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Metwally AM, Basha WA, Elshaarawy GA, Sallam SF, El-Alameey IR, Rifay ASE, Yousef W, Goda AA, Elashry GA, Ahmed DE, Hassan NE, El-Masry SA, Ibrahim NA, Dayem SMAE, Kandeel WA, El-Din EMS, Banna RAESE, Kamel IH, Abdelhamid EM, Abdelrahman M, Mahmoud WS. How did the use of the social marketing approach in Egyptian communities succeed in improving breastfeeding practices and infants' growth? BMC Public Health 2024; 24:1298. [PMID: 38741049 DOI: 10.1186/s12889-024-18469-y] [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: 08/03/2023] [Accepted: 03/28/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Improving breastfeeding practices does not always link to interventions relying only on improving nutrition awareness and education but needs cultural and behavioral insights . AIM This study aimed to evaluate the changes in core breastfeeding indicators as a result of the use of social marketing (SM) approach for improving breastfeeding practices of Egyptian women and the physical growth of infants aged 6 to 12 months. The core breastfeeding indicators were: Early initiation of breastfeeding within one hour of birth, Predominant and exclusive breastfeeding to 6 months (EBF), Bottle feeding with formula, continued breastfeeding to 1 and 2 years, and responsiveness to cues of hunger and satiety. METHODS A quasi-experimental longitudinal study with a posttest-only control design was done over 3 years in three phases; the first was in-depth interviews and formative research followed by health education and counseling interventions and ended by measuring the outcome. Motivating mothers' voluntary behaviors toward breastfeeding promotion "feeding your baby like a baby" was done using SM principles: product, price, place, and promotion. The interventions targeted 646 pregnant women in their last trimester and delivered mothers and 1454 women in their childbearing period. The statistical analysis was done by using SPSS program, version 26. RESULTS Most mothers showed significantly increased awareness about the benefits of breastfeeding and became interested in breastfeeding their children outside the house using the breastfeeding cover (Gawn) (p < 0.05). Breastfeeding initiation, exclusive breastfeeding under 6 months, frequency of breastfeeding per day, and percentage of children who continued breastfeeding till 2 years, were significantly increased (from 30%, 23%, 56%, and 32% to 62%, 47.3%, 69%, and 43.5% respectively). The girls who recorded underweight results over boys during the first year of life were significantly improved (p < 0.01) after the intervention (from 52.1% to 18.8% respectively). At the same time, girls found to be obese before the intervention (15.6%) became no longer obese. CONCLUSIONS Improvement for the majority of the key breastfeeding indicators and physical growth of infants indicates that raising a healthy generation should start by promoting breastfeeding practices that are respectable to societal norms.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt.
- Public Health and Community Medicine, Medical Research and Clinical Studies Institute, National Research Centre (ID: 60014618), Dokki, P.O. 12622, Giza, Egypt.
| | - Walaa A Basha
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ghada A Elshaarawy
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Sara F Sallam
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Inas R El-Alameey
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
- Clinical Nutrition Department,Faculty of Applied Medical Sciences, Taibahu University, El Medina, Saudi Arabia
| | - Amira S El Rifay
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Walaa Yousef
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Amira A Goda
- Department of Food Contaminants and Toxicology, Food Industry and Nutrition Research Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Galal A Elashry
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Doaa E Ahmed
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Nayera E Hassan
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Sahar A El-Masry
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Nihad A Ibrahim
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Soha M Abd El Dayem
- Pediatrics Departtment, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Wafaa A Kandeel
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Ebtissam M Salah El-Din
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Rokia Abd Elshafy S El Banna
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Iman H Kamel
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Enas M Abdelhamid
- Pediatrics Departtment, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Mohamed Abdelrahman
- Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Walaa S Mahmoud
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
- Faculty of Biotechnology, Medical Biotechnology Department, Misr University for Science and Technology MUST, Giza, Egypt
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Lakkis NA, Abdallah RM, Musharrafieh UM, Issa HG, Osman MH. Epidemiology of Breast, Corpus Uteri, and Ovarian Cancers in Lebanon With Emphasis on Breast Cancer Incidence Trends and Risk Factors Compared to Regional and Global Rates. Cancer Control 2024; 31:10732748241236266. [PMID: 38419342 PMCID: PMC10903209 DOI: 10.1177/10732748241236266] [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: 08/07/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES This study explores the incidence and trends of breast (Bca), corpus uteri (CUca), and ovarian (Oca) cancer in Lebanon, a Middle Eastern country. It compares the Bca rates to regional and global ones and discusses Bca risk factors in Lebanon. INTRODUCTION Globally, Bca is the premier cause of cancer morbidity and mortality in women. METHODS Data on female Bca, CUca, and Oca published by the Lebanese national cancer registry were obtained (ie, for the years of 2005 to 2016). The age-standardized incidence rates (ASIRw) and age-specific rates per 100,000 female population were computed. RESULTS From 2005 to 2016, Bca, Oca, and CUca ranked first, sixth, and seventh, respectively, for cancer incidence among women in Lebanon. Bca alone accounted for 39.4% of all new female cancer cases. The ASIRw increased significantly for Bca and CUca (APC: 3.60 and 3.73, P < .05) but not for Oca (APC: 1.27, P > .05). The Bca ASIRw (per 100,000) increased significantly from 71.0 in 2005 to 115.6 in 2013 (P < .05), then decreased steadily but non-significantly to reach 96.8 in 2016 (P > .05). Lebanon's Bca ASIRw is comparable to developed countries. This may reflect altered sociological and reproductive patterns as the country transitions from regional to global trends. The five-year age-specific rates analysis revealed that Bca rates rose steeply from 35-39 to 50-54, dropped slightly between 55 and 64, then rose till 75+. The five-year age-specific rates between 35 and 54 among Lebanese women were amongst the highest worldwide from 2008 to 2012, even higher than the rates in Belgium, which had the highest ASIRw of Bca worldwide in 2020. CONCLUSION Lebanon's Bca ASIRw is among the highest globally. It's important to investigate the contributing factors and develop a national Bca control strategy. This study supports the national recommendation in initiating Bca screening at age 40 for women.
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Affiliation(s)
- Najla A. Lakkis
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Reem M. Abdallah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Umayya M. Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Hanane G. Issa
- Institute of Health Informatics, University College London, London, UK
| | - Mona H. Osman
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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Dib S, Fewtrell M, Wells JCK. Maternal capital predicts investment in infant growth and development through lactation. Front Nutr 2023; 10:1272938. [PMID: 37885440 PMCID: PMC10598761 DOI: 10.3389/fnut.2023.1272938] [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: 08/04/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. Methods The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Results Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Conclusion Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.
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Affiliation(s)
| | | | - Jonathan C. K. Wells
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Chen Y, Zhao Y, Wang W, Wang F, Jiang H, Wang L. Factors associated with exclusive breastfeeding during postpartum in Lanzhou city, China: a cross-sectional study. Front Public Health 2023; 11:1089764. [PMID: 37711249 PMCID: PMC10498539 DOI: 10.3389/fpubh.2023.1089764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Aim Breastfeeding generates short-term and long-term benefits for both mother and child. Exclusive breastfeeding (EBF) is promoted in China for years, but its practice still lags far behind the international average, even among low- and middle- income countries. This study aimed to investigate factors associated with EBF during postpartum. Methods This study was conducted in a tertiary referral hospital in Gansu Province, Northwest China from October 2019 to April 2020. 3,738 postnatal women were finally included and each of them completed an elaborately designed questionnaire. Infant feeding patterns (EBF or not) and reasons for NEBF (non-exclusive breastfeeding) were collected. The feeding knowledge score was based on 17 questions in relation to breastfeeding. The total score ranges from 0 to 17. Higher score means better understanding about breastfeeding knowledge. Multivariate logistic regression models were used to determine associated factors of EBF during postpartum. A subgroup analysis was conducted to investigate the association between feeding knowledge score and exclusive breastfeeding. Results Six weeks after childbirth, 1891 mothers (50.6%) maintained EBF. Among the NEBF mothers, 57.01% (n = 1,053) of them stopped exclusive breastfeeding due to self-perceived lack of breast milk production. Factors associated with NEBF were higher maternal age, ethnic minorities and cesarean section. Protective factors of EBF included multipara, positive feeding attitude and high breastfeeding knowledge score. In subgroup analysis, we found the breastfeeding knowledge score had a significant impact on the mothers of Han nationality, underwent cesarean or natural delivery, both primiparous and multiparous, and those with positive attitude towards breastfeeding (p < 0.05). Conclusion We need a comprehensive and individualized framework of strategies to support children, mothers and their families. During puerperium, improving maternal knowledge of breastfeeding is beneficial to EBF practice. However, for ethnic minorities and those with less active breastfeeding attitudes, breastfeeding knowledge is of limited use, more researches are needed to explore the uncovered reasons, so that more personalized interventions could be developed for them.
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Affiliation(s)
- Yuelu Chen
- Department of Reproductive Health and Infertility, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- College of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Wenling Wang
- Perinatology Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China
| | - Fengdi Wang
- Department of Reproductive Health and Infertility, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Huimin Jiang
- Department of Reproductive Health and Infertility, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Lianlian Wang
- Department of Reproductive Health and Infertility, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
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Ulfa Y, Maruyama N, Igarashi Y, Horiuchi S. Early initiation of breastfeeding up to six months among mothers after cesarean section or vaginal birth: A scoping review. Heliyon 2023; 9:e16235. [PMID: 37292274 PMCID: PMC10245156 DOI: 10.1016/j.heliyon.2023.e16235] [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: 11/25/2022] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
Background Early initiation of breastfeeding is important for establishing continued breastfeeding. However, previous research report that cesarean section (C-section) may hinder early initiation of breastfeeding. Despite this, there is currently a lack of literature that examines the rates of breastfeeding after both cesarean section and vaginal birth globally. Research aims The objective of this scoping review was to systematically assess the available literature on the rate of early initiation of breastfeeding within the first hour and exclusive breastfeeding up to 6 months after C-section and vaginal birth, as well as any other factors associated with initiation and exclusive breastfeeding. Methods We adhered to the PRISMA extension guidelines for scoping reviews in conducting our review. In August 2022, we carried out an electronic database search on CINALH, PubMed, EMBASE, and Cochrane Library, and also manually searched the reference list. Results A total of 55 articles were included in the scoping review. The majority of these studies found that mothers who delivered vaginally had higher rates of breastfeeding compared to those who underwent a C-section, at various time points such as breastfeeding initiation, hospital discharge, one month, three months, and six months postpartum. Notably, there was a significant difference in the rate of early initiation of breastfeeding between the two groups. However, at 3 and 6 months after delivery the gap of exclusive breastfeeding rate between C-section and vaginal delivery is narrow. Breastfeeding education, health care providers support, and mother and baby bonding are other factors associate with initiation and exclusive breastfeeding. Conclusions The rate of breastfeeding initiation after C-section has remained low to date. This is due in part to insufficient knowledge about and support for breastfeeding from healthcare providers.
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Affiliation(s)
- Yunefit Ulfa
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- National Research and Innovation Agency, Jakarta, Indonesia
| | - Naoko Maruyama
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yumiko Igarashi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Naja F, Hwalla N, Chokor FAZ, Zgheib R, Nasreddine L. Infant and young child feeding practices in Lebanon: a cross-sectional national study. Public Health Nutr 2023; 26:143-159. [PMID: 35369892 PMCID: PMC11077449 DOI: 10.1017/s1368980022000842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess infant and young child feeding (IYCF) practices in Lebanon and investigate their associations with socio-demographic and lifestyle factors. DESIGN A cross-sectional national survey was conducted in 2012-2013. In addition to a socio-demographic and lifestyle questionnaire, a 24-h dietary recall for the children was collected, with mothers as proxies. IYCF practices were assessed based on the 2021 indicators of the WHO. SETTING Lebanon. PARTICIPANTS Children aged 0-23 months and their mothers (n 469). RESULTS While the majority of infants were ever breastfed (87·6 %), the prevalence of exclusive breast-feeding (BF) in those under 6 months of age was 11·0 %. Early initiation of BF was 28 %. A greater child's birth order, partner's support for BF, higher parental education, maternal BF knowledge and non-smoking were associated with higher odds of meeting BF recommendations. As for complementary feeding, 92·8 % of children (6-23 months) met the minimum meal frequency indicator, 37·5 % met the minimum dietary diversity (MDD) and 34·4 % met the minimum adequate diet (MAD). The consumption of unhealthy food was observed amongst 48·9 % of children, with nearly 37 % consuming sweet beverages. Older maternal age and maternal overweight/obesity were associated with lower odds of meeting MDD and MAD, while child's age and partner's support for BF were associated with higher odds. CONCLUSIONS The results documented suboptimal IYCF practices amongst Lebanese children and identified a number of factors associated with these practices. Findings from this study will help guide the development of culture-specific programmes aimed at improving IYCF practices in Lebanon.
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Affiliation(s)
- Farah Naja
- Department of Nutrition and Food Sciences, American
University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut1107 2020, Lebanon
- Department of Clinical Nutrition and Dietetics, Research
Institute of Medical & Health Sciences (RIMHS), College of Health Sciences,
University of Sharjah, Sharjah, United
Arab Emirates
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, American
University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut1107 2020, Lebanon
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, American
University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut1107 2020, Lebanon
| | | | - Lara Nasreddine
- Department of Nutrition and Food Sciences, American
University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut1107 2020, Lebanon
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Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study. Nutrients 2022; 14:nu14214459. [PMID: 36364722 PMCID: PMC9654662 DOI: 10.3390/nu14214459] [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: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
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Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
- Correspondence: or
| | - Theresa Jeremias
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC 27707, USA or
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
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Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape. Nutrients 2022; 14:nu14194201. [PMID: 36235853 PMCID: PMC9572091 DOI: 10.3390/nu14194201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition. METHODOLOGY PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR. RESULTS The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time. CONCLUSIONS In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.
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Hoteit M, Ibrahim C, Saadeh D, Al-Jaafari M, Atwi M, Alasmar S, Najm J, Sacre Y, Hanna-Wakim L, Al-Jawaldeh A. Correlates of Sub-Optimal Feeding Practices among under-5 Children amid Escalating Crises in Lebanon: A National Representative Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:817. [PMID: 35740754 PMCID: PMC9221782 DOI: 10.3390/children9060817] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Sub-optimal feeding practices among under-5 children are the major drivers of malnutrition. This study aims to assess the prevalence of malnutrition and the factors affecting exclusive breastfeeding, bottle feeding, and complementary feeding practices among under 5 children amid the COVID-19 pandemic as well as the economic and the political crises in Lebanon. A nationally representative stratified random sample of mother-child dyads (n = 511) was collected from households using a stratified cluster sampling design. The survey inquired about infant's feeding and complementary feeding practices using a valid questionnaire. Anthropometric measurements of the mother and child were collected. Multivariate logistic regression was conducted to explore the determinants associated with under-5 children's practices. The prevalence of underweight, stunting, wasting, overweight and obese children was 0.5%, 8.4%, 6.7%, 16.8% and 8.9%, respectively. In total, among under-5 children, the prevalence of ever breastfeeding, exclusive breastfeeding, and bottle feeding at birth was 95.1%, 59.1% and 25.8%, respectively. Half the children in this study started solid foods between 4 and 6 months. Regression analysis showed that supporting breastfeeding at hospital (aOR = 8.20, 95% CI (3.03-22.17)) and husband's support (aOR = 3.07, 95% CI (1.9-4.92)) were associated with increased breastfeeding odds. However, mother's occupation (aOR = 0.18, 95% CI (0.55-0.58)) was inversely associated with breastfeeding practices. Male children (aOR = 2.119, 95% CI (1.37-3.27), mothers diagnosed with COVID-19 (aOR = 0.58, 95% CI (0.35-0.95)), and bottle feeding at hospital (aOR = 0.5, 95% CI (0.32-0.77)) were more likely to induce early initiation of solid foods at 4 months of age. This study demonstrated non-negligible rates of malnutrition, low prevalence of exclusive breastfeeding, and high rates of early introduction of formula feeding and solid foods among Lebanese under-5-children amid escalating crises.
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Affiliation(s)
- Maha Hoteit
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon; (D.S.); (M.A.-J.); (M.A.); (S.A.); (J.N.)
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon;
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
| | - Carla Ibrahim
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon;
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh 1200, Lebanon;
| | - Danielle Saadeh
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon; (D.S.); (M.A.-J.); (M.A.); (S.A.); (J.N.)
- Faculty of Public Health, Section 2, Lebanese University, Beirut 6573, Lebanon
- INSPECT-LB (National Institute of Public Health, Clinical Epidemiology, and Toxicology), Beirut 00961, Lebanon
| | - Marwa Al-Jaafari
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon; (D.S.); (M.A.-J.); (M.A.); (S.A.); (J.N.)
| | - Marwa Atwi
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon; (D.S.); (M.A.-J.); (M.A.); (S.A.); (J.N.)
| | - Sabine Alasmar
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon; (D.S.); (M.A.-J.); (M.A.); (S.A.); (J.N.)
| | - Jessica Najm
- Faculty of Public Health, Section 1, Lebanese University, Beirut 6573, Lebanon; (D.S.); (M.A.-J.); (M.A.); (S.A.); (J.N.)
| | - Yonna Sacre
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh 1200, Lebanon;
| | - Lara Hanna-Wakim
- Department of Agricultural and Food Engineering, School of Engineering, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh 1200, Lebanon;
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt;
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Daher S, Ziade F, Nasreddine L, Baroudi M, Naja F. Breastfeeding and complementary feeding in fragile settings: the case of Syrian refugees and their host communities in North Lebanon. Int Breastfeed J 2022; 17:37. [PMID: 35568877 PMCID: PMC9107246 DOI: 10.1186/s13006-022-00480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities. METHODS Using two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6-24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis. RESULTS Among breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees' children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p < 0.05). Among refugees, education and spouse's employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months. CONCLUSION Breastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.
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Affiliation(s)
- Sara Daher
- Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El Solh, 1107 2020, Lebanon
| | - Moomen Baroudi
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El Solh, 1107 2020, Lebanon
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, 27272, UAE.
- Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El Solh, 1107 2020, Lebanon.
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11
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Abi Khalil H, Hawi M, Hoteit M. Feeding Patterns, Mother-Child Dietary Diversity and Prevalence of Malnutrition Among Under-Five Children in Lebanon: A Cross-Sectional Study Based on Retrospective Recall. Front Nutr 2022; 9:815000. [PMID: 35299758 PMCID: PMC8922217 DOI: 10.3389/fnut.2022.815000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/24/2022] [Indexed: 01/25/2023] Open
Abstract
Background Despite demonstrated benefits, most countries fall short of meeting international targets for breastfeeding patterns, optimal complementary feeding, mother-children's quality diet, and malnutrition among under-five children. Rationale Since mothers usually play the most vital role in the healthcare of their children, research is needed to illuminate maternal factors that might promote a child's health and nutritional status. Aim The purpose of this study is to retrospectively (1) examine the under-five children's (0–59 months) feeding habits including exclusive breastfeeding, exclusive bottle feeding, continued breastfeeding, and complementary feedings, (2) investigate the mother-child's dietary diversity, and (3) identify any factors that cause less optimal nutrition due to a lack of food diversity in children aged 6 to 59 months. Moreover, (4) the prevalence of wasting, stunting, underweight, and overweight in the under-five offspring living in households located in the main two provinces in Lebanon (Beirut and Mount Lebanon) was determined. Methods The data for this analysis were collected from a representative sample of 384 households [384 mothers (21–49 years old) and children (0–59 months)] between February 2019 and June 2019. A questionnaire was used to inquire mothers of children ages 0–23 months about exclusive breastfeeding (EBF), continuous breastfeeding (CBF), exclusive bottle feeding (EBOT), mixed feeding (MF), and complementary feeding patterns. Moreover, additional questions regarding dietary diversity were asked to mothers of children aged 6 to 59 months. This score was calculated based on the 24 h recall of the mother and her child's consumption of 7 food groups, during the 24 h prior to the survey. Moreover, stunting, wasting, overweight, and underweight were calculated using the z-score for height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ), respectively. Binary logistic regression was used to explore the dietary diversity among children (ages 6–59 months) adjusting for covariates at maternal and household levels. Results Around 44% of children (0–59 months) had normal body weight. In addition, 9.3% were underweight (WAZ < -2SD to −3SD), 6.5% were at risk of being overweight, 24.45% were overweight, 9.3% were stunted (HAZ < -2SD to −3SD), and 6.25% (WHZ < -2SD to −3SD) were wasted. In total, among under-five children, the prevalence of EBF at 40 d and 6 months was 27 and 30%, respectively. The prevalence of CBF was 23%. Around 60% of mothers breastfed their offspring between 0 and 6 months and half of them introduced infant formula at earlier stages between 0–6 months. Furthermore, 78.4% of mothers introduced food to their children between 4 and 6 months (of which 40% before 6 months) and 62.5% of them introduced sugary drinks before 6 months. As for dietary diversity (DD), one out of two mothers and one out of three children (ages 6–59 months) had a low DD score (DDS) (46 and 32%, respectively). The children's and mother's DD were strongly found to be correlated (p-value = 0.034). Regression analysis showed that children's DD increased around 2 times [AOR = 1.7; 95% CI (1.042–2.914)] in context of high maternal DDS, and about 12 times [AOR = 11.7; 95% CI (1.2–111)] when a member of the highest-income households. Conclusions Our findings demonstrated low rates of EBF and CBF, high prevalence of EBOT, and early introduction of complementary foods among children ages 0–59 months. Furthermore, for children ages 6–59 months, there was poor mother-child dietary diversity and a high prevalence of overweight and stunted children in the main two Lebanese provinces. This suggests the alarming need for continuous nutrition intervention to improve infant feeding patterns and dietary diversity to reduce the malnutrition rates.
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Affiliation(s)
| | - Mariam Hawi
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Maha Hoteit
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut, Lebanon
- *Correspondence: Maha Hoteit
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12
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Naja F, Chatila A, Ayoub JJ, Abbas N, Mahmoud A, Abdulmalik MA, Nasreddine L. Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar. Int Breastfeed J 2022; 17:15. [PMID: 35209913 PMCID: PMC8867651 DOI: 10.1186/s13006-022-00456-x] [Citation(s) in RCA: 5] [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: 04/22/2021] [Accepted: 02/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention. Methods Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk. Results Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68). Conclusions Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00456-x.
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Affiliation(s)
- Farah Naja
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah, UAE.,Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jennifer J Ayoub
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nada Abbas
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Amira Mahmoud
- Public Health Department, Ministry of Public Health, Doha, Qatar
| | | | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
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13
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Ramadan N, Bonmatí-Tomas A, Juvinyà-Canal D, Ghaddar A. Online breast-feeding support groups as a community asset in Lebanon after Beirut explosion. Public Health Nutr 2022; 25:1-11. [PMID: 35094725 PMCID: PMC9991805 DOI: 10.1017/s1368980022000295] [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: 11/07/2022]
Abstract
OBJECTIVE Breast-feeding rates are unsatisfactory in Lebanon. Social media groups could play an important role in promoting breast-feeding in normal conditions and post crisis. The aim of this study is to identify breast-feeding challenges, facilitators and assets and to describe how community assets via social media could build community resilience to pandemic's and disaster's effects. DESIGN A two-phase qualitative content analysis was performed on posts and comments collected from a Facebook breast-feeding support group. Data were categorised into themes, categories and subcategories. SETTING Posts and comments retrieved from a Facebook breast-feeding support group in Lebanon during the month of August 2020. PARTICIPANTS Group members: mothers who breastfed, breast-feeding mothers and group admins that are lactation consultants. RESULTS In phase one, breast-feeding 'Challenges' identified were lack of support from peers and family, lack of supportive policies, lack of knowledge and maternal stress related to political instability, COVID-19 and economic crisis. 'Assets and facilitators' included community support and donations. In phase two, analysis revealed how assets were being used on social media platform to build community resilience post crisis, through access to social support in challenging times, community engagement, material resources and transformative potential. CONCLUSION Challenges faced during breast-feeding were diminished due to the support and assets received on a Facebook breast-feeding support group, and social media has been shown to be an important community asset implicated in empowering women to breastfeed and to build community resilience in moments of crisis.
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Affiliation(s)
- Nabiha Ramadan
- Lebanese International University, Mazraa, Beirut146404, Lebanon
- University of Girona, Girona17003, Spain
| | | | | | - Ali Ghaddar
- Lebanese International University, Mazraa, Beirut146404, Lebanon
- Observatory of Public Policies and Health, Beirut, Lebanon
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14
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Naja F, Ayoub J, Baydoun S, Nassour S, Zgheib P, Nasreddine L. Development of national dietary and lifestyle guidelines for pregnant women in Lebanon. MATERNAL & CHILD NUTRITION 2021; 17:e13199. [PMID: 33973717 PMCID: PMC8476423 DOI: 10.1111/mcn.13199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 01/23/2023]
Abstract
Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low- and middle-income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed-method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context-specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture-specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.
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Affiliation(s)
- Farah Naja
- Department of Clinical Nutrition and Dietetics, Research Institute of Medical & Health Sciences (RIMHS), College of Health SciencesUniversity of SharjahSharjahUnited Arab Emirates
- Department of Nutrition and Food SciencesAmerican University of BeirutBeirutLebanon
| | - Jennifer Ayoub
- Department of Nutrition and Food SciencesAmerican University of BeirutBeirutLebanon
| | - Samar Baydoun
- Faculty of Agricultural and Food Sciences/Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Sahar Nassour
- Faculty of Agricultural and Food Sciences/Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Pamela Zgheib
- Mother, Child and School Health UnitMinistry of Public HealthBeirutLebanon
| | - Lara Nasreddine
- Department of Nutrition and Food SciencesAmerican University of BeirutBeirutLebanon
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15
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Nabulsi M, Smaili H, Tamim H, Wahidi M, El-Jamal C. Validation of the Arabic Maternal Breastfeeding Evaluation Scale (MBFES-A) among Lebanese women. Int Breastfeed J 2021; 16:60. [PMID: 34419097 PMCID: PMC8379770 DOI: 10.1186/s13006-021-00409-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Maternal satisfaction with the breastfeeding experience is an important determinant of breastfeeding success. There is currently no valid tool to measure perceived maternal satisfaction with breastfeeding in the Arab context. Methods This cohort study tested the Maternal Breastfeeding Evaluation Scale (MBFES) on 450 healthy Lebanese mothers for internal consistency reliability and construct validity. Participants were recruited between April 2018 and February 2020. Results The Cronbach’s alpha reliability coefficient of the Arabic MBFES (MBFES-A) was 0.87. Exploratory factor analysis revealed that it has three components: Infant Satisfaction/Growth, Maternal Enjoyment/Role Attainment, and Lifestyle/Body Image with reliability coefficients of 0.88, 0.87, and 0.68, respectively. Four items were deleted because of low factor loadings and three items were relocated to the Infant Satisfaction/Growth subscale based on their factor loadings. Participants who were exclusively breastfeeding at one and/or 3 months had higher mean MBFES-A total and Infant Satisfaction/Growth and Maternal Enjoyment/Role Attainment subscale scores than participants who were partially breastfeeding, and significantly higher mean scores than mothers who were not breastfeeding (all p values < 0.001), findings that support the scale’s construct validity. Moreover, scores on the Infant Satisfaction/Growth subscale correlated with exclusive breastfeeding at one (r = 0.37, p < 0.001) and 3 months (r = 0.31, p < 0.001). The MBFES-A score had positive modest correlations with maternal attitude towards breastfeeding (r = 0.30, p < 0.001), exclusive breastfeeding at one (r = 0.27) and at 3 months (r = 0.26, p < 0.001 for both), as well as with the longest previous exclusive breastfeeding (r = 0.27, p < 0.001). Conclusions The 26-item MBFES-A is a reliable and valid instrument to use in future breastfeeding research in Middle East North Africa countries. There is a need for replication of our findings in other Arab contexts using new constructs to establish stronger construct validity. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00409-w.
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Affiliation(s)
- Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
| | - Hanan Smaili
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Marya Wahidi
- Faculty of Arts and Sciences, Medical Research Volunteer Program (MRVP), American University of Beirut, Beirut, Lebanon
| | - Carine El-Jamal
- Faculty of Arts and Sciences, Medical Research Volunteer Program (MRVP), American University of Beirut, Beirut, Lebanon
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16
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Chehab RF, Nasreddine L, Forman MR. Determinants of nutritional status during the first 1000 days of life in Lebanon: Sex of the child matters. Paediatr Perinat Epidemiol 2021; 35:501-510. [PMID: 33428236 DOI: 10.1111/ppe.12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The first 1000 days of life support child growth and long-term health, but few studies address this period in Lebanon and the Eastern Mediterranean Region. OBJECTIVE To examine the determinants of nutritional status among Lebanese children ≤2 years old by child's sex. METHODS We analysed data from a nationally representative cross-sectional survey of 466 mother-child dyads. We classified socio-economic, maternal, and child characteristics using a hierarchical conceptual framework into distal, intermediate, and proximal levels, respectively. Sex-stratified weighted multiple linear regression was computed to identify the determinants of length-for-age z-scores (LAZ) and weight-for-length z-scores (WLZ). RESULTS The mean (standard deviation) of LAZ and WLZ was -0.3 (1.6) and 0.5 (1.5) among boys and -0.1 (1.4) and 0.5 (1.0) among girls, respectively. At the distal level, maternal intermediate or high school education was associated with higher boys' LAZ (β 1.0, 95% confidence interval (CI) 0.2, 1.8), and less crowded households were associated with higher girls' LAZ (β 0.8, 95% CI 0.3, 1.4). At the intermediate level, maternal obesity was associated with lower girls' LAZ (β -0.9, 95% CI -1.4, -0.4). At the proximal level, birth length directly (β 0.1, 95% CI 0.0, 0.2) and breast-feeding duration inversely (β -0.1, 95% CI -0.1, -0.0) associated with girls' LAZ. For WLZ, paternal attainment of university degree or technical diploma was associated with lower boys' WLZ (β -0.9, 95% CI -1.8, -0.1). Among the proximal determinants, birthweight was directly associated with boys' WLZ (β 1.2, 95% CI 0.6, 1.8), while being a third or later child was associated with lower girls' WLZ (β -0.5, 95% CI -0.8, -0.2). Child age was directly associated with WLZ among boys and girls (β 0.1, 95% CI 0.0, 0.1). CONCLUSIONS Nutritional status determinants differed by child's sex in Lebanon. These findings may help inform interventions to improve child growth.
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Affiliation(s)
- Rana F Chehab
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Lara Nasreddine
- Department of Nutrition and Food Science, American University of Beirut, Beirut, Lebanon
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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17
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Alyousefi NA. Determinants of Successful Exclusive Breastfeeding for Saudi Mothers: Social Acceptance Is a Unique Predictor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105172. [PMID: 34068140 PMCID: PMC8152981 DOI: 10.3390/ijerph18105172] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
Recent guidelines motivate health care professionals to promote exclusive breastfeeding (EBF). The reported rate of EBF is low in Saudi Arabia. This study aimed to explore the determinants of successful exclusive breastfeeding for Saudi mothers. A cross-sectional, survey-based study was conducted in family medicine clinics. The dependent variable was the actual practice of EBF. Independent variables were the mothers’ demographic information, comfortableness with breastfeeding in public, knowledge and attitudes about breastfeeding, previous experience of successful breastfeeding, and a previous feeding plan. Statistical analysis was carried out using bivariate analysis and multinomial logistic regression. Out of the 322 respondents, only 28% practiced exclusive breastfeeding for the first six months. Perceived insufficient milk (p = 0.011) was associated with a lower EBF rate. Mothers’ degrees of comfort with breastfeeding in front of their relatives (p = 0.024) and in front of friends (p = 0.028) were significantly associated with their infants’ actual feeding practices for the first six months of their infants’ lives. Mothers reported that the absence of a suitable place for breastfeeding caused them to stop breastfeeding (p = 0.043) and was associated with their infant’s actual feeding practices for the first six months of their infant’s lives. An antenatal breastfeeding intention was considered a significant predictor of EBF; OR: 7.31 (95% CI: 2.24—23.84). Mothers who do not stop breastfeeding when they get sick have a 5.054 times higher chance of continuing EBF (95% CI: 1.037—24.627) than the formula-only feeding group. Thus, social acceptance is a unique predictor for their success in exclusive breastfeeding. Mothers have good intentions and a desire to breastfeed. Therefore, they must be guided through their pregnancy and postpartum period to overcome breastfeeding issues.
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Affiliation(s)
- Nada A Alyousefi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia; ; Tel.: +966-114670836
- King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia
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