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Ahmed S, Mahmud N, Farzana N, Parvin MI, Alauddin M. Early Initiation of Breastfeeding (EIBF) and Its Associated Factors Among Mothers With Infants Aged 0 to 6 Months in Jashore District, Bangladesh: A Cross-Sectional Study. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2023; 42:737-745. [PMID: 36630312 DOI: 10.1080/27697061.2022.2161663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Early initiation of breastfeeding (EIBF) is one of the most successful interventions for minimizing newborn morbidity and death. According to the database (Bangladesh Demographic Health Survey 2014), only around half of babies begin breastfeeding during the first hour of life in Bangladesh. The goal of this study was to determine the prevalence of EIBF in the Jashore area while also investigating its associated factors among mothers of infants aged 0 to 6 months in order to better understand the variables that impacted breastfeeding initiation. METHOD A cross-sectional study was conducted in the maternity wards of the 3 busiest hospitals in the Jashore district of Bangladesh from May to July 2019. Using random sampling, a total of 423 mother-infant pairs were chosen. Pearson chi-square test and bivariable and multivariable logistic regression statistical analysis were used to identify factors linked to EIBF. RESULTS The prevalence of EIBF was 46.3% (196/423). Mothers who had skin-to-skin contact after delivery (adjusted odds ratio [AOR], 2.25; 95% confidential interval [CI], 1.40-3.59), who did not deliver prelacteal food (AOR, 3.68; 95% CI, 1.65-8.21), and who provided colostrum (AOR, 5.89; 95% CI, 1.62-21.49) were more likely to begin breastfeeding within 1 hour than were their counterparts. CONCLUSIONS EIBF was found to be strongly linked with skin-to-skin contact after delivery, avoidance of prelacteal feeding, and colostrum feeding practice. As a result, we strongly urge public health officials and health care practitioners to encourage these feeding behaviors in order to increase EIBF.
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Affiliation(s)
- Suzon Ahmed
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Niaz Mahmud
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
- Food and Nutritional Sciences Program, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, USA
| | - Nisat Farzana
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Mst Irin Parvin
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md Alauddin
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
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Bhattacharyya DS, Sarker T, Akter N, Shafique S, Nabi MH, Hawlader MDH, Mitra DK. Factors associated with fathers' involvement in infant and young child feeding and nurturing care in the urban slums of Bangladesh: A cross-sectional study. Food Sci Nutr 2023; 11:4020-4029. [PMID: 37457166 PMCID: PMC10345689 DOI: 10.1002/fsn3.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 07/18/2023] Open
Abstract
Optimal infant and young child feeding (IYCF) and nurturing care during the first years of children's lives are crucial for ensuring their growth and development. The IYCF and nurturing practices are associated with a multifaceted interplay of context-specific factors where fathers' involvement is necessary. The aim of this study is to explore the current scenario of fathers' involvement in IYCF practices in the urban slums of Bangladesh. A cross-sectional survey among the residents of the Sat Tola slum in Dhaka, the capital of Bangladesh was conducted. To avoid social desirability bias, 361 mothers of children aged <24 months were interviewed regarding fathers' involvement. An operational definition of father's involvement was developed based on 11 criteria and then scoring was applied to classify 'Good Involvement' and associated factors were identified using multivariable logistic regression. Fathers' mean age was around 31 (SD ± 6.09) years and the majority of them (44.32%) completed primary education. Fathers had diversified occupations such as day laborer (32.41%), garment worker (22.71%), and business (14.96%). Factors that were significantly associated with the father's involvement in IYCF practices include educational status (aOR = 3.98, 95% CI = 1.91, 8.26, p < .00) and theiroccupational status (aOR = 0.34, 95% CI = 0.16, 0.70, p = .00). Fathers were more active for their first child (aOR: 1.99, 95% CI = 1.04, 3.79, p = .03). Having child in the age group of 14-20 months (aOR = 2.73, 95% CI = 1.32, 5.64, p = <.01) and wife in the age group of 21-30 years (aOR = 2.34, 95% CI = 1.20, 4.58, p = .01) were significantly associated. The study finding explored that fathers' education and occupation as well as mothers' age and education were significantly associated factors for fathers' involvement in the IYCF practices. Further longitudinal studies are recommended to establish the causal relationship between fathers' involvement with IYCF and their impact on child growth and development.
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Affiliation(s)
- Dipika Shankar Bhattacharyya
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
- Department of Public HealthNorth South UniversityDhakaBangladesh
| | - Tonmoy Sarker
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Infectious Disease Divisionicddr,bDhakaBangladesh
| | - Nargis Akter
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
| | - Sohana Shafique
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
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Asaro T, Gutema BT, Weldehawaryat HN. Colostrum avoidance practice and associated factors among mothers of infants less than six months in Chencha District: cross-sectional study. BMC Nutr 2023; 9:18. [PMID: 36691106 PMCID: PMC9872284 DOI: 10.1186/s40795-023-00674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Colostrum avoidance is failure to feed first breast milk to a newborn baby for the first 2 to 3 days after delivery. The problem of avoiding colostrum is prevalent in Ethiopia. But it is not adequately addressed yet. Therefore, the purpose of this study was to assess prevalence of colostrum avoidance practices and associated factors among mothers of infants aged less than six months; and to explore barriers for colostrum feeding in ChenchaZuria District. METHODS A community-based cross-sectional study supplemented with a qualitative study was conducted in August 2020. The quantitative data were collected from 674 mothers selected by systematic sampling using a structured questionnaire. Both bi-variable and multi-variable binary logistic regression analysis was used to identify factors associated with the colostrum avoidance practices. The statistical significance was declared at a p-value < 0.05. The qualitative data were collected using in-depth interviews from breastfeeding mothers and thematic analysis was done manually. RESULT The prevalence of the colostrum avoidance practice was 15.3% (95% CI: 11.4%- 18.2%). Late initiation of breastfeeding (AOR 4.15 95% CI 2.51-6.84), giving pre-lacteal feeding (AOR 3.16 95% CI 1.93-5.15), not using of postnatal care (PNC) service (AOR 1.79 95% CI 1.05-3.04), and having poor maternal knowledge regarding colostrum. (AOR 1.88 95% CI 1.14-3.08) were factors significantly associated with the colostrum avoidance practices. And in the qualitative part, cultural beliefs and misconceptions, community influence, and complementary feeding practices were found to be facilitators for the colostrum avoidance. CONCLUSION About one in seven mothers practiced colostrum avoidance. Factors that contributed to the colostrum avoidance practices were breastfeeding initiation, pre-lacteal feeding, PNC utilization, and maternal knowledge regarding colostrum. Thus, efforts to prevent colostrum avoidance practices should focus on strengthening and promoting PNC services utilization, timely initiation of breastfeeding, and improving awareness creation activities on the importance of colostrum feeding and risks of pre-lacteal feeding.
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Affiliation(s)
| | - Befikadu Tariku Gutema
- grid.442844.a0000 0000 9126 7261School of Public Health, Arba Minch University, Arba Minch, Ethiopia
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Sanghvi TG, Homan R, Forissier T, Preware P, Kawu A, Nguyen TT, Mathisen R. The Financial Costs of Mass Media Interventions Used for Improving Breastfeeding Practices in Bangladesh, Burkina Faso, Nigeria, and Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16923. [PMID: 36554803 PMCID: PMC9779531 DOI: 10.3390/ijerph192416923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Breastfeeding is essential for child survival but globally less than fifty percent of infants receive adequate breastfeeding. Gaps in breastfeeding knowledge and misinformation are widespread. Mass media aims to motivate mothers and families, encourage care-seeking, improve social norms, and counteract misleading advertising. However, the costs and coverage of mass media are not well documented. Our study provides a cost-accounting of four large-scale mass media interventions and coverage obtained through mass media. We retrospectively calculated annual costs and costs per beneficiary of mass media interventions based on expenditure records in four countries. The interventions were a part of multi-component breastfeeding strategies in Bangladesh, Burkina Faso, Nigeria, and Vietnam. Annual costs ranged from 566,366 USD in Nigeria to 1,210,286 USD in Vietnam. The number of mothers of children under two years and pregnant women ranged from 685,257 to 5,566,882, and all designated recipients reached during the life of programs ranged from 1,439,040 to 11,690,453 in Burkina Faso and Bangladesh, respectively. The cost per mother varied from USD 0.13 USD in Bangladesh to 0.85 USD in Burkina Faso. Evaluations showed that mass media interventions reached high coverage and frequent exposure. This analysis documents the financial costs and budgetary needs for implementing mass media components of large-scale breastfeeding programs. It provides annual costs, cost structures, and coverage achieved through mass media interventions in four low- and middle-income countries.
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Affiliation(s)
- Tina G. Sanghvi
- Alive & Thrive Initiative, FHI Solutions, Washington, DC 20009, USA
| | - Rick Homan
- GHPR—Health Services Research, FHI 360, Durham, NC 27701, USA
| | - Thomas Forissier
- Alive & Thrive Initiative, FHI Solutions, New Delhi 110001, India
| | - Patricia Preware
- Alive & Thrive Initiative, FHI Solutions, Washington, DC 20009, USA
| | - Auwalu Kawu
- Alive & Thrive Initiative, FHI Solutions, Abuja 900271, Nigeria
| | - Tuan T. Nguyen
- Alive & Thrive East Asia Pacific, FHI Solutions/FHI 360, Hanoi 11022, Vietnam
| | - Roger Mathisen
- Alive & Thrive East Asia Pacific, FHI Solutions/FHI 360, Hanoi 11022, Vietnam
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Wable Grandner G, Rasmussen KM, Dickin KL, Menon P, Yeh T, Hoddinott J. Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh. MATERNAL & CHILD NUTRITION 2022; 18:e13408. [PMID: 35851830 PMCID: PMC9480912 DOI: 10.1111/mcn.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven ‘Alive & Thrive’ intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives. Analysis of narratives of nutrition‐promoting, rural Bangladeshi community health workers (CHWs) suggest that behavior change communication (BCC) strategies to persuade husbands require logical and credible information (logos and ethos) to establish their support, while childbearing women may additionally require emotional appeals (pathos) to adopt promoted behaviors. Mothers‐in‐law, who traditionally influence multiple nutrition behaviors, can be persuaded via strategic use of ethos and pathos. CHW communication strategies are useful in developing persuasive narratives that capture influential family members’ value beliefs and outcome expectancies and promote behavior change. However, additional programmatic efforts are needed to discourage use of unscientific narratives by CHWs.
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Affiliation(s)
- Gargi Wable Grandner
- Division of Nutritional Sciences Cornell University Ithaca New York USA
- Milken Institute School of Public Health The George Washington University Washington District of Columbia USA
| | | | | | - Purnima Menon
- Poverty, Health, and Nutrition Division International Food Policy Research Institute Washington District of Columbia USA
| | - Tiffany Yeh
- Division of Nutritional Sciences Cornell University Ithaca New York USA
| | - John Hoddinott
- Division of Nutritional Sciences Cornell University Ithaca New York USA
- Charles H. Dyson School of Applied Economics and Management, Division of Nutritional Sciences Cornell University Ithaca New York USA
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Uddin MF, Jabeen I, Islam MA, Rahman M, Chisti MJ, Ahmed T, Sarma H. Barriers to breastfeeding are shaped by sociocultural context: an exploratory qualitative study in Bangladesh. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:34. [PMID: 35964118 PMCID: PMC9375414 DOI: 10.1186/s41043-022-00312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Breastfeeding practice is still not optimum in Bangladesh. Understanding barriers to breastfeeding is needed to prevent harmful practices. This study aimed to understand barriers to breastfeeding among infants and young children in Bangladesh. Methods This qualitative study was conducted in five rural sub-districts and one urban slum in Bangladesh. We conceptualized that barriers to breastfeeding can be broadly grouped into individual, society, and system level barriers. We conducted in-depth interviews with 33 breastfeeding mothers and 13 grandmothers of breastfed children (total n = 46 interviews). We observed 23 of these infants and young children being breastfed. These data were supplemented by 3 focus group discussions held with the children’s fathers. We managed the data using Atlas.ti software and analyzed the data thematically using an inductive approach. Results Important individual-level barriers perceived to influence breastfeeding included misconceptions about the adverse effects of breastfeeding on maternal health, nutrition and physical appearance, and lack of awareness of the value of breastfeeding among family members. Perceived society-level barriers included sociocultural norms, beliefs, and practices such as mother obliged to give more attention on household chores than breastfeeding to become a good housewife and feeding formula milk perceived as a symbol of parents’ financial solvency in the society. System-level barriers included attractive advertisements of breastmilk substitutes, and inadequate facilities and support processes in mothers’ work environments. Conclusion A range of barriers at individual, society and system level have important implications for infant and young children’s breastfeeding practices in Bangladesh. Development of interventions that address the range of barriers that many mothers face is essential to support breastfeeding practices. Potential interventions include strengthening information-giving during interaction between mothers and health workers on breastfeeding techniques, and engaging fathers and other “significant others” in counseling on breastfeeding. Supplementary Information The online version contains supplementary material available at 10.1186/s41043-022-00312-y.
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Billah SM, Ferdous TE, Siddique AB, Raynes‐Greenow C, Kelly P, Choudhury N, Ahmed T, Gillespie S, Hoddinott J, Haider R, Menon P, El Arifeen S, Dibley MJ. The effect of electronic job aid assisted one‐to‐one counselling to support exclusive breastfeeding among 0–5‐month‐old infants in rural Bangladesh. MATERNAL & CHILD NUTRITION 2022; 18:e13377. [PMID: 35590451 PMCID: PMC9218319 DOI: 10.1111/mcn.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Abstract
Exclusive breastfeeding (EBF) for the first 6 months has established benefits, yet had slow improvements globally. Little is known about electronic job aid‐assisted counselling to support EBF. As a secondary outcome of a cluster randomized controlled trial in Bangladesh, we assessed the effect of electronic job aid‐supported nutrition counselling and practical demonstration on EBF. We randomized pregnant women to one of five study arms in the trial and followed mother–child dyads until 2 years of age. Community health workers (CHWs) provided breastfeeding counselling with or without prenatal and complementary nutrient supplements in all four intervention arms. The comparison arm continued with the usual practice where mothers could receive nutrition counselling at routine antenatal and postnatal care, and during careseeking for childhood illnesses. We assessed breastfeeding indicators at birth and monthly until the child was 6 months old, in both intervention and comparison arms. To evaluate the effect of nutrition counselling on breastfeeding, we combined all four intervention arms and compared them with the comparison arm. Intervention newborns had half the risk (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.39, 0.76) of receiving prelacteal feeds than those in the comparison arm. EBF declined steeply in the comparison arm after 3 months of age. EBF was 16% higher in the intervention than the comparison arm at 4 months (RR: 1.16, 95% CI: 1.08, 1.23) and 22% higher at 5 months of age (RR: 1.22, 95% CI: 1.12, 1.33). Maternal background and household characteristics did not modify the intervention effect, and we observed no difference in EBF among caesarean versus vaginal births. Breastfeeding counselling and practical demonstration using an electronic job aid by CHWs are promising interventions to improve EBF and are scalable into existing community‐based programmes. Using an electronic job aid, repeated, one‐to‐one counselling and practical demonstration to mothers by locally recruited CHWs reduced prelacteal feeding and improved EBF practice by delaying the early introduction of complementary food. The positive effect of counselling on EBF remains similar with or without nutrient supplementation. Electronic job aid supported counselling to promote breastfeeding should be integrated into existing community‐based maternal and child health programmes.
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Affiliation(s)
- Sk Masum Billah
- International Centre for Diarrhoeal Disease Research Maternal and Child Health Division, Bangladesh (icddr,b) Dhaka Bangladesh
- Sydney School of Public Health The University of Sydney Sydney New South Wales Australia
| | - Tarana E. Ferdous
- International Centre for Diarrhoeal Disease Research Maternal and Child Health Division, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Abu Bakkar Siddique
- International Centre for Diarrhoeal Disease Research Maternal and Child Health Division, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Camille Raynes‐Greenow
- Sydney School of Public Health The University of Sydney Sydney New South Wales Australia
| | - Patrick Kelly
- Sydney School of Public Health The University of Sydney Sydney New South Wales Australia
| | - Nuzhat Choudhury
- International Centre for Diarrhoeal Disease Research Nutrition and Clinical Science Division, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research Nutrition and Clinical Science Division, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Stuart Gillespie
- Poverty, Health, and Nutrition Division (PHND) International Food Policy Research Institute (IFPRI) Washington District of Columbia USA
| | - John Hoddinott
- Poverty, Health, and Nutrition Division (PHND) International Food Policy Research Institute (IFPRI) Washington District of Columbia USA
- Division of Nutritional Sciences Cornell University Ithaca New York USA
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition (TAHN) Foundation Bangladesh Dhaka
| | - Purnima Menon
- Poverty, Health, and Nutrition Division (PHND) International Food Policy Research Institute (IFPRI) Washington District of Columbia USA
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Maternal and Child Health Division, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Michael J. Dibley
- Sydney School of Public Health The University of Sydney Sydney New South Wales Australia
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Sultana F, Sheba IT. Factors Associated With Pre-Lacteal Feeding Practices Among Mothers Having Children Aged 0-36 Months in Bangladesh: Evidence From Bangladesh Demographic and Health Survey 2017-18. Glob Pediatr Health 2022; 9:2333794X221079550. [PMID: 35237714 PMCID: PMC8882935 DOI: 10.1177/2333794x221079550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Despite being a known barrier to optimal breast-feeding indicators, the practice
of Pre-lacteal Feeding (PLF) remains a key challenge in Bangladesh. This study
examines the prevalence and underlying factors associated with PLF, for which
data from a weighted sample of 4982 Bangladeshi mothers with children aged 0 to
36 months from the 2017-18 Bangladesh Demographic and Health Survey was used.
Step-by-step multivariate logistic regression was performed to identify the
association of significant determinants of PLF practices. Nearly 29% newborns
received PLF before breastmilk and timely initiation of breastfeeding did not
happen in case of 20.5% babies. The odds of PLF were significantly higher among
the inhabitants of Dhaka division compared to other regions. In addition,
birth-related factors such as optimal ANC visits (P < .01),
home delivery (P < .01) and delivered by cesarean section
(P < .01) showed significantly higher odds of
introducing PLF to the newborns. Our results demonstrated the need for
developing targeted policies and actions to prevent such practices of PLF in
order to improve optimal breastfeeding behavior in Bangladesh.
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Adhikari N, Acharya K, Upadhya DP, Pathak S, Pokharel S, Pradhan PMS. Infant and young child feeding practices and its associated factors among mothers of under two years children in a western hilly region of Nepal. PLoS One 2021; 16:e0261301. [PMID: 34914802 PMCID: PMC8675745 DOI: 10.1371/journal.pone.0261301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Nepal government has developed and implemented different programs to improve infant and young child feeding practice. However, the practice remains poor and is a major cause of malnutrition in Nepal. This study aims to identify infant and young child feeding practices and its associated factors among mothers of children aged less than two years in western hilly region of Nepal. A descriptive cross-sectional study was carried out among 360 mothers of under two years' children in Syangja district. A semi structural questionnaire was used. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics were used to report the feeding practices and other independent variables. Bivariate and multivariate logistic regression model was used to establish the factors associated with infant and young child feeding practices. The prevalence of breastfeeding, timely initiation of breastfeeding, exclusive breastfeeding, timely initiation of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet (MAD) were 95.6%, 69.2%, 47.6%, 53.3%, 61.5%, 67.3% and 49.9% respectively. Normal delivery (AOR 6.1, 95% CI 1.2-31.3) and higher maternal autonomy (AOR 5.2, 95% CI 1.8-14.6) were significantly associated with exclusive breastfeeding. Similarly, crop production and food security (AOR 3.8, 95% CI 1.9-7.7), maternal knowledge on MAD (AOR 2.5, 95% CI 1.0-6.2) and maternal autonomy (AOR 4.2, 95% CI 2.1-8.4) were significantly associated with minimum acceptable diet. Factors such as maternal education, maternal health services utilization, maternal knowledge, and maternal autonomy were associated with infant and young child feeding practices, which warrants further attention to these factors to reduce malnutrition.
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Affiliation(s)
- Nabin Adhikari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | | | - Dipak Prasad Upadhya
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Sumita Pathak
- Nursing Department, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Sachin Pokharel
- La-Grandee International College, Pokhara University, Kaski, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
- Nepalese Society of Community Medicine, Lalitpur, Nepal
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Ahinkorah BO, Seidu AA, Budu E, Mohammed A, Adu C, Ameyaw EK, Kissah-Korsah K, Adoboi F, Yaya S. Maternal and child factors associated with early initiation of breastfeeding in Chad: evidence from nationally representative cross-sectional data. Int Health 2021; 14:510-518. [PMID: 34614156 PMCID: PMC9450645 DOI: 10.1093/inthealth/ihab060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background Early initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad. Methods We used data from the children's recode file of the 2014–2015 Chad Demographic and Health Survey. A total of 3991 women ages 15–49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results We found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB. Conclusions Maternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.
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Affiliation(s)
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Aliu Mohammed
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia
| | - Kwaku Kissah-Korsah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Sanni Yaya
- University of Parakou, Faculty of Medicine, Parakou, Benin
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Kumar R, Mundhra R. A Cross-Sectional Study of Knowledge, Attitude, and Practice toward Breastfeeding among Postnatal Mothers Delivering at a Tertiary Care Center in Garhwal, India. Int J Appl Basic Med Res 2021; 11:64-69. [PMID: 33912423 PMCID: PMC8061610 DOI: 10.4103/ijabmr.ijabmr_605_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/02/2020] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Despite several initiatives taken, exclusive breastfeeding rates remain low. The objective of this study was to evaluate the knowledge, attitude, and practices of breastfeeding and to assess factors associated with breastfeeding practices among postnatal mothers delivering in Garhwal region of Uttarakhand, India. Methods A cross-sectional study was conducted from March 2018 to August 2018 among postpartum mothers who were selected through convenient nonrandom sampling. A semi-structured questionnaire including the participants' data, knowledge, attitude, and practices was used. Results A total of 361 postnatal mothers participated in the study. 88.92% knew that breastfeeding should be continued for 6 months after birth and almost 64.81% initiated breastfeeding within 1 h of birth. 26.59% of the women discarded colostrum. 16.35% of the mothers gave prelacteal feeds, with formula milk being the most common prelacteal feed. 82.82% of the mothers did not receive breastfeeding counseling during antenatal visits. Multiparous women, those undergoing vaginal delivery (VD), and those living in joint family were more likely to initiate breastfeeding within 1 h of birth as compared to primiparous women, those undergoing cesarean section, and those living with nuclear families (P < 0.05). A significant difference was also noted in terms of giving prelacteal feeds in those undergoing cesarean section as compared to VD (23.71% vs. 13.63%, P = 0.0217). Conclusion This study revealed that the rate of early initiation of breastfeeding is still low.
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Affiliation(s)
- Rakesh Kumar
- Department of Paediatrics, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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12
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Maharani M, Nurbaiti N, Lajuna L, Fitri Y, Santi P, Sutrisno S. The Influence of Giving Sweet Potato Leaf Boiled Water to the Acceleration of Breastmilk Production in Nursing Mothers in the Kuta Baro Health Center, Aceh Besar, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
BACKGROUND: Breastmilk (ASI) is the best food for babies. Adequacy of breast milk plays a vital role in the process of growth and development of babies. One way that can be done to increase the rate of secretion and production of breast milk is by giving boiled water for sweet potato leaves.
AIM: To analyze the effect of giving boiled sweet potato leaves on the acceleration of milk production in nursing mothers
METHODS: The research design used in this study was pre-experimental with a pretest-posttest design. This research was conducted in the Kuta Baro Health Center, Kuta Baro District, Aceh Besar District, and was carried out in May-August 2020. This study's population was all mothers who were breastfeeding and had babies aged 0-6 years. This study sample was part of breastfeeding mothers who had babies aged 0-6 months, selected by purposive sampling as much as 32. Data analysis was performed using the Chi-Square statistical test.
RESULTS: The results showed that there was an effect of intervention giving sweet potato boiled water for five days with an increase in the acceleration of breast milk production by 204.69 ml, and on the 10th day, it was 212.88 ml. Furthermore, the intervention of giving boiled water for sweet potato leaves on days 11 to 15, there was an increase in the average milk production by 214.25 ml. These results are evidenced by statistical tests where is a significant difference in acceleration of milk production between before the intervention and after the intervention on the 5th, 10th, and 15th day (p-value <0.05).
CONCLUSION: There is an effect of giving boiled sweet potato leaves water on the acceleration of milk production in breastfeeding mothers in the working area of the Kuta Baro Health Center, Kuta Baro District, Aceh Besar District.
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Teshale AB, Tesema GA. Timely initiation of breastfeeding and associated factors among mothers having children less than two years of age in sub-Saharan Africa: A multilevel analysis using recent Demographic and Health Surveys data. PLoS One 2021; 16:e0248976. [PMID: 33755702 PMCID: PMC7987153 DOI: 10.1371/journal.pone.0248976] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the significant advantages of timely initiation of breastfeeding (TIBF), many countries particularly low- and middle-income countries have failed to initiate breastfeeding on time for their newborns. Optimal breastfeeding is one of the key components of the SDG that may help to achieve reduction of under-five mortality to 25 deaths per 1000 live births. OBJECTIVE To assess the pooled prevalence and associated factors of timely initiation of breastfeeding among mothers having children less than two years of age in sub-Saharan Africa. METHODS We used pooled data from the 35 sub-Saharan Africa (SSA) Demographic and Health Surveys (DHS). We used a total weighted sample of 101,815 women who ever breastfeed and who had living children under 2 years of age. We conducted the multilevel logistic regression and variables with p<0.05, in the multivariable analysis, were declared significantly associated with TIBF. RESULTS The pooled prevalence of TIBF in SSA was 58.3% [95%CI; 58.0-58.6%] with huge variation between countries, ranging from 24% in Chad to 86% in Burundi. Both individual and community level variables were associated with TIBF. Among individual-level factors; being older-aged mothers, having primary education, being from wealthier households, exposure to mass media, being multiparous, intended pregnancy, delivery at a health facility, vaginal delivery, single birth, and average size of the child at birth were associated with higher odds of TIBF. Of community-level factors, rural place of residence, higher community level of ANC utilization, and health facility delivery were associated with higher odds of TIBF. CONCLUSION In this study, the prevalence of TIBF in SSA was low. Both individual and community-level factors were associated with TIBF. The authors recommend interventions at both individual and community levels to increase ANC utilization as well as health facility delivery that are crucial for advertising optimal breastfeeding practices such as TIBF.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Rothstein JD, Winch PJ, Pachas J, Cabrera LZ, Ochoa M, Gilman RH, Caulfield LE. Vulnerable families and costly formula: a qualitative exploration of infant formula purchasing among peri-urban Peruvian households. Int Breastfeed J 2021; 16:11. [PMID: 33468169 PMCID: PMC7816440 DOI: 10.1186/s13006-021-00356-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Substantial evidence exists surrounding the health risks of breast milk substitutes (BMS) in place of exclusive breastfeeding among infants < 6 months of age in resource-poor settings. Yet, mothers' experiences of selecting and purchasing BMS brands have not been well studied to date. This qualitative study explored the factors influencing BMS purchasing practices, along with the consequences of those decisions, in peri-urban Lima, Peru. METHODS We conducted in-depth interviews (IDIs) with 29 mothers who had begun mixed-feeding their infants during the first 6 months of life. Interviews explored participants' reasons for initiating infant formula use and their experiences of selecting, purchasing, and providing BMS to their children. Audio recordings were transcribed, coded, and key themes and illustrative vignettes were identified. RESULTS The primary reported reasons for initiating infant formula use included having received a recommendation for infant formula from a healthcare provider, concerns about an infant's weight gain, and the perception of insufficient breast milk. Mothers tended to initially purchase the BMS brand that had been recommended by a doctor, which was often more expensive than the alternatives. The costs of BMS, which escalated as infants grew, often disrupted the household economy and generated significant stress. While some mothers identified alternatives allowing them to continue purchasing the same brand, others chose to switch to less expensive products. Several mothers began to feed their infants follow-on formula or commercial milk, despite their awareness that such practices were not recommended for infants under 6 months of age. The approval of family members and the absence of an infant's immediate adverse reaction influenced mothers' decisions to continue purchasing these products. CONCLUSIONS The high costs of BMS may deepen existing socio-economic vulnerabilities and generate new risks for infant health. The continued dedication of resources towards breastfeeding education and support is critical, and strategies would benefit from underscoring the long-term financial and health consequences of infant formula use, and from strengthening women's self-efficacy to refuse to initiate infant formula when recommended. In addition, health providers should be trained in counseling to help women to relactate or return to exclusive breastfeeding after cessation.
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Affiliation(s)
- Jessica D Rothstein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Pachas
- Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Lilia Z Cabrera
- Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Mayra Ochoa
- Universidad Peruana Cayetano Heredia, Laboratorio de Investigación en Enfermedades Infecciosas, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Universidad Peruana Cayetano Heredia, Laboratorio de Investigación en Enfermedades Infecciosas, Lima, Peru
| | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Amadhila JN, Van Rensburg GH. Perceptions and experiences of nurse managers of the implementation of the baby and mother friendly initiative in Namibia: a qualitative study. Int Breastfeed J 2020; 15:94. [PMID: 33168038 PMCID: PMC7653859 DOI: 10.1186/s13006-020-00336-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background The baby and mother friendly initiative is a breastfeeding programme in Namibia aimed to protect, promote and support breastfeeding. The purpose of this study was to describe nurse managers’ perceptions and experiences of implementing the baby and mother friendly initiative in order to identify its successes and failures, as well as to develop guidelines for the strengthening of the programme. Methods An evaluation research design to collect qualitative data through face-to-face interviews was conducted. A total of 33 interviews with nurse managers in charge of the baby and mother friendly hospitals, were conducted. Results This study gave insight into the strength and weaknesses in the implementation of the programme implementation and make recommendations for improvement thereof. Four themes emerged from the study, namely: the extent of programme implementation, perceived benefits of the programme, challenges/hindrance to the implementation of the programme and recommendations for strengthening of the programme. The information was used to develop and validate guidelines that would help to strengthen the implementation of the programme. Conclusions The study makes a contribution to the body of knowledge in nursing in that it provides guidelines for the strengthening of the baby and mother programme.
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Affiliation(s)
- Justina N Amadhila
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Gebretsadik GG, Tkuwab H, Berhe K, Mulugeta A, Mohammed H, Gebremariam A. Early initiation of breastfeeding, colostrum avoidance, and their associated factors among mothers with under one year old children in rural pastoralist communities of Afar, Northeast Ethiopia: a cross sectional study. BMC Pregnancy Childbirth 2020; 20:448. [PMID: 32758166 PMCID: PMC7405449 DOI: 10.1186/s12884-020-03151-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background Early initiation of breastfeeding (EIBF) is defined as initiation of breastfeeding within 1 h of birth. This is also the time colostrum is secreted with its potential benefits. Globally, two out of five under 5 children die in the first month of life, more than a third of which being on the first day. Neonatal mortality is still a major health problem in Ethiopia. EIBF and colostrum feeding are associated with decreased neonatal morbidity and mortality. With this study, we aim to determine the magnitude and factors associated with EIBF and colostrum avoidance. Methods A community based cross-sectional study was conducted from May to June 2016 on 390 mothers in Afar region. Bivariate logistic regression was used to identify the association between the independent and the outcome variables. Multivariable logistic regression was used to determine the independent predictors of EIBF and colostrum avoidance. The strength of the association was measured by odds ratio and 95% confidence interval, and p-value < 0.05 was considered statistically significant. Hosmer and Lemeshow test was used to test model goodness of fitness and multi-collinearity between independent variables was checked. Results About 248(63.6%) respondents initiated breastfeeding within 1 h of birth. Mothers whose delivery was attended by a health professional had 4.75 times higher odds (AOR 4.75; 95% CI 1.71, 13.19) of EIBF as compared to those who were attended by others. Trust on nurses to provide pregnancy care (AOR 5.59; 95% CI 1.05, 29.8) was significantly associated with EIBF. About 300(76.9%) respondents discarded colostrum. Mothers who had no discussion with TBA on child nutrition were 6.6 times (AOR 6.63; 95% CI 1.43, 30.63) more likely to avoid colostrum than their counterparts. Conclusion More than one-third of infants didn’t start breastfeeding within 1 h of birth and three-fourth of the mothers discarded colostrum. Therefore, it is important to develop and/or strengthen services/advice on EIBF including colostrum feeding. Promoting delivery by health professionals, discussion on child nutrition and building trust between mothers and health professionals can be important community interventions to encourage EIBF and colostrum feeding.
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Affiliation(s)
| | - Helen Tkuwab
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Kidanemaryam Berhe
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Sandhi A, Lee GT, Chipojola R, Huda MH, Kuo SY. The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: a cross-sectional study. Int Breastfeed J 2020; 15:65. [PMID: 32680551 PMCID: PMC7367342 DOI: 10.1186/s13006-020-00310-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Perceived milk supply is an important modifiable factor for optimal breastfeeding. However, little is known about maternal perception of milk supply or how it impacts breastfeeding practices. The aim of this study was to examine relationships of perceived milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact with early initiation and exclusive breastfeeding among mothers of infants less than 6 months of age in Indonesia. Methods This was a cross-sectional study conducted in Yogyakarta City, Indonesia between August and October 2015. Maternal perception of milk supply was assessed using the Hill and Humenick Lactation Scale. Data on breastfeeding practices, and maternal and infant factors were collected using a structured questionnaire. Multiple regression and multivariate logistic regression analyses were performed to obtain estimates of associations. Results Thirty four percent of mothers had initiated breastfeeding within an hour after birth, and 62.4% of mothers were exclusively breastfeeding. High levels of perceived breast milk supply were reported in mothers who practiced skin-to-skin contact or rooming-in with their infants, experienced positive infant sucking behavior, or had high breastfeeding self-efficacy (p < 0.05). Mothers with a higher level of perceived milk production (Odds Ratio [OR] 3.20; 95% Confidence Interval [CI] 1.76, 5.83) or practicing skin-to-skin contact (OR 2.36; 95% CI 1.13, 4.91) were more likely to exclusively breastfeed, while employed mothers were less likely to breastfeed their infants exclusively (OR 0.47; 95% CI 0.24, 0.93). Conclusions In this study, skin-to-skin contact and breastfeeding self-efficacy are important determinants of perceived milk supply. Higher perception of milk supply was positively linked with exclusive breastfeeding. Our study highlights the importance of the assessment for mother’s perception of milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact in achieving optimal breastfeeding outcomes.
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Affiliation(s)
- Ayyu Sandhi
- Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Indonesia.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Gabrielle T Lee
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada
| | - Roselyn Chipojola
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mega Hasanul Huda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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Sen KK, Mallick TS, Bari W. Gender inequality in early initiation of breastfeeding in Bangladesh: a trend analysis. Int Breastfeed J 2020; 15:18. [PMID: 32178697 PMCID: PMC7075039 DOI: 10.1186/s13006-020-00259-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background Early initiation of breastfeeding within 1 hour after birth is essential for newborns, because it reduces risk of neonatal mortality and hypothermia to a great extent and also helps in preventing the long-term chronic diseases and in increasing energy and immunity to newborn. In order to reach the ‘very good state’ of timely or early initiation of breastfeeding recommended by WHO, Bangladesh needs to increase the current rate of 51.24 to 100%. An attempt has been made in this study to examine how the early breastfeeding practice changes among male and female children with time controlling the factors associated with this practice. Methods Data from last four consecutive Bangladesh Demographic and Health Surveys (BDHS) have been used in the study. The participants were included whose child born within the last 5 years preceding the surveys of 2004, 2007 and 2011, and within the last 3 years preceding the survey of 2014 in the study and the respective selected participants were 5145, 4765, 7099 and 4370. To conduct the trend analysis, the descriptive statistics of selected variables along with prevalence of early initiation of breastfeeding have been computed by different years and a multiple logistic regression model has been fitted to the pooled dataset of 2004–2014 considering survey years as time. Results Rate of early initiation of breastfeeding increased as time progressed and it was faster for female child compared to male child. For example, female children were significantly 10 and 6% less likely to be initiated early than their counterparts in 2004 and 2007, respectively; whereas after 2007 both male and female children were equally treated for breastfeeding practice. It was also found that rate of early initiation significantly increased for one unit increased in survey year and this increasing rate was higher for female child compared to male child. For example, for one unit of increased in survey year, the early initiation of breastfeeding increased by 60% for male child and by 67% for female child. Besides, survey time, gender, education of parents, wanted index child, mode of delivery, antenatal care visits, wealth index, exposure to media and division were found to have potential influence on early initiation of breastfeeding. Conclusion Demographic and health surveys conducted in Bangladesh since 2011 have shown no evidence of gender discrimination regarding timely initiation of breastfeeding. In order to achieve the target rate of early initiation of breastfeeding recommended by WHO, it requires to take effective intervention regarding maternal and child health education.
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Affiliation(s)
- Kanchan Kumar Sen
- Department of Statistics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | | | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, 1000, Bangladesh
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Mihrshahi S, Tait H, Haider R, Ara G, Kabir I, Dibley MJ. Characteristics and experiences of peer counsellors in urban Dhaka: a structured interview study. Int Breastfeed J 2019; 14:48. [PMID: 31708999 PMCID: PMC6836400 DOI: 10.1186/s13006-019-0240-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Interventions to promote breastfeeding are the cornerstone of efforts to reduce childhood illness and death from undernutrition. Evidence suggests that one of the most effective strategies to increase breastfeeding is through peer counsellors. However, the experiences of peer counsellors has not been studied in depth. This study aimed to collect and report the experiences of peer counsellors participating in an intervention study to improve breastfeeding in urban Dhaka, Bangladesh. Methods Peer counsellors underwent a 10 day training course in May 2013 which included practical sessions on position and attachment and common difficulties with breastfeeding. Home visits were conducted with new mothers and performance of peer counsellors was monitored by senior breastfeeding counsellors. The number of supervised home visits needed to achieve a satisfactory level of competency was recorded. Demographic data were collected and a structured interview was performed in the first six months of the project (May-September 2013). One structured interview per peer counsellor was conducted by the project manager at the project site office to gain understanding of their experiences in counselling mothers. The interview included some open-ended questions on specific aspects of the training that they found useful, challenges faced, and whether they developed close friendships with the mothers that they were counselling. Results Seventeen peer counsellors with an average age of 31 years (SD 6.8) and at least six years of schooling participated in the study. All peer counsellors were satisfied with their role and with the training that they received, and most felt that they were able to deal with common breastfeeding problems. The peer counsellors reported that building a personal rapport and establishing a peer-to-peer relationship was most important in supporting mothers to breastfeed. Common challenges included interruption of sessions by relatives/children, as well as mothers being too busy for the visits. Conclusion In future peer counselling for breastfeeding projects, more focus could be placed on the communications aspects of the training, especially in how to deal with non-supportive family members and managing interruptions effectively, as well as how to motivate and engage busy new mothers.
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Affiliation(s)
- Seema Mihrshahi
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
- School of Public Health, University of Queensland, Herston, Queensland Australia
| | - Hannah Tait
- School of Public Health, University of Queensland, Herston, Queensland Australia
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition Foundation (TAHN), Dhaka, Bangladesh
| | - Gulshan Ara
- International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Iqbal Kabir
- International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Michael J. Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
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The effect of maternal health service utilization in early initiation of breastfeeding among Nepalese mothers. Int Breastfeed J 2019; 14:33. [PMID: 31384286 PMCID: PMC6668139 DOI: 10.1186/s13006-019-0228-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) recommends early initiation of breastfeeding and exclusive breastfeeding for six months. Understanding the association of maternal health services and early initiation of breastfeeding might be useful on prioritizing the health services to promote early breastfeeding practices. The purpose of this study was to examine the association between utilization of maternal health services and early initiation of breastfeeding among Nepalese mothers. Methods Nationally representative data from the 2016 Nepal Demographic Health Survey (NDHS) was used to determine the association between early initiation of breastfeeding and variables related to maternal health services utilization. Association was measured by using Chi-square test followed by calculation of adjusted odds ratio (AOR) and 95% confidence intervals (CI) using multivariable logistic regression analysis. Results Out of 1,978 children, 55% were breastfed within an hour of birth. Early initiation of breastfeeding was associated among mothers who delivered at the health facilities (AOR 2.22; 95% CI 1.36, 3.60). Mothers who had a vaginal birth (AOR 6.70; 95% CI 4.30, 10.42) were significantly more likely to breastfeed within an hour of birth compared to mothers who had caesarean delivery. The odds of initiating early breastfeeding were higher among mothers from Province 5 (AOR 1.59; CI 1.02, 2.48), Province 6 (AOR 2.58; 95% CI 1.41,4.69) and Province 7 (AOR 2.30; CI 1.36, 3.87). Conclusions Health facility delivery and a vaginal delivery were strongly associated with early initiation of breastfeeding. It is vital to intensify maternal health service up to the community to aware pregnant women to utilize maternal health services to improve breastfeeding practices. Skilled Birth Attendant (SBA) training should include comprehensive breastfeeding counselling package to motivate mothers to initiate early breastfeeding especially for mothers having caesarean delivery.
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Karim F, Khan ANS, Tasnim F, Chowdhury MAK, Billah SM, Karim T, Arifeen SE, Garnett SP. Prevalence and determinants of initiation of breastfeeding within one hour of birth: An analysis of the Bangladesh Demographic and Health Survey, 2014. PLoS One 2019; 14:e0220224. [PMID: 31344069 PMCID: PMC6658080 DOI: 10.1371/journal.pone.0220224] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 07/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background Breastfeeding within one hour of birth is a critical component of newborn care and is estimated to avert 22% of neonatal mortality globally. Understanding the determinants of early initiation of breastfeeding (EIBF) is essential for designing targeted and effective breastfeeding promotion programmes. The aim of this study was to determine the prevalence and determinants of early initiation of breastfeeding among Bangladeshi women. Methods This paper analyses the data from the Bangladesh Demographic and Health Survey, 2014. Analysis was based on responses of women who had at least one live birth in the two years preceding the survey (n = 3,162) collected using a structured questionnaire. The primary outcome was breastfeeding initiation within one hour of birth ascertained by women’s self-report. Explanatory variables included woman’s age, education, religion, household wealth, place of residence and place of delivery, birth order, child’s size, antenatal care (ANC), postnatal care (PNC) and skin-to-skin contact. Associations between variables were assessed by simple and multivariable logistic regressions. Results Of the 3,162 recently delivered mothers, 51% initiated breastfeeding within one hour of delivery. Prevalence of EIBF varied significantly between different types of mode of delivery, among different geographical regions and among women who had PNC with their newborn. Women who had caesarean section (C-section) were less likely to initiate breastfeeding early after birth than women who had normal vaginal delivery (NVD) (AOR: 0.32, 95% CI 0.23 0.43; p value < 0.001). Women who had received PNC with their newborns within one hour of delivery were more likely to breastfeed their babies within one hour of birth compared to those who did not (AOR: 1.61, 95% CI 1.26 2.07; p value < 0.001). Mother’s age, education, religion, household wealth index, place of residence and place of delivery, birth order, number of antenatal visits, child’s size and skin-to-skin contact were not significantly associated with EIBF. Conclusions Findings from this study suggest that investing more effort in ensuring immediate PNC of mother-newborn pair can increase EIBF. Solutions should be explored to increase EIBF among mothers who undergo C-section as C-section is rising rapidly in Bangladesh. Further research is needed to explore the regional differences in the country, including specific cultural practices that influence EIBF.
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Affiliation(s)
- Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Fariha Tasnim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taseen Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sarah P. Garnett
- Discipline of Child and Adolescent Health, University of Sydney, Camperdown NSW, Australia
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Rahman A, Akter F. Reasons for formula feeding among rural Bangladeshi mothers: A qualitative exploration. PLoS One 2019; 14:e0211761. [PMID: 30807588 PMCID: PMC6391007 DOI: 10.1371/journal.pone.0211761] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
In Bangladesh the exclusive breastfeeding rate remains low and prelacteal, formula and bottle feeding is increasing. This study aims to explore reasons behind infant formula feeding practices from mothers, caregivers, and health care provider's perspective. This was a qualitative study carried out in four sub-districts of Sylhet and Jessore of rural Bangladesh. Data were collected through focus group discussions (12), in-depth interviews (4) and key informant interviews (12) from January to February 2014. The qualitative data collected and were analyzed using thematic content analysis. This study clearly showed the factor behind formula feeding by Bangladeshi rural women. One of the major findings was that women could not differentiate between formula and other milk. Main differences between formula and powder milk were the type of consumer where formula only was taken by infant and children less than 2 years. Other major reasons include; poor breastfeeding practices, lack of appropriate breastfeeding practices, superficial knowledge on harmful effect on infant formula; perceived insufficient breast milk production, the influence of family and society and authoritarian power of hospital staff. Rural mothers have intension to feed infant formula to their infants due to various factors including individual, social, cultural and institutional. These identified factors can contribute to policy making and develop more specific interventions targeting expected mother and their family members that can contribute to stop formula feeding and increase breastfeeding practices in rural Bangladesh.
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Affiliation(s)
- Atiya Rahman
- Research and Evaluation Division (RED), BRAC, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Akter
- Research and Evaluation Division (RED), BRAC, Mohakhali, Dhaka, Bangladesh
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Ramani S, Shaikh N, Das S, Pantvaidya S, Fernandez A, Jayaraman A. "Everybody breastfeeds if they have milk": factors that shape exclusive breastfeeding practices in informal settlements of Mumbai, India. Int Breastfeed J 2019; 14:10. [PMID: 30792751 PMCID: PMC6371460 DOI: 10.1186/s13006-019-0204-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background In India, though breastfeeding is universally practiced, exclusive breastfeeding (EBF) rates in urban informal settlements are low; and health programs face several challenges in promoting EBF. In this study, ensconced in one program area of a non-government organization, we focused on "positive deviant"- mothers who were able to practice EBF for six months and attempted to delineate factors that shaped their EBF practices. Typically, qualitative research from Lower and Middle Income countries on EBF has focused on understanding why women do not practice EBF; the converse perspective taken in this study has been less explored. Methods We employed the positive deviance approach which contends that important programmatic learnings can be attained from persons who adopt positive behaviours. We conducted twenty-five diverse, purposively sampled case-studies of "positive deviant" mothers from two urban informal settlements in Mumbai; and analysed these using a framework approach. The results were summarised using a socioecological framework (consisting of individual, interpersonal, organizational and environment levels). Results We found that mothers typically construed EBF as not giving breastmilk substitutes. Giving the infant minor supplements (water, honey) was not considered a violation of the EBF practice. The main themes that emerged as influencers of EBF included: at individual level, perceptions of having adequate milk; at interpersonal level, having role models who practiced EBF and having family support; at organizational level, advice from health workers (which was purported to play a secondary role); and at environmental level, financial constraints that limited access to supplements. One important finding was that women who practiced EBF could not always do it optimally; we encountered several instances of "poor EBF" practices, where mothers had breastfed infants inconsistently, allowing for long gaps between feeds, and had continued EBF even after six months. Conclusions There is an urgent need for health programs to clarify the meaning of EBF and counsel against "poor EBF" practices. Messages received by women from immediate family on EBF were powerful and families play an important role in the actualization of optimal EBF practices. Hence, it is imperative to counsel entire families on EBF rather than women alone.
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Affiliation(s)
- Sudha Ramani
- SNEHA (Society for Nutrition, Education and Health Action), Behind Bldg. No. 11, BMC Colony Shastri Nagar, Santa Cruz (W), Mumbai, 400 054 India
| | - Nikhat Shaikh
- SNEHA (Society for Nutrition, Education and Health Action), Behind Bldg. No. 11, BMC Colony Shastri Nagar, Santa Cruz (W), Mumbai, 400 054 India
| | - Sushmita Das
- SNEHA (Society for Nutrition, Education and Health Action), Behind Bldg. No. 11, BMC Colony Shastri Nagar, Santa Cruz (W), Mumbai, 400 054 India
| | - Shanti Pantvaidya
- SNEHA (Society for Nutrition, Education and Health Action), Behind Bldg. No. 11, BMC Colony Shastri Nagar, Santa Cruz (W), Mumbai, 400 054 India
| | - Armida Fernandez
- SNEHA (Society for Nutrition, Education and Health Action), Behind Bldg. No. 11, BMC Colony Shastri Nagar, Santa Cruz (W), Mumbai, 400 054 India
| | - Anuja Jayaraman
- SNEHA (Society for Nutrition, Education and Health Action), Behind Bldg. No. 11, BMC Colony Shastri Nagar, Santa Cruz (W), Mumbai, 400 054 India
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Khatun H, Comins CA, Shah R, Munirul Islam M, Choudhury N, Ahmed T. Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka's slums: a mixed method study. Int Breastfeed J 2018; 13:44. [PMID: 30275873 PMCID: PMC6158891 DOI: 10.1186/s13006-018-0186-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Despite the substantial impact on child and maternal health, breastfeeding practices for infants remain at the suboptimum level in Bangladesh. Yet the understanding of why these practices are suboptimal, especially surrounding urban slum dwelling mothers, is unclear. The purpose of this study was to assess early infant feeding practices, examine associations with maternal factors, and uncover the facilitators and barriers to early feeding practices in selected slums of Dhaka, Bangladesh. Methods A mixed method study was conducted from June to September 2016 using both quantitative and qualitative methods among mothers with children under the age of 6 months. The survey included 342 mother-infant pairs and 18 in-depth interviews were conducted. Univariate and multiple logistic regression was used to determine status of early infant feeding practices and factors associated with exclusive breastfeeding (EBF) within the previous 24 h. Transcripts were coded to uncover the facilitators and barriers surrounding early infant feeding practices. Results Sixty four percent (220/342) of mothers initiated breastfeeding within 1 h, 96.5% (330/342) reported feeding colostrum, and 36.3% (124/342) infants were EBF in the last 24 h. After adjusting for child gender, maternal age, education, diet and household income; infant’s age (adjusted odds ratio (AOR) for 61–120 days 6.42; 95% CI 3.42, 12.1; AOR for 121–180 days 45.6; 95% CI 18.33, 113.45), prelacteal feeding (AOR 2.53; 95% CI 1.14, 4.58), lack of planning for EBF during pregnancy (AOR 4.06; 95% CI 1.09, 15.12) and infants delivered by cesarean section (AOR 2.76; 95% CI 1.34, 5.67) were negatively associated with EBF. During the 18 interviews, eight mothers reported a cesarean delivery and none of these mothers initiated breastfeeding within 1 h or exclusively breastfed. Moreover, all eight mothers gave their infants prelacteal feeds. Conclusions The status of early infant feeding practices in Dhaka’s slums was poor. The negative impact of cesarean section on all early infant feeding practices was evident in both quantitative and qualitative analysis.
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Affiliation(s)
- Halima Khatun
- 1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Carly A Comins
- 2James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - M Munirul Islam
- 1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Nuzhat Choudhury
- 1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh
| | - Tahmeed Ahmed
- 1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212 Bangladesh.,2James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212 Bangladesh
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Weldesamuel GT, Atalay HT, Zemichael TM, Gebre HG, Abraha DG, Amare AK, Gidey EB, Alemayoh TT. Colostrum avoidance and associated factors among mothers having children less than 2 years of age in Aksum town, Tigray, Ethiopia: a cross-sectional study 2017. BMC Res Notes 2018; 11:601. [PMID: 30126446 PMCID: PMC6102877 DOI: 10.1186/s13104-018-3712-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To assess colostrum avoidance practices and associated factors among mothers of children aged less than two in Aksum town, Tigray, Ethiopia, 2017. Result Colostrum avoidance was practiced by 6.3% (95% CI = 4.2%, 8.6%) of mothers having children aged < 24 months in Aksum town. In a multivariate logistic regression analysis at P value of < 0.05, lower number of antenatal care visit (AOR = 4.45, 95% CI = 1.9, 10.5), lack postnatal follow up [AOR = 2.98 (95% CI = 1.22, 7)] and poor maternal level of information on colostrum feeding [AOR = 4.8 (95% CI = 1.83, 12.69)] were statistically associated with colostrum avoidance. Coordination, strengthening and sustaining of awareness creation strategies and approaches is recommended for the promotion of the nutritional value of colostrum and its health benefits.
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Affiliation(s)
| | - Hagos Tasew Atalay
- School of Nursing, Aksum University, Po. Box 298, Aksum, Tigray, Ethiopia
| | | | | | | | - Awoke Kebede Amare
- School of Nursing, Aksum University, Po. Box 298, Aksum, Tigray, Ethiopia
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Zakar R, Zakar MZ, Zaheer L, Fischer F. Exploring parental perceptions and knowledge regarding breastfeeding practices in Rajanpur, Punjab Province, Pakistan. Int Breastfeed J 2018; 13:24. [PMID: 29988704 PMCID: PMC6029391 DOI: 10.1186/s13006-018-0171-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 06/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding is significantly associated with strong infant immunity and optimal development. The importance of breastfeeding is underestimated. Parental lack of knowledge and unhealthy practices regarding breastfeeding deprive infants of their basic right to mother's milk. In developing countries, including Pakistan, with high child mortality and malnutrition, healthy breastfeeding practices can bring positive changes in child health status. From this perspective, the present study aims to understand parents' knowledge, attitudes and practical encounters with breastfeeding practices and the factors that prevent them from adopting such practices. METHODS A qualitative study was carried out in both rural and urban settings in Rajanpur District of Punjab Province, Pakistan. We conducted 12 focus-group discussions (FGDs) that involved 38 mothers and 40 fathers with children aged under two years who were being breastfed. A thematic content analysis of data collected through FGDs was performed manually. The themes were both inductive and deductive in nature. RESULTS The study found that a majority of participants believed that the first thing given to an infant after birth should not be breast milk but honey, rose flower, or goat's milk from the hands of an elder in the family or a religious person. No cleanliness measures were practised in this regard. The participants had misconceptions about the benefits of colostrum, which frequently prevented it being given to newborns. Participants reported many factors, such as: insufficient milk syndrome (slow growth of infants due to insufficient daily breast milk intake), a mother's high workload, lack of social support, the influence of culturally designated advisors, and the promotion and marketing strategies of infant formula companies, that undermined exclusive breastfeeding efforts and encouraged mothers to switch to infant formula. CONCLUSIONS Culturally acceptable and integrated public health interventions are needed to improve the breastfeeding-related health literacy and practices of parents, grandparents and communities. This will ultimately reduce the high infant mortality and malnutrition rates in Pakistan.
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Affiliation(s)
- Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Lubna Zaheer
- Institute of Communication Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- School of Public Health, Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
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Phukan D, Ranjan M, Dwivedi LK. Impact of timing of breastfeeding initiation on neonatal mortality in India. Int Breastfeed J 2018; 13:27. [PMID: 29988694 PMCID: PMC6029033 DOI: 10.1186/s13006-018-0162-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 05/10/2018] [Indexed: 11/06/2022] Open
Abstract
Background Neonatal mortality defined as a death during the first 28 days of life and is the most critical phase of child survival. In spite of the strong evidence supporting immediate and long term health benefits of timely initiation of breastfeeding in India, only two-fifths (44%) of children receive breastfeeding within 1 h of birth. This study aims to examine the role of a behavioral factor i.e., timing of initiation of breastfeeding on neonatal deaths. Methods Data from India Human Development Survey-II (IHDS-II), 2011–12, a nationally representative, large scale population-based dataset has been used. Sample Registration System (SRS) has been used to examine the rate of change in Neonatal Mortality Rates from the year 2011 to 2015. District Level Household & Facility Survey (DLHS-4), 2012–2013 and Annual Health Survey(AHS), 2012–13 data have been used to show the district wise distribution of women who have breastfed their child within 1 h of birth. Population Attributable fraction has been computed using binary logistic regression model for various scenarios of breastfeeding within first hour of birth. Results Less than one fourth (21%) of children were breastfed within 1 h of birth across the different districts of India, which varies from the lowest 15% in Sarasvati of Uttar Pradesh state to the highest 94.6% in Thiruvananthapuram of Kerala state. Findings suggest when women did not breastfeed their newborn within the 1 h after his birth, the odds of neonatal deaths were increased by nearly threefold (OR 2.93; 95% CI 1.89, 4.53) in comparison with those neonates who have breastfed within 1 h of birth. Population Attributable Risk estimates that the risk of the neonatal deaths could be reduced to a maximum of 15% when all babies would expose to early breastfeeding from the present level of breastfeeding. Conclusions We found that timely initiation of breastfeeding is beneficial for child survival within the first 28 days of birth, including all causes of mortality. Therefore, efforts in formulating an effective policy focusing on early initiation of breastfeeding are needed.
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Affiliation(s)
- Deepika Phukan
- 1Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Mukesh Ranjan
- 2Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - L K Dwivedi
- 2Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
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Yimer NB, Liben ML. Effects of home delivery on colostrum avoidance practices in North Wollo zone, an urban setting, Ethiopia: a cross sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:4. [PMID: 29482631 PMCID: PMC6389058 DOI: 10.1186/s41043-018-0134-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Colostrum is the first liquid that is produced in the first few days after delivery. It is the perfect first food for newborns which is considered as an infant's first immunization. Despite of this fact colostrum is discarded as unclean and bad for the infant's health. This study aimed to investigate the prevalence and the factors associated with colostrum avoidance in Woldia, Kobo and Lalibela town administrations of North Wollo zone. METHODS A quantitative community based cross sectional study was employed in March 2015 on 810 mothers of children aged less than 24 months. Descriptive statistics, binary and multivariable logistic regression analysis were employed to identify the factors associated with colostrum avoidance. Variables with a p-value < 0.05 in the multivariable model were identified as predictors of colostrum avoidance practices. RESULTS Colostrum was discarded by 12.0% (95%CI: 10.0-14.0%) of mothers of children aged less than 24 months. In multivariable logistic regression analysis late initiation of breastfeeding [AOR (95% CI) =2.03 (1.18, 3.49)], prelacteal feeding [AOR (95% CI) =3.38 (1.83, 6.24)], mothers not living with their husband [AOR (95% CI) = 2.24 (1.22, 4.12)] and delivering the index child at home [AOR (95% CI) =2.92 (1.521, 5.59)] were independent positive predictors of colostrum avoidance practices. CONCLUSION The foundation of any nutrition package for the prevention of childhood malnutrition is the promotion of an optimal breastfeeding practices, including colostrum feeding, in the community. Therefore, promoting institutional delivery, early initiation of breastfeeding and creating awareness on the dangers of prelacteal feeding and the advantages of colostrum feeding are recommended interventions to reduce colostrum avoidance practices in the study area.
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Affiliation(s)
- Nigus Bililign Yimer
- Department of Midwifery, Faculty of Health Sciences, Woldia University, Amhara, Ethiopia
| | - Misgan Legesse Liben
- Department of Public Health, College of Medical and Health sciences, Samara University, P.O.Box 132, Afar, Ethiopia
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Rahman MS, Rahman MM, Gilmour S, Swe KT, Krull Abe S, Shibuya K. Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995-2030: a Bayesian analysis of population-based household data. LANCET GLOBAL HEALTH 2018; 6:e84-e94. [PMID: 29241620 DOI: 10.1016/s2214-109x(17)30413-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving of UHC targets of 80% essential health-service coverage and 100% financial risk protection by 2030. METHODS We estimated the coverage of UHC indicators-13 prevention indicators and four treatment indicators-from 19 nationally representative population-based household surveys done in Bangladesh from Jan 1, 1991, to Dec 31, 2014. We used a Bayesian regression model to estimate the trend and to predict the coverage of UHC indicators along with the probabilities of achieving UHC targets of 80% coverage of health services and 100% coverage of financial risk protection from catastrophic and impoverishing health payments by 2030. We used the concentration index and relative index of inequality to assess wealth-based inequality in UHC indicators. FINDINGS If the current trends remain unchanged, we estimated that coverage of childhood vaccinations, improved water, oral rehydration treatment, satisfaction with family planning, and non-use of tobacco will achieve the 80% target by 2030. However, coverage of four antenatal care visits, facility-based delivery, skilled birth attendance, postnatal checkups, care seeking for pneumonia, exclusive breastfeeding, non-overweight, and adequate sanitation were not projected to achieve the target. Quintile-specific projections showed wide wealth-based inequality in access to antenatal care, postnatal care, delivery care, adequate sanitation, and care seeking for pneumonia, and this inequality was projected to continue for all indicators. The incidence of catastrophic health expenditure and impoverishment were projected to increase from 17% and 4%, respectively, in 2015, to 20% and 9%, respectively, by 2030. Inequality analysis suggested that wealthiest households would disproportionately face more financial catastrophe than the most disadvantaged households. INTERPRETATION Despite progress, Bangladesh will not achieve the 2030 UHC targets unless the country scales up interventions related to maternal and child health services, and reforms health financing systems to avoid high dependency on out-of-pocket payments. The introduction of a national health insurance system, increased public funding for health care, and expansion of community-based clinics in rural areas could help to move the country towards UHC. FUNDING Japan Ministry of Health, Labour, and Welfare.
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Affiliation(s)
- Md Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Global Public Health Research Foundation, Dhaka, Bangladesh.
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Global Public Health Research Foundation, Dhaka, Bangladesh; Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh; Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Stuart Gilmour
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Khin Thet Swe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Sarah Krull Abe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo, Japan
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Kambale RM, Buliga JB, Isia NF, Muhimuzi AN, Battisti O, Mungo BM. Delayed initiation of breastfeeding in Bukavu, South Kivu, eastern Democratic Republic of the Congo: a cross-sectional study. Int Breastfeed J 2018; 13:6. [PMID: 29456590 PMCID: PMC5810029 DOI: 10.1186/s13006-018-0150-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background Timely initiation of breastfeeding can decrease neonatal mortality. However, about 50% of newborns are not breastfeed within 1 h of birth in the Democratic Republic of Congo. The aim of this study was to identify factors associated with delayed initiation of breastfeeding in an urban and rural area of Bukavu, South Kivu province, Democratic Republic of Congo. Methods We interviewed 396 mother-newborn pairs (185 in the urban area and 211 in the rural area) between 20 July and 10 October 2016. We used descriptive statistics to demonstrate the prevalence of early initiation of breastfeeding. Variables that showed association with delayed initiation of breastfeeding in the bivariate models were entered in a multivariable logistic model. Results Overall, the rate of early initiation of breastfeeding was 65.9% (69.7% in the rural area, 61.6% in the rural area). Two hundred and seventy-four (62.9%) mothers (159 in rural area and 115 in urban area) were counselled on early initiation of breastfeeding during prenatal care. Most mothers, 65.2% received counselling by a health professional. On multivariable regression analyses after adjusting for other variables in the model, unmarried mothers [Odds Ratio (OR): 1.5 (95% Confidence Interval (CI): 1.13, 1.95)], cesarean delivery [OR: 2.24 (95% CI: 1.74, 2.88)], no counselling on timely initiation of breastfeeding [OR: 1.71 (95% CI: 1.29, 2.20)] and counselling by a non-health professional [OR: 1.84 (95% CI: 1.08, 3.12)] were associated with delayed initiation of breastfeeding. Conclusion Systemic changes are needed for women having caesarean births to experience skin-to-skin and early initiation. In addition, information, education and communication on the importance of timely initiation of breastfeeding must be supported to improve maternal and infant wellbeing.
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Affiliation(s)
- Richard Mbusa Kambale
- 1Faculty of Medicine, Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo.,Department of Pediatrics, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Jérémie Bisimwa Buliga
- 1Faculty of Medicine, Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Nancy Francisca Isia
- 1Faculty of Medicine, Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo.,Department of Pediatrics, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Adolphe Nyakasane Muhimuzi
- 1Faculty of Medicine, Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo.,Department of Pediatrics, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
| | - Oreste Battisti
- 1Faculty of Medicine, Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo.,3Department of Pediatrics, University of Liège, Liège, Belgium
| | - Bruno Masumbuko Mungo
- 1Faculty of Medicine, Catholic University of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo.,Department of Pediatrics, Reference Provincial General Hospital of Bukavu, Bukavu, South-Kivu Province Democratic Republic of the Congo
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Ekubay M, Berhe A, Yisma E. Initiation of breastfeeding within one hour of birth among mothers with infants younger than or equal to 6 months of age attending public health institutions in Addis Ababa, Ethiopia. Int Breastfeed J 2018; 13:4. [PMID: 29410699 PMCID: PMC5782370 DOI: 10.1186/s13006-018-0146-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022] Open
Abstract
Background Breast milk is comprised of the essential nutrients that an infant needs in the first six months of life. Timely initiation of breastfeeding guarantees that infants receive the colostrum, ‘the first breastmilk’, which contains antibodies that protect the newborn against diseases. Breastfeeding within the first hour of life prevents newborn death due to sepsis, pneumonia, diarrhea and hypothermia. Although breastfeeding is a common practice in sub-Saharan Africa, evidence show that early initiation of breastfeeding is low. Methods We conducted a cross-sectional study of 583 mothers with infants younger than or equal to 6 months of age attending Maternal and Child Health (MCH) clinics of public health institutions in Addis Ababa, Ethiopia from April to May 2012. A simple random sampling design was used to select the institutions included in this study. Data from mothers of infants were collected using interviewer-administered questionnaire. We analyzed the data to examine factors associated with initiation of breastfeeding within one hour of birth using logistic regression models. Results Of 564 (96.7%, 564/583) mothers who breastfed their infants, 58.3% (329/564) initiated breastfeeding within one hour of birth. In the adjusted analysis, mothers who had three or more infants had about twice higher odds of timely initiation of breastfeeding within one hour of birth (Adjusted Odds Ratio [aOR] 2.10; 95% Confidence Interval [CI]1.04, 4.30) compared with mothers who had one infant. Furthermore, women who started antenatal care at their fourth month of pregnancy or later had a 49.0% higher odds of initiation of breastfeeding within one hour of birth (aOR 1.49; 95% CI 1.01, 2.19) compared to mothers who started antenatal care before their fourth month of pregnancy. Conclusions Initiation of breastfeeding within one hour of birth was low. Initiation of breastfeeding within one hour of birth was highest among multiparous women, mothers aged 30–34 years, and women who began antenatal care at their fourth month of pregnancy or later. Public health officials and health care providers should consider interventions to promote and support early initiation of breastfeeding.
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Affiliation(s)
- Meseret Ekubay
- 1Department of Nursing, College of Health Sciences, Institute of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Aster Berhe
- Midwifery Advisor, UNFPA Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Engida Yisma
- 3School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,4Robinson Research Institute, School of Medicine, The University of Adelaide, Adelaide, Australia
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Adewuyi EO, Zhao Y, Khanal V, Auta A, Bulndi LB. Rural-urban differences on the rates and factors associated with early initiation of breastfeeding in Nigeria: further analysis of the Nigeria demographic and health survey, 2013. Int Breastfeed J 2017; 12:51. [PMID: 29299048 PMCID: PMC5747139 DOI: 10.1186/s13006-017-0141-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background This study investigates and compares the rates and factors associated with early initiation of breastfeeding (EIBF) within one hour of birth in rural and urban Nigeria. Methods Data from the 2013 Nigeria Demographic and Health Survey (NDHS) were analyzed. The rates of EIBF were reported using frequency tabulation. Associated factors were examined using Chi-Square test and further assessed on multivariable logistic regression analysis. Results The rates of EIBF were 30.8% (95% confidence interval [CI] 29.0, 32.6) and 41.9% (95% CI 39.6, 44.3) in rural and urban residences, respectively (p < 0.001). The North-Central region had the highest EIBF rates both in rural (43.5%) and urban (63.5%) residences. Greater odds of EIBF in rural residence were significantly associated with higher birth order (Adjusted Odds Ratio [AOR] 1.29, 95% CI 1.10, 1.60), large birth size (AOR 1.33, 95% CI 1.10, 1.60), and health facility delivery (AOR 1.46, 95% CI 1.23, 1.72). Rural mothers in the rich wealth index, not working and whose husbands obtained at least a secondary school education had significantly higher odds of early initiation of breastfeeding. Regardless of residence, greater odds of EIBF were significantly associated with non-cesarean delivery (Rural AOR 3.50, 95% CI 1.84, 6.62; Urban AOR 2.48, 95% CI 1.60, 3.80) and living in North-Central (Rural AOR 1.84, 95% CI 1.34, 2.52; Urban AOR 4.40, 95% CI 3.15, 6.15) region. Also, higher odds of EIBF were significantly associated with living in North-East (Rural AOR 1.48, 95% CI 1.05, 2.08; Urban AOR 3.50, 95% CI 2.55, 4.83), South-South (Rural AOR 1.51, 95% CI 1.11, 2.10; Urban AOR 2.84, 95% CI 2.03, 3.97) and North-West (Urban residence only AOR 2.08, 95% CI 1.54, 2.80) regions. Conclusions Rural-urban differences in the rates and factors associated with EIBF exist in Nigeria with rural residence having significantly lower rates. Intervention efforts which address the risk factors identified in this study may contribute to improved EIBF rates. Efforts need to prioritize rural mothers generally, (particularly, those in rural North-West region) as well as mothers in urban South-West region of Nigeria.
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Affiliation(s)
- Emmanuel Olorunleke Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Federal Ministry of Defense, 2 Division Hospital, Adekunle Fajuyi Cantonment, Ibadan, Oyo State, Nigeria
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Bentley Campus, Perth, Australia
| | | | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
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Nguyen PH, Kim SS, Sanghvi T, Mahmud Z, Tran LM, Shabnam S, Aktar B, Haque R, Afsana K, Frongillo EA, Ruel MT, Menon P. Integrating Nutrition Interventions into an Existing Maternal, Neonatal, and Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster-Randomized Program Evaluation. J Nutr 2017; 147:2326-2337. [PMID: 29021370 PMCID: PMC5697969 DOI: 10.3945/jn.117.257303] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/15/2017] [Accepted: 09/20/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh.Objectives: We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices.Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n ∼ 300 and 1000 pregnant or recently delivered women, respectively, per survey round). We derived difference-in-difference effect estimates, adjusted for geographic clustering and infant age and sex.Results: Coverage of interpersonal counseling was high; >90% of women in the nutrition-focused MNCH group were visited at home by health workers for maternal nutrition and breastfeeding counseling. The coverage of community mobilization activities was ∼50%. Improvements were significantly greater in the nutrition-focused MNCH group than in the standard MNCH group for consumption of iron and folic acid [effect: 9.8 percentage points (pp); 46 tablets] and calcium supplements (effect: 12.8 pp; 50 tablets). Significant impacts were observed for the number of food groups consumed (effect: 1.6 food groups), percentage of women who consumed ≥5 food groups/d (effect: 30.0 pp), and daily intakes of several micronutrients. A significant impact was also observed for exclusive breastfeeding (EBF; effect: 31 pp) but not for early initiation of breastfeeding.Conclusions: Addressing nutrition during pregnancy by delivering interpersonal counseling and community mobilization, providing free supplements, and ensuring weight-gain monitoring through an existing MNCH program improved maternal dietary diversity, micronutrient supplement consumption, and EBF practices. This trial was registered at clinicaltrials.gov as NCT02745249.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC;
| | - Sunny S Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | | | | | | | | | | | | | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Marie T Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
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Osman A, Gaffer Y, Sharkawy A, Brandon D. Maternal cultural practices for neonates' care in upper Egypt. Women Birth 2017; 31:e278-e285. [PMID: 29102383 DOI: 10.1016/j.wombi.2017.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/13/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM Little is known about the home practices and care given to neonates born in Egypt. BACKGROUND Two thirds of all infant deaths in Egypt occur in the neonatal period and many of these deaths occur in the home environment out of sight of health care providers. Understanding cultural practices and beliefs about caring for neonates may help direct appropriate interventions to improve infant outcomes. AIM To describe maternal cultural care practices used with neonates and highlight harmful practices in order to identify areas of required change in care. METHODS A descriptive study using a convenience sample of 200 women recruiting from outpatient pediatric facilities in Qena, Egypt. Face to face interviews were used to gather data. FINDINGS More than one third (37.5%) of the studied women given birth in the home, and a traditional birth attendant assisted with the majority of home births (90%). Breast-feeding was delayed between 1 and 4days in 27% of the women and they were more likely to use cultural practices, rather than modern medical practices, for neonatal eye and umbilical care. Maternal cultural practices used in the home can be categorized as being harmful, beneficial, and as having no-effect on neonatal health based upon available evidence. DISCUSSION A variety of cultural practices are used by women for neonatal care in upper Egypt. Many of these practices may have a negative effect on neonatal health and should be discontinued. CONCLUSION Comprehensive interventions are needed to modify women' care practices.
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Affiliation(s)
- Atiat Osman
- South Valley University, Faculty of Nursing, Egypt; Duke University, School of Nursing, 2724 Campus Walk, 27705 Durham, NC, USA.
| | - Yousr Gaffer
- Alexandria University, Faculty of Nursing, Egypt.
| | | | - Debra Brandon
- Duke University, School of Nursing, USA; Department of Pediatrics, School of Medicine, Neonatal CNS, Duke Intensive Care Nursery Duke University, School of Nursing, USA.
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Sanghvi T, Haque R, Roy S, Afsana K, Seidel R, Islam S, Jimerson A, Baker J. Achieving behaviour change at scale: Alive & Thrive's infant and young child feeding programme in Bangladesh. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 1:141-54. [PMID: 27187912 PMCID: PMC6680185 DOI: 10.1111/mcn.12277] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/29/2015] [Accepted: 11/29/2015] [Indexed: 01/20/2023]
Abstract
Abstract The Alive & Thrive programme scaled up infant and young child feeding interventions in Bangladesh from 2010 to 2014. In all, 8.5 million mothers benefited. Approaches – including improved counselling by frontline health workers during home visits; community mobilization; mass media campaigns reaching mothers, fathers and opinion leaders; and policy advocacy – led to rapid and significant improvements in key practices related to breastfeeding and complementary feeding. (Evaluation results are forthcoming.) Intervention design was based on extensive formative research and behaviour change theory and principles and was tailored to the local context. The programme focused on small, achievable actions for key audience segments identified through rigorous testing. Promotion strategies took into account underlying behavioural determinants and reached a high per cent of the priority groups through repeated contacts. Community volunteers received monetary incentives for mothers in their areas who practised recommended behaviours. Programme monitoring, midterm surveys and additional small studies to answer questions led to ongoing adjustments. Scale‐up was achieved through streamlining of tools and strategies, government branding, phased expansion through BRAC – a local non‐governmental implementing partner with an extensive community‐based platform – and nationwide mainstreaming through multiple non‐governmental organization and government programmes. Key messages Well‐designed and well‐implemented large‐scale interventions that combine interpersonal counselling, community mobilization, advocacy, mass communication and strategic use of data have great potential to improve IYCF practices rapidly. Formative research and ongoing studies are essential to tailor strategies to the local context and to the perspectives of mothers, family members, influential community members and policymakers. Continued use of data to adjust programme elements is also central to the process. Scale‐up can be facilitated through strategic selection of partners with existing community‐based platforms and through mass media, where a high proportion of the target audience can be reached through communication channels such as broadcast media. Sustaining the impacts will involve commitments from government and capacity building. The next step for capacity building would involve understanding barriers and constraints and then coming up with appropriate strategies to address them. One of the limitations we experienced was rapid transition of staff in key positions of implementing agencies, in government leadership, donors and other stakeholders. There was a need for continued advocacy, orientation and teaching related to strategic programme design, behaviour change, effective implementation and use of data.
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Affiliation(s)
| | | | - Sumitro Roy
- FHI 360, Washington, District of Columbia, USA
| | | | | | | | | | - Jean Baker
- FHI 360, Washington, District of Columbia, USA
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Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications. Public Health Nutr 2017; 20:3120-3134. [PMID: 28965508 DOI: 10.1017/s1368980017002531] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low- and middle-income countries and discuss implications for programmes. DESIGN A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. SETTING Low- and middle-income countries. SUBJECTS Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. RESULTS Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h post-delivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from cross-sectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. CONCLUSIONS Improving the counselling skills of health workers to address breast-feeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low- and middle-income countries.
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Hoddinott J, Ahmed A, Karachiwalla NI, Roy S. Nutrition behaviour change communication causes sustained effects on IYCN knowledge in two cluster-randomised trials in Bangladesh. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28782306 PMCID: PMC5763316 DOI: 10.1111/mcn.12498] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 01/20/2023]
Abstract
Behaviour change communication (BCC) can improve infant and young child nutrition (IYCN) knowledge, practices, and health outcomes. However, few studies have examined whether the improved knowledge persists after BCC activities end. This paper assesses the effect of nutrition sensitive social protection interventions on IYCN knowledge in rural Bangladesh, both during and after intervention activities. We use data from two, 2‐year, cluster randomised control trials that included nutrition BCC in some treatment arms. These data were collected at intervention baseline, midline, and endline, and 6–10 months after the intervention ended. We analyse data on IYCN knowledge from the same 2,341 women over these 4 survey rounds. We construct a number correct score on 18 IYCN knowledge questions and assess whether the impact of the BCC changes over time for the different treatment groups. Effects are estimated using ordinary least squares accounting for the clustered design of the study. There are 3 main findings: First, the BCC improves IYCN knowledge substantially in the 1st year of the intervention; participants correctly answer 3.0–3.2 more questions (36% more) compared to the non‐BCC groups. Second, the increase in knowledge between the 1st and 2nd year was smaller, an additional 0.7–0.9 correct answers. Third, knowledge persists; there are no significant decreases in IYCN knowledge 6–10 months after nutrition BCC activities ended.
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Affiliation(s)
- John Hoddinott
- Division of Nutrition Sciences, Cornell University, Ithaca, New York, USA
| | - Akhter Ahmed
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh
| | - Naureen I Karachiwalla
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, District of Columbia, USA
| | - Shalini Roy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, District of Columbia, USA
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Menon P, Nguyen PH, Saha KK, Khaled A, Kennedy A, Tran LM, Sanghvi T, Hajeebhoy N, Baker J, Alayon S, Afsana K, Haque R, Frongillo EA, Ruel MT, Rawat R. Impacts on Breastfeeding Practices of At-Scale Strategies That Combine Intensive Interpersonal Counseling, Mass Media, and Community Mobilization: Results of Cluster-Randomized Program Evaluations in Bangladesh and Viet Nam. PLoS Med 2016; 13:e1002159. [PMID: 27780198 PMCID: PMC5079648 DOI: 10.1371/journal.pmed.1002159] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009-2014) and aimed to improve breastfeeding practices through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) intervention components delivered at scale in the context of policy advocacy (PA) in Bangladesh and Viet Nam. In Bangladesh, IPC was delivered through a large non-governmental health program; in Viet Nam, it was integrated into government health facilities. This study evaluated the population-level impact of intensified IPC, MM, CM, and PA (intensive) compared to standard nutrition counseling and less intensive MM, CM, and PA (non-intensive) on breastfeeding practices in these two countries. METHODS AND FINDINGS A cluster-randomized evaluation design was employed in each country. For the evaluation sample, 20 sub-districts in Bangladesh and 40 communes in Viet Nam were randomized to either the intensive or the non-intensive group. Cross-sectional surveys (n ~ 500 children 0-5.9 mo old per group per country) were implemented at baseline (June 7-August 29, 2010, in Viet Nam; April 28-June 26, 2010, in Bangladesh) and endline (June 16-August 30, 2014, in Viet Nam; April 20-June 23, 2014, in Bangladesh). Difference-in-differences estimates (DDEs) of impact were calculated, adjusting for clustering. In Bangladesh, improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h (DDE 36.2 percentage points [pp], 95% CI 21.0-51.5, p < 0.001; prevalence in intensive group rose from 48.5% to 87.6%) and engaging in early initiation of breastfeeding (EIBF) (16.7 pp, 95% CI 2.8-30.6, p = 0.021; 63.7% to 94.2%). In Viet Nam, EBF increases were greater in the intensive group (27.9 pp, 95% CI 17.7-38.1, p < 0.001; 18.9% to 57.8%); EIBF declined (60.0% to 53.2%) in the intensive group, but less than in the non-intensive group (57.4% to 40.6%; DDE 10.0 pp, 95% CI -1.3 to 21.4, p = 0.072). Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a "pure control" area with no MM or national/provincial PA. CONCLUSIONS At-scale interventions combining intensive IPC with MM, CM, and PA had greater positive impacts on breastfeeding practices in Bangladesh and Viet Nam than standard counseling with less intensive MM, CM, and PA. To our knowledge, this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation designs. Strategies to design and deliver similar programs could improve breastfeeding practices in other contexts. TRIAL REGISTRATION ClinicalTrials.gov NCT01678716 (Bangladesh) and NCT01676623 (Viet Nam).
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Affiliation(s)
- Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Kuntal Kumar Saha
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Adiba Khaled
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Andrew Kennedy
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Lan Mai Tran
- Alive & Thrive, FHI360, Washington, District of Columbia, United States of America
| | - Tina Sanghvi
- Alive & Thrive, FHI360, Washington, District of Columbia, United States of America
| | - Nemat Hajeebhoy
- Alive & Thrive, FHI360, Washington, District of Columbia, United States of America
| | - Jean Baker
- Alive & Thrive, FHI360, Washington, District of Columbia, United States of America
| | - Silvia Alayon
- Save the Children, Washington, District of Columbia, United States of America
| | | | | | - Edward A. Frongillo
- University of South Carolina, Columbia, South Carolina, United States of America
| | - Marie T. Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Rahul Rawat
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
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Akter T, Dawson A, Sibbritt D. The determinants of essential newborn care for home births in Bangladesh. Public Health 2016; 141:7-16. [PMID: 27932018 DOI: 10.1016/j.puhe.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 07/22/2016] [Accepted: 08/06/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the association of sociodemographic, antenatal and delivery care factors with the essential newborn care (ENC) practices of neonates born at home in Bangladesh. STUDY DESIGN This study analyzed data of a cross-sectional survey-the Bangladesh Demographic and Health Survey, 2011. METHODS This analysis considered 3190 most recent live-born infants who were delivered at home within three years of the survey. Logistic regression models were used to identify the factors affecting the implementation of six ENC practices, namely using disinfected instruments to cut the umbilical cord, avoidance of application of any substances to the umbilical cord stump, immediate drying and wrapping of newborns, delayed bathing of newborns, and immediate initiation of breastfeeding. RESULTS Factors affecting ENC practices in Bangladesh are low parental education, low utilization of antenatal care services, the absence of skilled birth attendants, smaller size at birth, higher birth order and mother's age at birth. Regional factors also seem to considerably affect ENC practices. CONCLUSION There is ample scope to improve the coverage of ENC practices in Bangladesh. Health promotion programmes that target parents with low education and older mothers may help to build awareness of ENC practices. This investigation provides insight into the key determinants of ENC practices, which require consideration when scaling up ENC practices in low-income and lower middle-income countries.
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Affiliation(s)
- T Akter
- Faculty of Health, University of Technology, Sydney, Building 10, 235-253 Jones St, Ultimo, NSW 2007, Australia.
| | - A Dawson
- Faculty of Health, University of Technology, Sydney, Building 10, 235-253 Jones St, Ultimo, NSW 2007, Australia.
| | - D Sibbritt
- Faculty of Health, University of Technology, Sydney, Building 10, 235-253 Jones St, Ultimo, NSW 2007, Australia.
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Sharma IK, Byrne A. Early initiation of breastfeeding: a systematic literature review of factors and barriers in South Asia. Int Breastfeed J 2016; 11:17. [PMID: 27330542 PMCID: PMC4912741 DOI: 10.1186/s13006-016-0076-7] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/10/2016] [Indexed: 11/12/2022] Open
Abstract
Background Early or timely initiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition however remains low in South Asia and the factors and barriers warrant greater consideration for improved action. This review synthesises the evidence on factors and barriers to initiation of breastfeeding within 1 h of birth in South Asia encompassing Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Methods Studies published between 1990 and 2013 were systematically reviewed through identification in Academic Search Complete, CINAHL, Global Health, MEDLINE and Scopus databases. Twenty-five studies meeting inclusion criteria were included for review. Structured thematic analysis based on leading frameworks was undertaken to understand factors and barriers. Results Factors at geographical, socioeconomic, individual, and health-specific levels, such as residence, education, occupation, income, mother’s age and newborn’s gender, and ill health of mother and newborn at delivery, affect early or timely breastfeeding initiation in South Asia. Reported barriers impact through influence on acceptability by traditional feeding practices, priests’ advice, prelacteal feeding and discarding colostrum, mother-in-law’s opinion; availability and accessibility through lack of information, low access to media and health services, and misperception, support and milk insufficiency, involvement of mothers in decision making. Conclusions Whilst some barriers manifest similarly across the region some factors are context-specific thus tailored interventions are imperative. Initiatives halting factors and directed towards contextual barriers are required for greater impact on newborn survival and improved nutrition in the South Asia region. Electronic supplementary material The online version of this article (doi:10.1186/s13006-016-0076-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Indu K Sharma
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Abbey Byrne
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC Australia
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Tamiru D, Tamrat M. Constraints to the optimal breastfeeding practices of breastfeeding mothers in the rural communities of Arba Minch Zuria Woreda, Ethiopia: a community-based, cross-sectional study. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2015.11734548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Legesse M, Demena M, Mesfin F, Haile D. Factors Associated with Colostrum Avoidance Among Mothers of Children Aged less than 24 Months in Raya Kobo district, North-eastern Ethiopia: Community-based Cross-sectional Study. J Trop Pediatr 2015; 61:357-63. [PMID: 26141533 PMCID: PMC4590259 DOI: 10.1093/tropej/fmv039] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND UNICEF and WHO recommend colostrum as newborns' perfect food that should be initiated within the first hour after birth. OBJECTIVE To assess colostrum avoidance practices and associated factors among mothers of children aged <24 months in Raya Kobo district, North-eastern Ethiopia. METHODS A quantitative community-based cross-sectional study supplemented by qualitative method was used. Descriptive statistics, binary and multivariable logistic regression analyses were used in the statistical analysis. RESULTS Colostrum avoidance was practiced by 13.5% (95% confidence interval: 10.99-16.33) of mothers having children aged <24 months. In multivariable logistic regression analysis, giving birth at home, mother-heading households, lack of awareness on the advantages of colostrum and late initiation of breastfeeding remained statistically significant factors associated with colostrum avoidance practices. CONCLUSION Promoting institutional delivery, timely initiation of breastfeeding and creating awareness on the advantages of colostrum feeding are recommended interventions to reduce colostrum avoidance.
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Affiliation(s)
- Misgan Legesse
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Ethiopia
| | - Melake Demena
- Department of Public Health, College of Health Science and Medicine, Haramaya University, Ethiopia
| | - Firehiwot Mesfin
- Department of Public Health, College of Health Science and Medicine, Haramaya University, Ethiopia
| | - Demewoz Haile
- Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
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Factors associated with Early Initiation of Breastfeeding in Western Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9562-74. [PMID: 26287223 PMCID: PMC4555298 DOI: 10.3390/ijerph120809562] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022]
Abstract
The initiation of breastfeeding within one hour of birth has numerous nutritional and immunological benefits and has been found to reduce neonatal mortality. This community-based prospective cohort study aimed to report the rate of, and factors associated with, early initiation of breastfeeding in Western Nepal. The rate of early initiation of breastfeeding was reported, and associations between early initiation and independent variables were tested by Chi-square test, followed by multiple logistic regression. Of the 735 mother-infant pairs, a total of 310 (42.2%) reported early initiation. Mothers who were assisted by traditional attendants during childbirth, delivered by caesarean section, from ethnically disadvantaged families and had delivered low birth weight infants, were less likely to initiate breastfeeding early whereas the mothers who were from the poorest families and did not introduce prelacteal feeds to their infants were more likely to initiate breastfeeding within the first hour. Skills-training to support breastfeeding as part of the training of skilled birth attendants and other health workers is likely to promote recommended infant feeding practices.
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Hackett KM, Mukta US, Jalal CSB, Sellen DW. A qualitative study exploring perceived barriers to infant feeding and caregiving among adolescent girls and young women in rural Bangladesh. BMC Public Health 2015; 15:771. [PMID: 26259575 PMCID: PMC4531479 DOI: 10.1186/s12889-015-2115-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant feeding and caregiving by adolescent girls and young women in rural Bangladesh remains relatively understudied despite high potential vulnerability of younger mothers and their children due to poverty and high rates of early marriage and childbearing. This key knowledge gap may hamper the effectiveness of maternal, infant and child health interventions not specifically tailored to teenage mothers. This study aimed to narrow this gap by documenting key barriers to optimal infant and young child feeding and caregiving perceived by adolescent girls and young women in rural Bangladesh. METHODS Focus group discussions and in-depth semi-structured interviews were conducted with 70 adolescent girls and young women participating in a community-based adolescent empowerment program in two rural regions of northwestern Bangladesh. Participants were stratified into three groups: unmarried, married without child, and married with child(ren). Thematic analysis was performed to elucidate dominant ideas regarding challenges with child feeding and caregiving across participant strata. RESULTS Participants in all three strata and in both geographical regions attributed actual and anticipated caregiving difficulties to five major contextual factors: early marriage, maternal time allocation conflicts, rural life, short birth intervals, and poverty. Indications are that many girls and young women anticipate difficulties in feeding and caring for their future children from an early age, and often prior to motherhood. Participants articulated both perceived need and unmet demand for additional education in infant and young child feeding, childcare, and family planning techniques. CONCLUSIONS Provision during adolescence of appropriate education, services and financial aid to support best practices for infant feeding and childcare could significantly improve maternal self-efficacy, mental health, nutrition security and young childcare, nutrition and health in rural Bangladesh. Lessons learned can be applied in future programs aimed at supporting adolescent women along a continuum of care.
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Affiliation(s)
- Kristy M Hackett
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
| | - Umme S Mukta
- Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
| | | | - Daniel W Sellen
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
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Bazzano AN, Oberhelman RA, Potts KS, Taub LD, Var C. What health service support do families need for optimal breastfeeding? An in-depth exploration of young infant feeding practices in Cambodia. Int J Womens Health 2015; 7:249-57. [PMID: 25733931 PMCID: PMC4337513 DOI: 10.2147/ijwh.s76343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Appropriate and timely breastfeeding practices markedly improve lifelong health outcomes for newborns, children, and mothers. Exclusive breastfeeding is reported to be widely practiced in Cambodia, and important progress has been made toward achieving improved child health outcomes, but newborn mortality has been slow to reduce and breastfeeding practices remain suboptimal. Methods Formative research was conducted in Takeo province, Cambodia to describe the practical, cultural, and social factors underlying current breastfeeding behaviors to inform the design of a newborn survival intervention that may improve breastfeeding. In-depth interviews, observations, a collection of visual media, and focus groups were employed to gather qualitative data. Results The results revealed knowledge and practice gaps in behavior that likely contribute to breastfeeding barriers, particularly in the areas of infant latch, milk production, feeding frequency, and the use of breast milk substitutes. The predominant theme identified in the research was a dearth of detailed information, advice, and counseling for mothers beyond the message to exclusively breastfeed for 6 months. Conclusion Future newborn survival interventions and postnatal care counseling in this area must go beyond the exclusive breastfeeding message. To achieve further impact, it will be necessary to disseminate comprehensive and locally appropriate information on breastfeeding and to improve counseling in order to support successful breastfeeding and to contribute to population-level health gains.
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Affiliation(s)
- Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Richard A Oberhelman
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Kaitlin Storck Potts
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Leah D Taub
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Chivorn Var
- National Institute of Public Health, Tuol Kork, Phnom Penh, Cambodia
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Adhikari M, Khanal V, Karkee R, Gavidia T. Factors associated with early initiation of breastfeeding among Nepalese mothers: further analysis of Nepal Demographic and Health Survey, 2011. Int Breastfeed J 2014; 9:21. [PMID: 25493094 PMCID: PMC4260185 DOI: 10.1186/s13006-014-0021-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 11/15/2014] [Indexed: 11/16/2022] Open
Abstract
Background Timely initiation of breastfeeding has been reported to reduce neonatal mortality by 19.1%. The World Health Organisation recommends early initiation of breastfeeding i.e. breastfeeding a newborn within the first hour of life. Knowledge on the rate and the determinants of early initiation of breastfeeding may help health program managers to design and implement effective breastfeeding promotion programs. The aim of this study was to determine the rate and the determinants of early initiation of breastfeeding in Nepal. Methods This study used the data from Nepal Demographic and Health Survey (NDHS) 2011 which is a nationally representative sample study. Chi square test and multiple logistic regression analysis were used to examine the factors associated with early initiation of breastfeeding (within one hour of birth). Results Of 4079 mothers, 66.4% initiated breastfeeding within one hour of delivery. Mothers with higher education (Odds Ratio (OR) 2.56; 95% CI : 1.26, 5.21), mothers of disadvantaged Janjati ethnicity (OR 1.43; 95% CI : 1.04, 1.94), mothers who were involved in agriculture occupation (OR 1.51; 95% CI : 1.16, 1.97), mothers who delivered in a health facility (OR 1.67; 95% CI : 1.25, 2.23), whose children were large at birth (OR 1.46; 95% CI : 1.07, 1.99) were more likely to initiate breastfeeding within the first hour of child birth. Conclusions Results suggest that two thirds of children in Nepal were breastfed within the first hour after birth. Although there was a higher prevalence of early initiation of breastfeeding among mothers who delivered in health facilities compared to mothers who delivered at home, universal practice of early initiation of breastfeeding should be a routine practice. The findings suggest the need of breastfeeding promotion programs among the mothers who are less educated, and not working. Such breastfeeding promotion programmes could be implemented via Nepal’s extensive network of community-based workers.
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Affiliation(s)
- Mandira Adhikari
- Women's Health Project, Population Services International, Nawalparasi, Nepal
| | - Vishnu Khanal
- Independent Consultant, Kathmandu, Nepal ; School of Public Health, Curtin University, Perth, Australia
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Tania Gavidia
- Centre for International Health, Curtin University, Perth, Australia
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Factors associated with exclusive breastfeeding in Timor-Leste: findings from Demographic and Health Survey 2009-2010. Nutrients 2014; 6:1691-700. [PMID: 24756151 PMCID: PMC4011060 DOI: 10.3390/nu6041691] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 12/16/2022] Open
Abstract
Exclusive breastfeeding is known to have nutritional and health benefits. This study investigated factors associated with exclusive breastfeeding among infants aged five months or less in Timor-Leste. The latest data from the national Demographic and Health Survey 2009–2010 were analyzed by binary logistic regression. Of the 975 infants included in the study, overall 49% (95% confidence interval 45.4% to 52.7%) were exclusively breastfed. The exclusive breastfeeding prevalence declined with increasing infant age, from 68.0% at less than one month to 24.9% at five months. Increasing infant age, mothers with a paid occupation, who perceived their newborn as non-average size, and residence in the capital city Dili, were associated with a lower likelihood of exclusive breastfeeding. On the other hand, women who could decide health-related matters tended to breastfeed exclusively, which was not the case for others whose decisions were made by someone else. The results suggested the need of breastfeeding promotion programs to improve the exclusive breastfeeding rate. Antenatal counseling, peer support network, and home visits by health workers could be feasible options to promote exclusive breastfeeding given that the majority of births occur at home.
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Baker J, Sanghvi T, Hajeebhoy N, Martin L, Lapping K. Using an Evidence-Based Approach to Design Large-Scale Programs to Improve Infant and Young Child Feeding. Food Nutr Bull 2013; 34:S146-55. [DOI: 10.1177/15648265130343s202] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Global interest in scaling up nutrition outcomes has focused attention on the need for more effective programs to improve infant and young child feeding (IYCF). However there are few examples in the literature of comprehensive programs that have been systematically designed. Objective To describe an evidence-based approach for designing large-scale yet tailored IYCF programs in varied country settings. Methods Behavior change principles, epidemiological data, situational analysis, stakeholder consultations, formative research, and feasibility studies informed the design of IYCF programs delivered at scale in Bangladesh, Ethiopia, and Vietnam. Results Impact, scale, and sustainability objectives guided the choice of partners, service delivery platforms, and advocacy, systems strengthening, and communication strategies for reaching mothers and decision makers. All programs focused on the critical first 2 years of life, followed global World Health Organization and UNICEF guidelines for IYCF, and applied a common theory of change. Formative research, stakeholder consultations, trials of improved practices, and assessments of media habits were most useful for making program decisions. Opinion leader research, monitoring of the policy environment, and stakeholder analysis were key elements in the design of advocacy strategies. All programs found that setting measurable and explicit targets, strengthening systems to provide support for mothers, multichannel communication, and advocacy for opinion leaders were vital components in the design. Conclusions A systematic, evidence-based collaborative approach can facilitate the design of comprehensive IYCF programs. Programs should also embed design flexibility to enable changes as new challenges and opportunities arise.
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Daelmans B, Ferguson E, Lutter CK, Singh N, Pachón H, Creed-Kanashiro H, Woldt M, Mangasaryan N, Cheung E, Mir R, Pareja R, Briend A. Designing appropriate complementary feeding recommendations: tools for programmatic action. MATERNAL & CHILD NUTRITION 2013; 9 Suppl 2:116-30. [PMID: 24074322 PMCID: PMC6860844 DOI: 10.1111/mcn.12083] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of stunting in young children from age 6 months. The design of effective programmes to improve infant and young child feeding requires a sound understanding of the local situation and a systematic process for prioritizing interventions, integrating them into existing delivery platforms and monitoring their implementation and impact. The identification of adequate food-based feeding recommendations that respect locally available foods and address gaps in nutrient availability is particularly challenging. We describe two tools that are now available to strengthen infant and young child-feeding programming at national and subnational levels. ProPAN is a set of research tools that guide users through a step-by-step process for identifying problems related to young child nutrition; defining the context in which these problems occur; formulating, testing, and selecting behaviour-change recommendations and nutritional recipes; developing the interventions to promote them; and designing a monitoring and evaluation system to measure progress towards intervention goals. Optifood is a computer-based platform based on linear programming analysis to develop nutrient-adequate feeding recommendations at lowest cost, based on locally available foods with the addition of fortified products or supplements when needed, or best recommendations when the latter are not available. The tools complement each other and a case study from Peru illustrates how they have been used. The readiness of both instruments will enable partners to invest in capacity development for their use in countries and strengthen programmes to address infant and young child feeding and prevent malnutrition.
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Affiliation(s)
- Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Harvey SA, Paredes Olórtegui M, Leontsini E, Ramal Asayag C, Scott K, Winch PJ. Trials of improved practices (TIPs): a strategy for making long-lasting nets last longer? Am J Trop Med Hyg 2013; 88:1109-15. [PMID: 23530074 DOI: 10.4269/ajtmh.12-0641] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Long-lasting insecticidal net (LLIN) use is a proven malaria prevention method. Mass distribution has greatly expanded LLIN access in sub-Saharan Africa, but a gap remains between LLIN ownership and use. Furthermore, LLINs wear out more quickly than anticipated. This paper suggests a participatory research strategy-trials of improved practices (TIPs)-that could identify locally appropriate approaches to prolonging net life and increasing effective use. We used TIPs to overcome barriers to optimal net use in the Peruvian Amazon. Working with 15 families in three villages, we tested home treatment of cotton nets, use of an alternative netting fabric, and alternative washing and care instructions. TIPs helped confirm feasibility of these interventions. Although our findings are time- and context-specific, TIPs could help improve consistency and effectiveness of current LLIN use and prolong net lifespan in sub-Saharan Africa and elsewhere. This would help maximize the value of shrinking donor resources for malaria.
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Affiliation(s)
- Steven A Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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