Exclusive breastfeeding practices in an urban settlement of Vellore, southern India: findings from the MAL-ED birth cohort

Knowledge and practice of breastfeeding among lactating mothers in AIIMS, Bhubaneswar - A hospital-based cross-sectional study

BACKGROUND

44% of infants under 6 months of age worldwide are only adequately breastfed. It is also found that only 41.6% of women breastfeed their child within one hour of birth and less than 50% of women continue breastfeeding up to 2 years. This study was conducted to assess the prevalence of early initiation of breastfeeding practice, to explore the knowledge and practices about breastfeeding among lactating mothers, and to find the effect of breastfeeding on the nutritional status of the child.

MATERIALS AND METHODS

A hospital-based study was conducted among 160 lactating mothers of infants below six months of age presenting to the immunization clinic at AIIMS Bhubaneswar. A semi-structured questionnaire based on the CDC breastfeeding questionnaire was administered to assess the knowledge and practice. The nutritional status of the infant was assessed by plotting the weight for age and length for age of the infant in the WHO growth charts.

RESULTS

102 (75%) of mothers had initiated breastfeeding within the first hour of delivery. Adequate knowledge and practice of breastfeeding was present only in 4 (2.5%) and 3 (1.9%), respectively. It was found that 13.75% of women were using formula feed. The prevalence of underweight and less than normal length was 40% (n = 64) and 34.37% (n = 55) among infants, respectively.

CONCLUSION

This study emphasizes the importance of awareness among lactating mothers about the hindmilk, appropriate practice, and to find its effect on the nourishment of the children.

Prevalence, trend, and inequality of prolonged exclusive breastfeeding among children aged 6-23 months old in India from 1992-2021: A cross-sectional study of nationally representative, individual-level data

Background

Prolonged exclusive breastfeeding (PEB) for children older than six months old is a threat to appropriate complementary feeding practices. This study aims to examine the trend of PEB among children aged 6-23 months in India.

Methods

We adopted five waves of National Family Health Survey (NFHS) data between 1992-93 and 2019-21. PEB was defined as children aged six months and above currently consuming breastmilk as the only source of energy, protein and micronutrients. We generated descriptive statistics and a series of multivariable logistic regressions to estimate the prevalence and trend in the PEB rate. Moreover, we assessed how child age and socioeconomic factors (i.e. child gender and age, place of residence, household wealth, and maternal education) were related with PEB using mutually and single-adjusted model.

Results

There were 184 891 Indian children aged 6-23 months old included in this study with 48.0% being female. We found that the proportion of PEB increased from 4.3% in 1992 to 7.7% in 2021, of which the rate for children aged six-eight months rose from 14.0 to 20.1%. Our results showed that children who were from poorer households or with lower-educated mothers were more likely to experience prolonged exclusive breastfed. Take the year of 2019-21 as an example, compared to the households of the richest quintile, children from households of the poorer quintile were significantly more likely to experience PEB, with odds ratio (OR) of 1.33 (95% confidence interval (CI) = 1.09-1.61). Moreover, children with illiterate mothers had 21% higher odds of having prolonged exclusively breastfeeding (OR = 1.21; 95% CI = 1.01-1.44) compared with children with mothers who have college and above education.

Conclusions

PEB among children over six months old is prevalent in India, particularly among children from disadvantaged households. Poverty reduction and maternal education are of great potential importance for policymakers to promote appropriate complementary feeding practice.

To Determine the Quality of Life in Indian Women After Peripartum Hysterectomy Using a Hindi Version of the SF-36 Questionnaire

Objective

The objective of the study was to determine the quality of life in women after peripartum hysterectomy using a Hindi version of the SF-36 questionnaire.

Background

There are long-term effects on quality of life in women after peripartum hysterectomy. The effects on physical, mental, and social functioning have a prolonged recovery. No studies have been done in Indian women after peripartum hysterectomy to evaluate quality of life.

Methods

Patients who underwent peripartum hysterectomy from January 2017 to May 2021 were contacted to participate in the study. To determine the quality of life post-surgery, a Hindi version of the 36-item Short-Form Health Survey (SF-36) was used for a face-to-face personal interview-based assessment. The participants were divided into two groups based on the duration between surgery and the interview. The aggregate scores for the eight components of SF-36 were calculated, and responses were analyzed.

Results

Out of the 138 post-hysterectomy women, 118 were enrolled in the study. Women who could not be contacted [14 (10.14%)] and those who died post-procedure [6 (4.35%)] were excluded. Out of the total, 43 assessed participants were within 2 years of surgery, and 75 were after 2 years of surgery. The group that was assessed after 2 years of surgery had a significantly lower quality of life in six, out of the eight aspects of SF-36 domains.

Conclusion

Women after peripartum hysterectomy undergo a prolonged recovery phase with effects on physical, mental, and social functioning. A multi-disciplinary long-term follow-up including physiotherapy and psychotherapy is required and that should be guided by a dedicated clinical team.

Exclusive breastfeeding practices and its determinants in Indian infants: findings from the National Family Health Surveys-4 and 5

BACKGROUND

The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in infants for the first 6 months of life. This analysis aims to estimate the proportion of Indian infants exclusively breastfed for the first 6 months using the National Family Health Surveys (NFHS)-4 and 5, and further, determine factors associated with EBF practices.

METHODS

EBF for this analysis was defined as when infants received only breast milk and no complementary feeds (solid food, water, animal milk, baby formula, juice, and fortified food) in the last 24 h prior to the survey. The proportion of infants exclusively breastfed was plotted from birth to 6 months as per the age of children at the time of the survey, and this was computed for individual states, union territories, and overall, for India. Univariate and multivariable logistic regression analyses were performed to examine factors influencing EBF in Indian infants.

RESULTS

The proportion of Indian infants exclusively breastfed for 6 months was 31.3% (1280/4095; 95% CI 29.9, 32.7) and 43% (1657/3853; 95% CI 41.4, 44.6) as per the NFHS-4 and 5 surveys, respectively. In NFHS-5, infants of scheduled tribes (aOR 1.5; 95% CI 1.2, 1.9) and mothers who delivered at public health facilities (aOR 1.3; 95% CI 1.1, 1.5) showed an increased odds of being exclusively breastfed at 6 months of life compared to their counterparts. Further, infants of mothers aged < 20 years (aOR 0.5; 95% CI 0.4, 0.7), low birth weight infants (aOR 0.6; 95% CI 0.4, 0.8), and infants in whom breastfeeding was initiated one hour after birth (aOR 0.8; 95% CI 0.7, 0.9) showed a reduced odds of being exclusively breastfed at 6 months compared to their counterparts.

CONCLUSIONS

The overall EBF practice showed an increasing trend in the NFHS-5 compared to the NFHS-4 survey. However, a vast gap remains unaddressed in the Indian setting with > 50% of the population still not exclusively breastfeeding their infants for the WHO recommended duration of first 6 months. Behavioral studies dissecting the complex interplay of factors influencing EBF within the heterogenous Indian population can help plan interventions to promote and scale-up EBF in Indian infants.

Usage of postpartum intrauterine contraceptive device (postpartum-IUD) after an increase in the institutional delivery rate in India: time to re-visit the effect of timing of counselling on its acceptance

PURPOSE

While increase in institutional deliveries brings an opportunity to counsel women for postpartum family planning (PPFP), its uptake remains low. Reasons for poor acceptance of postpartum intrauterine contraceptive device (postpartum-IUD), and its relation with the timing of counselling need to be investigated.

METHODS

Women attending the antenatal clinic, reporting in labour, and within 48 h of delivery respectively were invited to participate. Eligible women were asked about awareness and choice for PPFP. After counselling, acceptance for PPFP was compared with the baseline. Acceptance and continuation of postpartum-IUD were compared between women counselled in the antenatal, intrapartum, and postpartum periods.

RESULTS

Only 23% of 360 women were aware of postpartum-IUD. After counselling, acceptance for PPFP increased from 14% to 97% and for postpartum-IUD, from 0.5% to 33.9%. Acceptance of postpartum-IUD among women counselled in the antenatal, intrapartum and postpartum period was 45%, 35% and 21.7% respectively. Acceptance was higher among the antenatal-counselling group than the postpartum-counselling group (OR 0.45; CI 0.22-0.94; p = 0.03).

CONCLUSION

Counselling, irrespective of its timing, improves acceptance for PPFP. Acceptance and continuation of postpartum-IUD are higher following counselling in antenatal period. All eligible women should be counselled irrespective of 'when' they approach the facility.

Malnutrition in Devbhumi Dwarka: A Situation Analysis

Background

Malnutrition among children, adolescent girls and women is a serious public health issue in India. Malnutrition among adolescent girls is likely to carry on this vicious cycle by giving birth to low birthweight babies. Moreover, low birthweight babies who survive are likely to suffer growth retardation and illness throughout their childhood, adolescence and adulthood. Present situation analysis highlights not only the overall nutrition picture of Devbhumi Dwarka but also narrates the uptake of current nutrition and healthcare services in the Devbhumi Dwarka district.

Methods

A descriptive cross-sectional study was conducted with 3,738 study population (1,301 children, 1,185 pregnant and lactating women and 1,252 adolescent girls) across four blocks of the Devbhumi Dwarka district of Gujarat. Anthropometric assessments were carried out and the WHO Asia Pacific classification was used for the assessment of malnutrition.

Results

The prevalence of wasting, underweight and stunting was 14%, 17% and 32%, respectively, in children under two years of age. The prevalence of anaemia among pregnant women (Hb <11 g/dL) was 72.92%; 91.36% of lactating women were anaemic (Hb <12 g/dL). The prevalence of underweight (<-2 SD) among adolescent girls was 19.6%. Block-wise variation in prevalence was observed. Overall, utilization of integrated child development services and health services by these target groups remained sub-optimal.

Conclusion

The study has revealed the suboptimal nutritional status of children, pregnant and lactating women and adolescent girls of Devbhumi Dwarka, which signifies the need for urgent attention. Several areas of priority have been identified and discussed to improve the overall nutrition status in the district.

Knowledge, preferences, practices, and attitudes about breastfeeding among postnatal mothers in Uttarakhand, India: a cross-sectional study

Background: Breastmilk is the natural and safest first food for the newborn. It has nutritional, immunological, behavioural, and offers mother-infant bonding. Objective: The objective of the study was to explore the knowledge, practice, and attitudes of mothers towards breastfeeding. Material & Methods: A cross-sectional study was conducted among conveniently selected 950 postnatal mothers attending the immunization clinic and paediatric OPD with their children for vaccination and treatment of other minor illnesses from April 2018 to November 2019 in selected hospitals of Rishikesh, Uttarakhand. Mothers were face-to-face interviewed using structured knowledge, preference, practices, and attitude questionnaires about newborn breastfeeding. Tools were validated and tested for reliability. Results: The average knowledge scores (11.72±1.78) indicated that mothers have good knowledge about breastfeeding. Most mothers (81.45%) fed their babies with colostrum, and 82% were exclusively breastfeeding. It was also reported about top feeds like honey, coconut water, grape water, ghuttee, lactogen among about 20% of the participants. The average score of the Iowa Infant Feeding Attitude Scale (IIFAS) (58.11±6.44) lay in the range of neutral attitudes related to breastfeeding practices among the mothers. Conclusion: Breastfeeding practices were adequate among many mothers, but there were practices of throwing colostrum, topfeed baby and early initiation of weaning. Thus, it is necessary to create awareness among the mothers and their families about the correct practices of feeding the newborn baby; eventually, the attitude will change.

A study on parental awareness of feeding practices in children in the age-group 12-24 months

Introduction

Nutrition plays an integral part in growth and development of a child. Age-appropriate feeding is known to improve the child's well-being and reduce the risk of specific diseases. The present study aimed to assess the awareness of parents regarding breastfeeding and complementary feeding practices.

Methodology

This health-based prospective observational study was conducted in a tertiary care hospital enrolling 95 parents with children in the age group 1-2 years. The data was analyzed using SPSS version 26 and Microsoft excel.

Results

In the present study, the prevalence of exclusive breastfeeding was 73.68%. Eighty-six (90.53%) parents initiated complementary feeds at 6 months. However, only 45.26% of children were consuming adequate quantity of complementary foods. The association of child's calorie consumption with maternal age and occupation was found to be statistically significant.

Conclusion

Adequate nutrition during childhood and infancy is a key factor influencing growth and development. In the present study, the overall breastfeeding and complimentary feeding practices were satisfactory. However, the quantity of complementary feeding was inadequate. Counselling the mothers on appropriate breastfeeding and complementary feeding practices during antenatal and postnatal visits may have a positive impact on infant feeding practices.

Impact of exclusive breast feeding until six months of age on common illnesses: A prospective observational study

Objectives:

The WHO recommends exclusive breast feeding (EBF) for all infants for the first six months of life. National Family Health Survey-4 (2015-16) shows EBF rates of only 54.9%. We conducted a prospective study to assess prevalence of EBF and incidences of illnesses in infants from birth till six months of age.

Methods:

Healthy term infants born in our hospital between December 2017 and November 2018 were recruited at birth. Structured diary cards were given to mothers to record feeding patterns, occurrence and severity of illnesses. Mothers were interviewed at 6, 10, 14 and 26 weeks or contacted by telephone at 18 and 22 weeks. Data were analyzed using SPSS IBM Statistics 22.

Results:

The prevalence of EBF among 450 infants (M:F = 1.3:1) who completed the study was 47% at 6 months. 185 (69 EBF + 116 non-EBF) of 450 infants reported a total of 242 illnesses, most commonly respiratory (82.6%) followed by gastrointestinal (11.6%). Number of illnesses per infant was 0.45 and 0.6 in EBF group and non-EBF group respectively (p = 0.015). Illness incidences in EBF infants were significantly lower during all successive time intervals after 10 weeks of age. Logistic regression analysis confirmed significantly lower illness incidences in EBF infants at 10-14 weeks [OR = 0.27 (CI 0.12-0.64)] and 18-22 weeks [OR = 0.50 (CI 0.27-0.90)].

Conclusions:

The prevalence of EBF is suboptimal in our setting, with illness incidences significantly higher in non-EBF children. Appropriate intervention strategies need to be tailored to reinforce early initiation and continuation of EBF throughout the first six months of life.

Maternity Leave Access and Breastfeeding Practices among Working Mothers in an Urban Residential Area of East Delhi

Background:

Despite the provision of maternity leave benefits under the maternity benefit amendment act, its access by working mothers in the community is unknown.

Objectives:

The objective is to find out access to maternity leave among working mothers and its association with breastfeeding practices.

Materials and Methods:

A cross-sectional, community-based study was conducted among 150 working mothers with children 6 months to 3 years of age. Chi-square tests and logistic regression were applied to find the association of breastfeeding practices with maternity leave and independent predictors of exclusive breastfeeding (EBF), respectively.

Results:

Paid maternity leave was accessed by majority (103, 68.7%) of the working mothers. EBF among mothers working in government organizations was more (Adjusted odds ratio: 2.3, 95% confidence interval: 1.0–5.1) than in private organizations.

Conclusion:

Lower proportion of mothers in private organizations had availed paid maternity leave as compared to government organizations. Increase in coverage of maternity benefits in the private sector is needed.

Predictors of recovery in children aged 6-59 months with uncomplicated severe acute malnutrition: a multicentre study

OBJECTIVE

To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM).

DESIGN

This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6-17 months and 18-59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed.

SETTING

Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu.

PARTICIPANTS

In total, 906 children (age: 6-59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors.

RESULTS

Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child's father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM.

CONCLUSION

The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

Postnatal newborn care practices and knowledge of newborn danger signs among mothers in rural area of Lucknow, Uttar Pradesh: A cross-sectional study

Introduction

The postnatal period is the most critical period for mothers and her newborn especially during the hours and days after birth. Proper utilization of postnatal care services plays a vital role in dropping the maternal mortality ratio and infant mortality rate.

Methods

The community based, cross-sectional study was carried out in the field practice area of Primary Health Centre (PHC) Sarojini Nagar, Lucknow UP. A total of 200 mothers of newborn (age 03 days to 60 days) born in the catchment area of PHC Sarojini Nagar during eight months period were included in this study. A semi-structured pre-tested questionnaire was used for interview of eligible mother. The objective of study was to assess the postnatal newborn care practices and the knowledge of newborn danger sign among mothers in rural area of Lucknow, U.P.

Results

The results showed that 49.50% of mothers applied substances to the stump after birth. 52.5% of mothers applied Kajal on the eye of the baby after birth. More than half of the mothers breastfed the baby within 1-4 hours of birth and Exclusive breastfeeding were practiced by nearly half (47%) of the mothers. Less than one-third of mothers used ambulance service 102/108 as their means of transportation to the health facility.

Conclusion

Unsafe and harmful traditional newborn care practices are more prevalent in the rural areas. Health education and awareness programmes are recommended to improve maternal knowledge on the various aspects of newborn care.

Breastfeeding practices after a counselling intervention for factory workers in Bangladesh

Breastfeeding may be particularly challenging for female factory workers who have long working hours and inadequate access to health information and care. In Chattogram, Bangladesh, a peer counselling intervention was undertaken to improve infant feeding practices of factory workers. Counselling started during pregnancy and continued until children were 18 months old. This article presents the results of a cross‐sectional survey undertaken during 2 weeks in March–April 2017, after the project's conclusion. The aim was to compare breastfeeding practices, specifically early breastfeeding initiation and exclusive breastfeeding (EBF), among factory workers who had received peer counselling in the intervention areas (IA) with those of non‐counselled factory workers in the nearby comparison areas (CA). Six female interviewers, trained over 3 days, conducted interviews at the workers' homes. Data were analysed to assess the association of peer counselling with infant feeding practices. Factory workers (N = 382) with infants between 0 and 18 months of age participated in the survey, in IA (n = 188) and in CA (n = 194). Although there were more health facility deliveries among the CA workers, only 43 (22%) of those workers had initiated breastfeeding within 1 h of birth versus 166 (88%) of the IA workers (p < .001). EBF prevalence on 24‐h recall in infants aged 0–6 months was only 7/83 (8%) for the CA workers versus 73/75 (97%) for IA workers (p < .001). The survey showed that breastfeeding practices of factory workers in the IA after the intervention were significantly better than those of factory workers in the CA.