soumaya Ayash
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Abdel Khalek
- 1 Suliman Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Amanda Abou Ezzi
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
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Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
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Casal CS, Lei A, Young SL, Tuthill EL. A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support. J Hum Lact 2017; 33:21-47. [PMID: 28135474 PMCID: PMC6377936 DOI: 10.1177/0890334416677029] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breastfeeding provides beneficial health outcomes for infants and their mothers, and increasing its practice is a national priority in many countries. Despite increasing support to exclusively breastfeed, the prevalence at 6 months remains low. Breastfeeding behavior is influenced by a myriad of determinants, including breastfeeding attitudes, knowledge, and social support. Effective measurement of these determinants is critical to provide optimal support for women throughout the breastfeeding period. However, there are a multitude of available instruments measuring these constructs, which makes identification of an appropriate instrument challenging. Research aim: Our aim was to identify and critically examine the existing instruments measuring breastfeeding attitudes, knowledge, and social support. METHODS A total of 16 instruments was identified. Each instrument's purpose, theoretical underpinnings, and validity were analyzed. RESULTS An overview, validation and adaptation for use in other settings was assessed for each instrument. Depth of reporting and validation testing differed greatly between instruments. CONCLUSION Content, construct, and predictive validity were present for most but not all scales. When selecting and adapting instruments, attention should be paid to domains within the scale, number of items, and adaptation.
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Affiliation(s)
- Corrine S Casal
- 1 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Ann Lei
- 1 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Sera L Young
- 1 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.,2 Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Emily L Tuthill
- 3 School of Nursing, University of California, San Francisco, CA, USA
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Tamim H, Ghandour LA, Shamsedine L, Charafeddine L, Nasser F, Khalil Y, Nabulsi M. Adaptation and Validation of the Arabic Version of the Infant Breastfeeding Knowledge Questionnaire among Lebanese Women. J Hum Lact 2016; 32:682-688. [PMID: 27565201 DOI: 10.1177/0890334416663474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Hani Tamim
- 1 Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Lilian A Ghandour
- 2 Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Shamsedine
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Charafeddine
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Fatima Nasser
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Yvette Khalil
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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Charafeddine L, Tamim H, Soubra M, de la Mora A, Nabulsi M. Validation of the Arabic Version of the Iowa Infant Feeding Attitude Scale among Lebanese Women. J Hum Lact 2016; 32:309-14. [PMID: 25944647 DOI: 10.1177/0890334415586192] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is need in the Arab world for validated instruments that can reliably assess infant feeding attitudes among women. The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has consistently shown good reliability and validity in different cultures and the ability to predict breastfeeding intention and exclusivity. OBJECTIVE This study assessed the psychometric properties of the Arabic version of the IIFAS (IIFAS-A). METHODS After translating to classical Arabic and back-translating to English, the IIFAS-A was pilot tested among 20 women for comprehension, clarity, length, and cultural appropriateness. The IIFAS-A was then validated among 170 women enrolled in a breastfeeding promotion and support clinical trial in Lebanon. RESULTS The IIFAS-A showed acceptable internal consistency reliability (Cronbach's α = 0.640), with principal components analysis revealing that it is unidimensional. The 17 items had good interitem reliabilities ranging between 0.599 and 0.665. The number of breastfed children was the only predictor of the overall IIFAS-A score in a multivariate stepwise regression model (β = 1.531, P < .0001). CONCLUSION The 17-item IIFAS-A is a reliable and valid instrument for measuring women's infant feeding attitudes in the Arab context.
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Affiliation(s)
- Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Marwa Soubra
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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