Feeding practices among children attending child welfare clinics in Ragama MOH area: a descriptive cross-sectional study

Challenges of Continuation of Exclusive Breast Feeding up to 6 Months in a Setting with High Exclusive Breast Feeding Rates Reported. Experience from Eastern Province of Sri Lanka

BACKGROUND

According to the World Breastfeeding Trends Initiative, Sri Lanka ranked as number one and only country to achieve green status. Exclusive breastfeeding (EBF) for six months is current practice with a rate of 75.5% among 0-5 months.

AIM

Identify factors contributing early cessation of breastfeeding in a single centre of Eastern province Sri Lanka.

METHODS

A descriptive cross-sectional study conducted in Sammanthurai Medical officer of Health area. Consecutive mother-infant days with the infant ageing < 6 months were included from 25 public health midwife areas using an interviewer administered questionnaire. Missing values imputed using 'missForest' algorithm.

RESULTS

The mean age of the sample was 28.4(SD ± 5.6). Of the 257 mothers recruited, 15(5.8%) were teenagers and 42(16.3%) > 35 years. 251(97.6%) had children 1-5 and 86(33.5%) were first born. 140 (54.5%) had tertiary education, 28 (10.9%).31(12.1%) were employed. EBF rates 0-6 months was 79.8% (n = 205). 239(93.0%) started breastfeeding within an hour. EBF was not associated with maternal age, birth order or income. 18 employed mothers and 186 unemployed mothers continued EBF. Regarding the factors associated with EBF, having a tertiary education (p < .001), being employed (p = .004) and having less than 3 children (p = .03) were associated with non-exclusive breastfeeding. Tertiary education was the significant predictor of non-exclusive breastfeeding in this population with an odds ratio of 4.50 (95% CI 1.331-15.215).

CONCLUSION

Employment identified as a risk factor for early cessation of EBF needs well planned further research to overcome this practical issue. Also might need revision of workplace policies, establishment of lactation areas in office premises to overcome some of these issues.

Determinants of early cessation of exclusive breastfeeding practices among rural mothers from Jaffna District of Sri Lanka

BACKGROUND

Sri Lanka is an upper-middle-income country with excellent health statistics. However, 2016 Demographic and Health Survey data have shown 82% and 64% of mothers exclusively breastfed infants aged 0-6 months and 4-5 months, respectively. The short duration of exclusive breastfeeding (EBF) has an impact on the growth and development of babies. Since no studies have been reported on EBF practices of the rural mothers in Jaffna District, an administrative district among 25 districts of Sri Lanka, this study aimed to assess the factors influencing the early cessation of EBF.

METHODS

For this community-based cross-sectional study, 338 mother-child pairs were selected from 2013-14. EBF was defined as children not receiving any food or drink, including complementary foods, formula milk or milk products except for medicines and vitamins or mineral drops, other than breast milk since birth. Socio-economic and demographic factors, the influence of the mode of delivery, and knowledge on EBF were obtained using an interviewer-administered questionnaire. The details of EBF and reasons for the cessation of breastfeeding before six months were obtained from a subgroup of mothers (n = 208). Multivariate analysis was performed to explore the correlates of breastfeeding.

RESULTS

In this study, 71.2% (95% CI 64.5, 77.2) had practiced EBF for six months. Early discontinuation of EBF was practiced by employed mothers (AOR 4.3; 95% CI 1.3, 13.9), mothers of low birth weight babies (AOR 3.6; 95% CI 1.6, 8.2) and those who experienced Cesarean section birth (AOR 2.9; 95% CI 1.2, 6.9). The EBF practiced by mothers of rural Jaffna was not associated with the gender of the babies, type of family, number of children in a family, religion of the household, knowledge on EBF, or family income.

CONCLUSION

The prevalence of EBF up to six months was low in rural Jaffna, and it was influenced by employment, birthweight of the babies, and the mode of delivery. To enhance EBF, the Regional Directorate of Health Service, Jaffna, should take necessary action with policymakers to increase maternity leave for at least six months, reduce the Cesarean section rate, and provide nutritional support to pregnant mothers.

Prevalence of exclusive breastfeeding and barriers for its continuation up to six months in Kandy district, Sri Lanka

Background

Since 2005, the national policy on breastfeeding in Sri Lanka is exclusive breastfeeding up to 6 months, as recommended by World Health Organization. The objective of this study was to assess the prevalence of exclusive breastfeeding and barriers for its’ continuation up to 6 months, in Kandy District, Sri Lanka.

Methods

A clinic based cross-sectional study was conducted from August to November 2016, in six randomly selected Medical Officer of Health areas in the Kandy District. The sample was selected proportionate to the population of each Medical Officer of Health area and 354 mothers with infants aged 6 months, attending the child welfare clinics were recruited. Data were collected by an interviewer administered questionnaire using mother recall data since birth. A focus group discussion was conducted on 21 mothers who discontinued exclusive breastfeeding early. The infant taking only breast milk and no additional food, water, or other fluids with the exception of medicines and vitamins or mineral drops for the first 6 months was used as the definition of exclusive breastfeeding.

Results

The prevalence of exclusive breastfeeding for 6 months was 50.8% (180/354) while the median duration was 6 months. Mother being employed (AOR 3.01; 95% CI 1.45, 6.29), mother’s poor knowledge on what she meant by exclusive breastfeeding (AOR 3.75; 95% CI 2.14, 6.54) and mother’s poor attitudes towards exclusive breastfeeding (AOR 2.98; 95% CI 1.76, 5.03) were independently associated with early cessation of exclusive breastfeeding. Unsupported environment in public places was not significantly associated with early cessation of exclusive breastfeeding. Focus group discussion revealed controversial health messages on exclusive breastfeeding delivered at different points of healthcare delivery, cultural practices which discouraged exclusive breastfeeding and difficulties in obtaining maternity leave as barriers for exclusive breastfeeding.

Conclusions

The prevalence of exclusive breastfeeding up to 6 months was not satisfactory and there were barriers identified in healthcare system, family and work places towards exclusive breastfeeding. For further improvement in the prevalence of exclusive breastfeeding these issues need to be addressed and necessary changes in legislation implemented.

Hubungan ASI Eksklusif dengan Kejadian Underweight di Jawa Timur Tahun 2016

Background: Underweight is a public health problem caused by many factors. The prevalence of underweight in East Java in 2016 was 17.3%, wich was higher than the program’s targetted (12.9%). Breast milk is the best food to support the growth and development of the baby. Coverage of Exclusive Breast Milk in East Java in 2015 decreased (68.8%), compared to 2014 (72.89%). Early supplementary feeding in infants under 6 months may affect nutritional status. Objectives: The purpose of this study was to analyze the relationship of Exclusive Breast milk with the incidence of underweight in infants aged 0-23 months in East Java Province in 2016. Method: This study is a secondary data analysis of Nutrition Status Monitoring in East Java Province. The study population was all babies in East Java. Total sample is 4738. The data were analyzed using Chi-square test and Logistic Regression, with 95% CI (α = 0.05). Results: The results showed there was a significant relationship between exclusive breastfeeding only from birth until before the last 24 hours in infants aged 0-23 months with the incidence of underweight, with (p=0.000010;OR=1.654;95%CI=1.319–2.052), there was a significant  relationship of first to provide a food other than breast milk in infants aged 0-23 months  with the occurrence of underweight, (p = 0.000;OR=0.272; 95%CI=0.217–0.341).Conclusion: In conclusion, breastfeeding only in infants from birth until before the last 24 hours and first provide food other than breast milk in infants aged 0-23 months associated with underweight. Because breast milk is sufficient nutritional needs of infants aged 0-6 months.ABSTRAK Latar Belakang: Masalah gizi kurang merupakan masalah kesehatan masyarakat yang disebabkan oleh banyak faktor. Prevalensi underweight di Jawa Timur tahun 2016 sebesar 17,3%, lebih tinggi dari target program Dinas Kesehatan Provinsi Jawa Timur sebesar 12,9%. ASI merupakan makanan terbaik untuk mendukung pertumbuhan dan perkembangan bayi. Cakupan ASI Eksklusif di Jawa Timur tahun 2015 menurun (68,8%), dibandingkan tahun 2014 (72,89%). Pemberian makanan pendamping ASI dini pada bayi di bawah 6 bulan dapat mempengaruhi status gizi. Tajuan: Tujuan penelitian untuk menganalisis hubungan ASI Ekslusif dengan kejadian underweight pada bayi usia 0-23 bulan di Provinsi Jawa Timur tahun 2016.Metode: Penelitian ini merupakan analisis data sekunder survei Pemantauan Status Gizi Provinsi Jawa Timur. Populasi penelitian adalah semua bayi berusia 0-59 bulan yang ada di Jawa Timur. Total sampel sebanyak 4738 bayi.  Analisis data dilakukan dengan menggunakan uji Chi-square dan Regresi Logistik.Hasil: Hasil penelitian menunjukkan ada hubungan antara pemberian ASI saja sejak lahir sampai sebelum 24 jam terakhir pada bayi usia 0-23 bulan dengan kejadian underweight (p=0,000010;OR=1,654;95%CI=1,319–2,052), ada hubungan pertama kali memberikan makanan selain ASI pada bayi usia 0-23 bulan dengan kejadian underweight,  (p = 0,000;OR=0,272; 95%CI=0,217–0,341).Kesimpulan: Simpulan yaitu pemberian ASI saja pada bayi sejak lahir sampai sebelum 24 jam terakhir dan pertama kali memberikan makanan selain ASI pada bayi usia 0-23 bulan berhubungan dengan kejadian underweight. Pemberian ASI saja sudah mencukupi kebutuhan nutrisi bayi usia 0-6 bulan.

Circadian feeding patterns of 12-month-old infants

Early life nutrition and feeding practices are important modifiable determinants of subsequent obesity, yet little is known about the circadian feeding pattern of 12-month-old infants. We aimed to describe the 24-h feeding patterns of 12-month-old infants and examine their associations with maternal and infant characteristics. Mothers from a prospective birth cohort study (n 431) reported dietary intakes of their 12-month-old infants and respective feeding times using 24-h dietary recall. Based on their feeding times, infants were classified into post-midnight (00.00-05.59 hours) and pre-midnight (06.00-23.59 hours) feeders. Mean daily energy intake was 3234 (sd 950) kJ (773 (sd 227) kcal), comprising 51·8 (sd 7·8) % carbohydrate, 33·9 (sd 7·2) % fat and 14·4 (sd 3·2) % protein. Mean hourly energy intake and proportion of infants fed were lower during post-midnight than pre-midnight hours. There were 251 (58·2 %) pre-midnight and 180 (41·8 %) post-midnight feeders. Post-midnight feeders consumed higher daily energy, carbohydrate, fat and protein intakes than pre-midnight feeders (all P<0·001). The difference in energy intake originated from energy content consumed during the post-midnight period. Majority (n 173) of post-midnight feeders consumed formula milk during the post-midnight period. Using multivariate logistic regression with confounder adjustment, exclusively breast-feeding during the first 6 months of life was negatively associated with post-midnight feeding at 12 months (adjusted OR 0·31; 95 % CI 0·11, 0·82). This study provides new insights into the circadian pattern of energy intake during infancy. Our findings indicated that the timing of feeding at 12 months was associated with daily energy and macronutrient intakes, and feeding mode during early infancy.

Factors associated with anemia among Sri Lankan primary school children in rural North Central Province

Background

Despite interventions, childhood anemia is still a major public health problem in low and middle income countries. Purpose of the present study is to determine factors associated with anemia among rural primary school children in Sri Lanka, a country undergoing rapid socioeconomic changes.

Methods

Multi stage cluster sampling was used to select 100 rural schools in NCP and a maximum of 50 children aged 60–131 months were enrolled from each school. Self-administered questionnaires were sent to parents. Anthropometric measurements and blood samples were obtained by trained investigators. Blood reports were analyzed in a commercial laboratory with external quality control measures.

Results

Total of 4412 children were included in the analysis. A Multiple regression was performed for hemoglobin. Only 4.2% of the change in hemoglobin could be explained by the model. District (p > 0.001), age (p > 0.001), timing of warm treatment(p = 0.026) and BMI for age (p = 0.002) uniquely contributed 1.12%, 1.19%, 0.13% and 0.26% to change in hemoglobin level respectively whereas, sex, monthly family income and frequency of meat and green leaf consumption didn’t contribute significantly.

Peripheral blood film analyses were available for 146 anemic children. Blood film was reported as normal in 19.9% while evidence of iron deficiency (18.5%), early iron deficiency (32.5%) and thalassemia trait with iron deficiency (29.5%) were reported in the rest.

Serum ferritin level was available for 417 children with hemoglobin less than 12 g/dl. Mean ferritin level was 63.7 microgram/l. Only 0.5% had depleted iron stores. A multiple regression was performed for serum ferritin and R² was 0.123 (p < 0.001). Area under the curve for serum ferritin and anemia was 0.436.

Conclusion

Anemia among rural primary school children in NCP cannot be well explained by routinely assessed socioeconomic characteristics which mainly provide clues to access for food. Commonly used anemia related investigations have low validity in detecting and explaining anemia in this population. Since behavioral factors have been shown to affect nutrition of younger children in Sri Lanka, studying weather behaviors are related to anemia in primary school children is important. Possible etiologies including but not limited to nutritional deficiencies need to be studied further.

Predictors of non-exclusive breastfeeding at 6 months among rural mothers in east Ethiopia: a community-based analytical cross-sectional study

BACKGROUND

Exclusive breastfeeding in infants aged under six months is a simple and cost-effective feeding method that ensures better infant and child survival and boosts the achievement of child related Millennium Development Goals in the developing world. Identifying factors associated with good breastfeeding practice helps to increase its coverage and maximize its advantages through improved advocacy. The objective of this study was to identify the predictors of non-exclusive breastfeeding in the rural areas of eastern Ethiopia.

METHODS

A community-based analytical cross-sectional study was conducted on mother/caregiver-child pairs in east Ethiopia from July to August 2011. Data on infant feeding practices were collected by trained interviewers who used a pretested and structured questionnaire. Odds ratio with a 95% confidence interval was estimated for the predictors of non-exclusive breastfeeding using the multivariable logistic regression.

RESULTS

The prevalence of non-exclusive breastfeeding in infants aged under six months, was 28.3%. Non-exclusive breastfeeding was more likely to be practiced by mothers who were not married at the moment [AOR (95% CI) = 2.6 (1.1, 6.0)], mothers who had no access to health facility [AOR (95% CI) = 2.9 (1.9, 4.3)], and mothers whose knowledge about infant and young child feeding practices was low [AOR (95% CI) = 3.4 (2.4, 4.7)].

CONCLUSION

Non-exclusive breastfeeding was more common among mothers with no marital relationships, poor access to health facilities, and inadequate knowledge about infant and young child feeding practices. Family support, education, and behavior change communication on infant feeding, especially on exclusive breastfeeding, at the community level may improve the knowledge, behavior, and practice of mothers on optimal infant and young child feeding practices.

Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study

BACKGROUND

Exclusive breastfeeding (EBF) during the early months of life reduce infant morbidity and mortality. Current recommendation in Sri Lanka is to continue exclusive breastfeeding up to six months of age. Exclusive breastfeeding rates are generally assessed by the 24 recall method which overestimates the actual rates. The objective of this study was to determine actual exclusive breast feeding rates in a cohort of Sri Lankan children and to determine the reasons that lead to cessation of breastfeeding before six months of age.

METHODS

From a cohort of 2215 babies born in Gampaha district, 500 were randomly selected and invited for the study. They were followed up at two (n = 404), four (n = 395) and six (n = 286) months. An interviewer administered questionnaire asked about feeding history and socio-demographic characteristics. Child health development record was used to assess the growth.

RESULTS

Exclusive breastfeeding rates at two, four and six months were 98.0%, 75.4% and 71.3% respectively. The main reasons to stop exclusive breastfeeding between two to four months was concerns regarding weight gain and between four to six months were mothers starting to work. Majority of the babies that were not exclusively breastfed still continued to have breast milk. Mothers above 30 years had lower exclusive breastfeeding rates compared to younger mothers. Second born babies had higher rates than first borns. There was no significant association between maternal education and exclusive breastfeeding rates.

CONCLUSIONS

Exclusive breastfeeding rates were high among this cohort of children. A decrease in EBF was noted between two and four months. EBF up to six months does not cause growth failure. Mothers starting to work and concerns regarding adequacy of breast milk were the major reasons to cease EBF. The actual exclusive breastfeeding rates up to six months was 65.9%.

Patterns of daily duration and frequency of breastfeeding among exclusively breastfed infants in Shiraz, Iran, a 6-month follow-up study using Bayesian generalized linear mixed models

INTRODUCTION

Despite numerous studies on the benefits of exclusive breastfeeding during the first half year of life, little information is available on actual breastfeeding practices in terms of daily duration and frequency of suckling. This study proposes to determine daily breastfeeding patterns among exclusively breastfed infants from birth to six months.

SUBJECT AND METHODS

An observational prospective follow-up study of daily feeding practices among exclusively breastfed infants was conducted in 2007/2008. Mothers were recruited and interviewed during their first month postpartum health center visit. A total of 287 mothers were recruited into the study. Primary outcome measures were suckling duration and frequency of breastfeeding during daytime and nighttime. Mothers were asked at each healthcare visit to report the daily duration in minutes and the daily number of breastfeeding sessions. Mixed models were used to determine breastfeeding patterns and predictors.

RESULTS

Of 287 mothers selected for this study, 174 (61%) exclusively breastfeeding until six months after delivery. Mixed modeling showed that as the infant's age increased duration of one suckling, cumulative duration and frequency of breastfeeding during daytime, nighttime and a twenty four hour period all gradually decreased. Infants gender and receiving professional advice about breastfeeding were also significant factors in breastfeeding patterns (p<0.05).

CONCLUSIONS

The one suckling duration and frequency of feeds in this study population were considerably higher than values reported in other populations. The variation of feeding patterns between exclusively breastfed infants was very wide. The distributions of one suckling duration, frequency of breastfeeding and cumulative duration of feeds were right-skewed. The current professional advices about breastfeeding are not appropriate because they do not consider unique condition within specific populations.

Prevalence of dental caries among a cohort of preschool children living in Gampaha district, Sri Lanka: a descriptive cross sectional study

Background

Dental caries among young children are a global problem. Scant attention is paid towards primary teeth, leading to high prevalence of dental caries. There are only few studies done in Sri Lanka, addressing oral hygiene among preschool children. Scientific evidence is in need to persuade authorities to establish a programme promoting oral hygiene among preschool children.

Methods

A descriptive cross sectional study was conducted in Ragama Medical officer of Health area. Consecutive children between 2 – 5 years of age, attending child welfare clinics were recruited for the study. Practices related to dental hygiene and socio-economic characteristics were obtained using an interviewer administered questionnaire. Mouth was examined for evidence of dental caries. Data collection and examination were done by two doctors who were trained for this purpose. The data were analysed using SSPS version 16.

Results

Total of 410 children were included. None had a routine visits to a dentist. Practices related to tooth brushing were satisfactory. Prevalence of dental caries gradually increased with age to reach 68.8% by 5 years. Mean total decayed-extracted-filled (deft) score for the whole sample was 1.41 and Significant caries index (SIC) was 4.09. Decayed tooth were the main contributor for the deft score and Care index was only 1.55. Girls had a significantly higher prevalence of caries than boys.

Conclusions

Dental care provided for Sri Lankan preschool children appears to be unsatisfactory as prevalence of dental caries among this cohort of preschool children was very high. There is an urgent need to improve dental care facilities for Sri Lankan preschool children.