1
|
Guajardo-Villar A, Pelat C, Blondel B, Lebreton E, Demiguel V, Salanave B, Mitha A, Pilkington H, Regnault N. The impact of the Baby-Friendly Hospital Initiative on breastfeeding rates at maternity units in France. Int J Epidemiol 2024; 53:dyae080. [PMID: 38857529 PMCID: PMC11164413 DOI: 10.1093/ije/dyae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative (BFHI) is associated with improved breastfeeding outcomes in many high-income countries including the UK and the USA, but its effectiveness has never been evaluated in France. We investigated the impact of the BFHI on breastfeeding rates in French maternity units in 2010, 2016 and 2021 to assess if the BFHI aids to reduce inequalities in breastfeeding. METHODS We examined breastfeeding in maternity units (exclusive, mixed and any breastfeeding) in mothers of singleton full-term newborns using the 2010 (n = 13 075), 2016 (n = 10 919) and 2021 (n = 10 209) French National Perinatal Surveys. We used mixed-effect hierarchical multinomial regression models adjusting for neonatal, maternal, maternity unit and French administrative department characteristics, and tested certain interactions. RESULTS The adjusted rate of exclusive breastfeeding was higher by +5.8 (3.4-8.1) points among mothers delivering in BFHI-accredited maternity units compared with those delivering in non-accredited units. When compared with average-weight newborns, this difference was sharper for infants with low birthweight: +14.9 (10.0-19.9) points when their birthweight was 2500 g. Mixed breastfeeding was lower by -1.7 points (-3.2-0) in BFHI-accredited hospitals, with no notable difference according to the neonatal or maternal characteristics. CONCLUSION Mothers delivering in BFHI-accredited maternity units had higher exclusive breastfeeding rates and lower mixed breastfeeding rates than those delivering in non-accredited maternity units. The positive impact of the BFHI was stronger among low-birthweight neonates, who are less often breastfed, helping reduce the gap for this vulnerable group while favouring mothers with higher education levels.
Collapse
Affiliation(s)
- Andrea Guajardo-Villar
- Data Support, Processing and Analysis Department (DATA), French National Public Health Agency, Saint‐Maurice, France
| | - Camille Pelat
- Data Support, Processing and Analysis Department (DATA), French National Public Health Agency, Saint‐Maurice, France
| | - Beatrice Blondel
- Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics (CRESS), INSERM, Université Paris Cité, Paris, France
| | - Elodie Lebreton
- Non-Communicable Diseases and Trauma Department (DMNTT), French National Public Health Agency, Saint-Maurice, France
| | - Virginie Demiguel
- Non-Communicable Diseases and Trauma Department (DMNTT), French National Public Health Agency, Saint-Maurice, France
| | - Benoit Salanave
- Non-Communicable Diseases and Trauma Department (DMNTT), French National Public Health Agency, Saint-Maurice, France
| | - Ayoub Mitha
- Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics (CRESS), INSERM, Université Paris Cité, Paris, France
- Pediatric and Neonatal Intensive Care Transport Unit, Department of Emergency Medicine, SAMU 59, CHU Lille, Lille, France
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Pilkington
- Département de Géographie, UMR7533 Ladyss, Université Paris, Saint‐Denis, France
| | - Nolwenn Regnault
- Non-Communicable Diseases and Trauma Department (DMNTT), French National Public Health Agency, Saint-Maurice, France
| |
Collapse
|
2
|
Cunha JF, Gama SGND, Thomaz EBAF, Gomes MADSM, Ayres BVDS, Silva CMFPD, Leal MDC, Bittencourt SDDA. [Factors associated with breastfeeding at birth in maternity hospitals linked to the Rede Cegonha, Brazil, 2016-2017]. CIENCIA & SAUDE COLETIVA 2024; 29:e04332023. [PMID: 38655952 DOI: 10.1590/1413-81232024294.04332023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 04/26/2024] Open
Abstract
Breastfeeding (BF) is a human right, and it must start from birth. The adequacy of Rede Cegonha (RC) strategies can contribute to the promotion of BF. The objective was to identify factors associated with BF in the first and 24 hours of live births at full-term maternity hospitals linked to CR. Cross-sectional study with data from the second evaluation cycle 2016-2017 of the RC that covered all of Brazil. Odds ratios were obtained through binary logistic regression according to a hierarchical model, with 95% confidence intervals and p-value < 0.01. The prevalence of BF in the first hour was 31% and in the 24 hours 96.6%. The chances of BF in the first hour increased: presence of a companion during hospitalization, skin-to-skin contact, vaginal delivery, delivery assistance by a nurse and accreditation of the unit in the Baby-Friendly Hospital Initiative. Similar results at 24 hours, and association with maternal age below 20 years. BF in the first hour was less satisfactory than in the 24 hours, probably due to the high prevalence of cesarean sections, a factor associated with a lower chance of early BF. Continuous training of professionals about BF and the presence of an obstetric nurse during childbirth are recommended to expand BF in the first hour.
Collapse
Affiliation(s)
- Joice Ferreira Cunha
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Silvana Granado Nogueira da Gama
- Departamento de Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | | | | | | | - Maria do Carmo Leal
- Departamento de Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Sonia Duarte de Azevedo Bittencourt
- Departamento de Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| |
Collapse
|
3
|
Boccolini CS, Lacerda EMDA, Bertoni N, Oliveira N, Alves-Santos NH, Farias DR, Crispim SP, Carneiro LBV, Schincaglia RM, Giugliani ERJ, Castro IRRD, Kac G. Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO/UNICEF 2030 targets. BMJ Glob Health 2023; 8:e012529. [PMID: 37666574 PMCID: PMC10481725 DOI: 10.1136/bmjgh-2023-012529] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The comprehension of breastfeeding patterns and trends through comparable indicators is essential to plan and implement public health policies. OBJECTIVE To evaluate the trends of breastfeeding indicators in Brazil from 1996 to 2019 and estimate the gap to achieve the WHO/UNICEF 2030 targets in children under 5 years. METHODS Microdata from two National Surveys on Demography and Health of Women and Children (PNDS-1996 and PNDS-2006) and the Brazilian National Survey on Child Nutrition-2019 were used. The indicators of early initiation of breastfeeding (EIBF), exclusive breastfeeding of infants 0-5 months of age (EBF<6 mo), continued breastfeeding at 1 year of age (CBF1yr) and CBF at 2 years of age (CBF2yr) were analysed using prevalence and 95% CI. The average annual variation and years to achieve the WHO/UNICEF 2030 targets were calculated for Brazil and the macroregions. Statistical analyses considered the survey's complex sample design for each database. RESULTS EIBF increased from 36.3% (95% CI 33.6% to 39.0%) in 1996 to 60.9% (95% CI 56.5% to 65.3%) in 2006 (statistically significant) and 62.5% (95% CI 58.3% to 66.6%) in 2019. EBF<6 mo increased from 26.9% (95% CI 21.3% to 31.9%) in 1996 to 39.0% (95% CI 31.0% to 47.1%) in 2006 and 45.8% (95% CI 40.9% to 50.7%) in 2019 (significant increases for 1996-2019 for Brazil, Northeast and Midwest regions). CBF1yr rose from 36.6% (95% CI 30.8% to 42.4%) in 1996 to 48.7% (95% CI 38.3% to 59.0%) in 2006, and 52.1% (95% CI 45.4% to 58.9%) in 2019. CBF2yr increased from 24.7% (95% CI 19.5% to 29.9%) in 1996 to 24.6% (95% CI 15.7% to 33.5%) in 2006 and 35.5% (95% CI 30.4% to 40.6%) in 2019 (significant increase for 1996-2019). The South and Southeast regions need to double the 2019 prevalence to reach the target for the CBF1yr and CBF2yr; the Northeast and North need to increase 60% the current prevalence for the indicator of EBF<6 mo. CONCLUSION A substantial improvement in breastfeeding indicators occurred in Brazil from 1996 to 2019, although at an insufficient rate to achieve the WHO/UNICEF 2030 targets.
Collapse
Affiliation(s)
- Cristiano Siqueira Boccolini
- Laboratório de Informática em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Elisa Maria de Aquino Lacerda
- Departamento de Nutrição e Dietética, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Neilane Bertoni
- Divisão de Pesquisa Populacional, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Natália Oliveira
- Observatório de Epidemiologia Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nadya Helena Alves-Santos
- Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Maraba, Brazil
| | - Dayana Rodrigues Farias
- Observatório de Epidemiologia Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Raquel Machado Schincaglia
- Observatório de Epidemiologia Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elsa Regina Justo Giugliani
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Inês Rugani Ribeiro de Castro
- Departamento de Nutrição Social, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Observatório de Epidemiologia Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Walsh A, Pieterse P, Mishra N, Chirwa E, Chikalipo M, Msowoya C, Keating C, Matthews A. Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review. Int Breastfeed J 2023; 18:22. [PMID: 37061737 PMCID: PMC10105160 DOI: 10.1186/s13006-023-00556-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/26/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally. METHODS This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken. RESULTS A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies. CONCLUSION At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.
Collapse
Affiliation(s)
- Aisling Walsh
- RCSI, University of Medicine and Health Sciences, Dublin, Ireland.
| | | | | | - Ellen Chirwa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | | |
Collapse
|
5
|
Khatib MN, Gaidhane A, Upadhyay S, Telrandhe S, Saxena D, Simkhada PP, Sawleshwarkar S, Quazi SZ. Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review. Front Public Health 2023; 11:984876. [PMID: 36761137 PMCID: PMC9904444 DOI: 10.3389/fpubh.2023.984876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Background Optimal breastfeeding (BF) practices are essential for child survival and proper growth and development. The purpose of this overview is to evaluate the effectiveness of different interventions for promoting and optimizing breastfeeding. Methods We included systematic reviews (SRs) [including trials from Low-Income (LICs) and Low Middle-Income countries (LMICs)] that have evaluated the effect of various interventions for promoting and optimizing breastfeeding and excluded non-systematic reviews, and SRs based on observational studies. We searched various electronic databases. We followed the standard methodology as suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Two sets of reviewers undertook screening followed by data extraction and assessment of the methodological quality of included SRs. Result We identified and screened 1,002 Cochrane SRs and included six SRs in this overview. Included SRs reported only two of the primary outcomes, early initiation of breastfeeding (EIBF) and/or exclusive breastfeeding (EBF). None of the included SR reported continued BF up to 2 years of age. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Overall results from included SRs showed that there were improvements in the rates of EIBF and EBF among women who received BF intervention such as BF education sessions and support compared to those women who received only standard care. However, BF intervention via mobile devices showed no improvements. In Target Client Communication (TCC) via mobile devices intervention group, no significant improvements were reported in BF practices, and also the reported evidence was of very low certainty. Conclusion Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their Antenatal care (ANC) and/or Postnatal care (PNC) periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF compared to women who received standard care. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups. This overview highlighted the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize practices. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020174998, PROSPERO [CRD42020174998].
Collapse
Affiliation(s)
- Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Abhay Gaidhane
- Centre of One Health, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Upadhyay
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shital Telrandhe
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Deepak Saxena
- i Health Consortium, Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Padam Prasad Simkhada
- Global Consortium of Public Health Research, School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Shailendra Sawleshwarkar
- Postgraduate Coursework Programs, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney Institute for Infectious Diseases (Sydney ID), University of Sydney, Camperdown, NSW, Australia
| | - Syed Zahiruddin Quazi
- South Asia Infant Feeding Research Network (SAIFRN), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| |
Collapse
|
6
|
Alves RDV, de Oliveira MIC, Domingues RMSM, Pereira APE, Leal MDC. Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project. Reprod Health 2023; 20:10. [PMID: 36609292 PMCID: PMC9817241 DOI: 10.1186/s12978-022-01538-z] [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] [Accepted: 11/25/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative's Step 4 recommends: "support mothers to start breastfeeding as soon as possible after birth", thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the "Adequate Childbirth Project", a quality-of-care improvement project, and to analyze determinants of this outcome. METHODS Secondary analysis of data collected by the cross-sectional evaluative "Healthy Birth Study", conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns' severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. RESULTS The prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6-59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528-0.782), lower economic status (aOR 0.687; CI 95% 0.504-0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529-0.797), preterm birth (aOR 0.660; CI 95% 0.460-0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559-0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102-3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065-1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791-2.525) and female newborn (aOR 1.194; CI 95% 1.008-1.415) were factors positively associated with the outcome. CONCLUSIONS The private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life.
Collapse
Affiliation(s)
- Rachael de Vasconcelos Alves
- grid.411173.10000 0001 2184 6919Postgraduate Program in Public Health, Universidade Federal Fluminense, Rua Marquês de Paraná, no 303, Anexo, 4° Andar, Centro, Niterói, Rio de Janeiro, CEP: 24033-900 Brazil
| | - Maria Inês Couto de Oliveira
- grid.411173.10000 0001 2184 6919Department of Epidemiology and Biostatistics, Collective Health Institute, Universidade Federal Fluminense, Rua Marquês de Paraná, no 303, anexo, 3° Andar, Centro, Niterói, Rio de Janeiro, CEP: 24033-900 Brazil
| | - Rosa Maria Soares Madeira Domingues
- grid.418068.30000 0001 0723 0931National Institute of Infectious Diseases Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil no 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro CEP: 21040-360 Brazil
| | - Ana Paula Esteves Pereira
- grid.418068.30000 0001 0723 0931National School of Public Health, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões no 4480, Sala 814. Manguinhos, Rio de Janeiro, Rio de Janeiro CEP: 21041-210 Brazil
| | - Maria do Carmo Leal
- grid.418068.30000 0001 0723 0931National School of Public Health, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões no 4480, Sala 809. Manguinhos, Rio de Janeiro, Rio de Janeiro CEP: 21041-210 Brazil
| |
Collapse
|
7
|
Boccolini CS, Victora CG. Is there an "acceptable" percentage of using infant formula during hospital stays? J Pediatr (Rio J) 2022; 98:439-441. [PMID: 35644257 PMCID: PMC9510797 DOI: 10.1016/j.jped.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cristiano Siqueira Boccolini
- Fundação Oswaldo Cruz, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Rio de Janeiro, RJ, Brazil.
| | | |
Collapse
|
8
|
A scoping review of research on policies to address child undernutrition in the Millennium Development Goals era. Public Health Nutr 2021; 24:4346-4357. [PMID: 33926609 DOI: 10.1017/s1368980021001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies. DESIGN We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate. SETTING Low-, middle- and high-income countries. PARTICIPANTS Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age. RESULTS Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects. CONCLUSIONS Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.
Collapse
|
9
|
Pujól von Seehausen M, Pérez-Escamilla R, Couto de Oliveira MI, do Carmo Leal M, Siqueira Boccolini C. Social support modifies the association between pre-pregnancy body mass index and breastfeeding initiation in Brazil. PLoS One 2020; 15:e0233452. [PMID: 32438388 PMCID: PMC7242016 DOI: 10.1371/journal.pone.0233452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many biological, social and cultural barriers for suboptimal breastfeeding practices have been identified in literature. Among these, excessive pre-pregnancy weight has been identified as a risk factor for not initiating breastfeeding early. Social support, coming from social networks (e.g. a partner, family or friends) or health care providers, has been positively associated with breastfeeding. This study aimed to examine the association between pre-pregnancy excessive weight and breastfeeding within the first hour after birth and if social support modifies this association. DESIGN National population-based study conducted with 21,086 postpartum women from February 1, 2011 to October 31, 2012 in 266 hospitals from all five regions of Brazil. Social support was defined as having a companion at the hospital. Main effects and interactions were tested with multivariable regression analyses. RESULTS Multivariate regression analyses indicated that class I and class II obese women had lower odds of breastfeeding within the first hour when a companion was not present (AOR = 0.59, 95% CI 0.42-0.82 and AOR = 0.59, 95% CI 0.36-0.97, respectively), but there was no association when the companion was present. Among overweight and obese women, the predicted probability of breastfeeding within the first hour was lower for those without a companion. This association was not found among those with normal pre-pregnancy BMI. CONCLUSIONS Social support modifies the relationship between pre-gestational BMI and breastfeeding initiation among women who are overweight or obese, specifically it reduces the risk of delayed breastfeeding initiation.
Collapse
Affiliation(s)
- Mariana Pujól von Seehausen
- Programa de Pós-Graduação em Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Maria Inês Couto de Oliveira
- Departamento de Epidemiologia e Bioestatística, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristiano Siqueira Boccolini
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
10
|
The World Breastfeeding Trends Initiative: Implementation of the Global Strategy for Infant and Young Child Feeding in 84 countries. J Public Health Policy 2019; 40:35-65. [PMID: 30538269 DOI: 10.1057/s41271-018-0153-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Breastfeeding could save the lives of more than 820,000 children and 20,000 women. Worldwide, despite evidence of the importance of both, only 42% women begin breastfeeding within an hour of birth, and 41% practice exclusive breastfeeding. In 2002, to mobilise action and support optimal breastfeeding, the World Health Assembly adopted the Global Strategy for Infant and Young Child Feeding. The WHO identified the need to assess implementation of policies and programmes at the national level and provided an assessment tool. International Baby Food Action Network Asia adapted the tool to launch the World Breastfeeding Trends Initiative (WBTi). The WBTi facilitates measurement of the status of implementation of policy and programmes, and stimulates local action towards positive changes. Results of assessments from 84 countries reveal lack of attention to policy in almost all areas. Repeat WBTi assessments allowed us to analyse trends that showed positive changes towards strengthening the policy and programmes to support women to be successful in breastfeeding.
Collapse
|
11
|
Araújo RG, Fonseca VDM, de Oliveira MIC, Ramos EG. External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil. Int Breastfeed J 2019; 14:1. [PMID: 30627208 PMCID: PMC6321706 DOI: 10.1186/s13006-018-0195-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the “Ten Steps to Successful Breastfeeding”, International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI’s criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.
Collapse
Affiliation(s)
- Renara Guedes Araújo
- Coordination of the Brazilian Child Health and Breastfeeding Program, Anexo do Ministério da Saúde, SAF Sul Quadra 1, Bloco B, 4 andar, Brasília, DF CEP 70058-900 Brazil
| | - Vânia de Matos Fonseca
- 2Fernandes Figueira Institute, Oswaldo Cruz Foundation, Unidade de Pesquisa Clínica, Av. Rui Barbosa, 716, Rio de Janeiro, RJ CEP 20021-140 Brazil
| | - Maria Inês Couto de Oliveira
- 3Biostatistics and Epidemiology Department, Public Health Institute, Fluminense Federal University, Av. Marquês do Paraná, 303, Niterói, RJ CEP 24020-071 Brazil
| | - Eloane Gonçalves Ramos
- 2Fernandes Figueira Institute, Oswaldo Cruz Foundation, Unidade de Pesquisa Clínica, Av. Rui Barbosa, 716, Rio de Janeiro, RJ CEP 20021-140 Brazil
| |
Collapse
|
12
|
Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Collapse
Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Silva OLDO, Rea MF, Venâncio SI, Buccini GDS. The Baby-Friendly Hospital Initiative: increasing breastfeeding and decreasing infant mortality in Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from the II Breastfeeding Prevalence Survey of 2008. Initially, the effect of BFHI on breastfeeding in the first hour of life, exclusive breastfeeding, and any breastfeeding based on the prevalence of the outcomes among infants born in BFHI or non-BFHI was calculated. Second, the population attributable fraction of nonbreastfeeding was estimated for late neonatal mortality, mortality by all causes and infant mortality by infections, for BFHI and non-BFHI, and the number of potentially avoidable deaths if all children were born in BFH. Results: reduction of 4.2% of late neonatal deaths due to the increase in BF prevalence in the first hour, as provided by BFHI. BFHI potentially contributed with 3.5% of all-cause deaths and 4.2% of deaths from infection by BF promotion in infants below 6 months. Conclusions: the reduction of mortality in children between 7 and 180 days in 2008 potentially attributable to BFHI through the promotion of BF indicators reinforces the importance of strengthening and expanding this initiative in Brazil to ultimately enhance child survival.
Collapse
|
14
|
Raheel H, Tharkar S. Why mothers are not exclusively breast feeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia. Sudan J Paediatr 2018; 18:28-38. [PMID: 30166760 PMCID: PMC6113778 DOI: 10.24911/sjp.2018.1.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/07/2018] [Indexed: 11/11/2022]
Abstract
The noble practice of breast feeding is on the decline across the globe. Our objective was to research why women stop feeding their infants before the recommended 6 months of exclusive breast feeding and to assess the mothers' knowledge regarding importance and benefits of breast feeding. A cross-sectional study was conducted in two cities of Riyadh and Dammam using a structured questionnaire to 614 Saudi females in reproductive age group (15-45 years) from February to April 2016. Majority of the respondents were <30 years old, housewives and multiparous. The breast feeding initiation rate was 76% while only 37% continued to exclusively breast feed the infants until 6 months. Mothers of Dammam city showed higher rates of overall breast feeding, higher initiation of breast feeding within 24 hours of delivery and longer duration of breast feeding practices. Mothers older than 30 years (p < 0.014), residents of Dammam city (P < 0.000) and receiving information on breast feeding during antenatal care (P < 0.001) were associated with higher knowledge scores. Residents of Riyadh, working mothers, delayed initiation of breast feeding after 24 hours of giving birth, and those who did not get information on breast feeding during antenatal classes were at higher risk of stopping exclusive breast feeding before 6 months. Regional differences exist with Dammam city having greater awareness and better compliance to breast feeding practices. There is a need to strengthen the education facilities at ANC clinics in Riyadh regarding duration and benefits of breast feeding along with nationwide promotion of breast feeding practices as per guidelines.
Collapse
Affiliation(s)
- Hafsa Raheel
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shabana Tharkar
- Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
15
|
Torloni MR, Betrán AP, Belizán JM. Born in Brazil: shining a light for change. Reprod Health 2016; 13:133. [PMID: 27756402 PMCID: PMC5070232 DOI: 10.1186/s12978-016-0247-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022] Open
Abstract
The Birth in Brazil study is the largest national hospital-based survey in Brazil regarding birth practices. Conducted in 2011–2012, it collected information from 266 public and private healthcare facilities and interviewed nearly 24,000 postpartum women. It is also the latest effort to map out how labor and delivery are managed in this county in the 21st century. The journal Reproductive Health has published a supplement including 10 articles presenting the results of a series of analyses using this valuable resource. These articles describe a range of practices, determinants and risk factors that affect women and their babies in Brazil, a country of paradoxes. In the era of overmedicalization and high-tech medicine – arguably –, these articles highlight the unprecedented rates of cesarean sections in Brazil and differences between the public and the private sectors. It provides evidence for the need for adequate human resources, medications and emergency care equipment in many settings; and explains the use of non-evidence based interventions during labor and delivery. On the other hand, these studies also point to promising interventions that could be used to change this situation not only in Brazil but also in other countries facing similar challenges.
Collapse
Affiliation(s)
- Maria Regina Torloni
- Department of Internal Medicine, Evidence Based Healthcare Post-Graduate Programme, São Paulo Federal University, São Paulo, Brazil.
| | - Ana Pilar Betrán
- Department of Reproductive Health and Research, UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - José M Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| |
Collapse
|