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Mukuria‐Ashe A, Nyambo K, Uyehara M, Guta J, Mtengowadula G, Nyirongo G, Alvey J. Health professional competency building for the Baby-Friendly Hospital Initiative in Malawi. MATERNAL & CHILD NUTRITION 2024; 20:e13591. [PMID: 38444304 PMCID: PMC11168349 DOI: 10.1111/mcn.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 03/07/2024]
Abstract
Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization (WHO)/United Nations Children's Fund (UNICEF) implementation guidance for the Baby-Friendly Hospital Initiative (BFHI). With stagnating rates of exclusive breastfeeding worldwide, skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. Few studies exist on how low-income countries are integrating BFHI into their standards of care. This qualitative case study describes Malawi's experience. We interviewed 48 key informants and conducted a desk review of the literature on BFHI programming, national plans, policies and other related documents. We explored the findings using the seven key domains and 16 competencies to implement the Ten Steps to successful breastfeeding from the WHO and UNICEF Competency Verification Toolkit. The study found that although the focus of the guidance is on preservice training, continuing education and in-service training remain important. To achieve universal coverage for health professional competency, Malawi uses preservice, in-service and refresher training. However, their main limitations to aligning with the new guidance are a lack of preservice BFHI- and breastfeeding-specific curricula, experienced lecturers and sufficient time to dedicate to practical skill development. Conducted during the coronavirus disease 2019 pandemic, this study confirmed disruptions to BFHI training and service delivery, while also documenting Malawi's resilient attempts to mitigate impacts on breastfeeding support through mentoring and coaching. Opportunities exist for strengthening and scaling up, including engaging preservice training institutions and standardizing mentoring, coaching and competency verification.
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Affiliation(s)
- Altrena Mukuria‐Ashe
- USAID Advancing NutritionArlingtonVirginiaUSA
- Save the Children USAWashingtonDistrict of ColumbiaUSA
| | | | - Malia Uyehara
- USAID Advancing NutritionArlingtonVirginiaUSA
- John Snow, Inc. (JSI) Research & Training Institute, Inc.ArlingtonVirginiaUSA
| | | | | | | | - Jeniece Alvey
- United States Agency for International Development (USAID)Washington, District of ColumbiaUnited States
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Syahri IM, Laksono AD, Fitria M, Rohmah N, Masruroh M, Ipa M. Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter? BMC Public Health 2024; 24:1225. [PMID: 38702668 PMCID: PMC11069251 DOI: 10.1186/s12889-024-18619-2] [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: 08/02/2023] [Accepted: 04/16/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers. METHODS The cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage. RESULTS The result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028-2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight. CONCLUSION The study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.
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Affiliation(s)
| | - Agung Dwi Laksono
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Maya Fitria
- Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Sciences, Muhammadiyah University of Jember, Jember, Indonesia
| | - Masruroh Masruroh
- Faculty of Health Science, Universitas Pesantren Tinggi Darul Ulum, Jombang, Indonesia
| | - Mara Ipa
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
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Lubbe W, Kubeka Z, Behr A, Tshitaudzi G, Dlamini-Nqeketo S, Botha J. Revival of the mother-baby friendly initiative (MBFI) in South Africa: towards a quality improvement project. Int Breastfeed J 2024; 19:28. [PMID: 38650000 PMCID: PMC11036704 DOI: 10.1186/s13006-024-00634-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The discontinuation of "Mother-Baby Friendly" accreditation, coupled with the impact of the COVID-19 pandemic, has contributed to reduced breastfeeding rates observed in parts of South Africa. Consequently, the Child, Youth and School Health cluster of the National Department of Health, with support from the World Health Organization and United Nations Children's Fund, organised a Mother-Baby Friendly initiative revitalisation workshop. METHODS Held in Johannesburg, South Africa, on June 29-30, 2022, the workshop brought together local and international breastfeeding promotion experts to engage on issues related to the revitalisation of the Mother-Baby Friendly Initiative. The workshop included presentations and group sessions aimed at setting expectations, evaluating the Ten Steps to Successful Breastfeeding, and developing actionable revitalisation strategies. RESULTS Inadequate monitoring of the Mother-Baby Friendly Initiative implementation and adherence to the Ten Steps was identified as a major implementation bottleneck. Participants identified steps ten (coordinating discharge so that parents and their infants have timely access to ongoing support and care), five (supporting mothers to initiate and maintain breastfeeding and manage common difficulties), and two (ensuring that staff have sufficient knowledge, competence, and skills to support breastfeeding) of the Baby-Friendly Hospital Initiative as the most difficult to implement. Step seven (enabling mothers and their infants to remain together and to practise rooming-in 24 h a day) was the least difficult to implement. Workshop participants identified the following proposed solutions to revitalise breastfeeding promotion: strengthening capacity building and mentorship, improving monitoring and accountability measures, and certification of facilities meeting the initiative's standards. CONCLUSION Current breastfeeding policies and practices must be evaluated by the National Department of Health in collaboration with provincial and private representatives of the initiative to effectively revitalise the Mother-Baby Friendly Initiative. Moreover, an integrative monitoring framework must be developed through stakeholder engagement, role clarification, and ownership. While collaboration between the private and public sectors is required to promote training and communication within healthcare facilities and communities.
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Affiliation(s)
- Welma Lubbe
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa.
| | | | - Ann Behr
- National Department of Health, Pretoria, South Africa
| | | | | | - Jessica Botha
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa
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Koroma AS, Stephenson KB, Iversen PO, Manary MJ, Hendrixson DT. The Effect of Breastfeeding Practices of Undernourished Mothers in Rural Sierra Leone on Infant Growth and Mortality. CHILDREN (BASEL, SWITZERLAND) 2024; 11:233. [PMID: 38397345 PMCID: PMC10888085 DOI: 10.3390/children11020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Breastfeeding provides optimal infant nutrition; however, <50% of infants are exclusively breastfed (EBF) for 6 months. We aimed to describe breastfeeding practices and their effects on growth and mortality among a high-risk mother-infant cohort in rural Sierra Leone. This was a secondary analysis of data from a randomized nutrition intervention trial among undernourished pregnant women. The study's primary outcomes were infant weight and length gains at 6 weeks of age. We included 1270 singleton infants in the analysis, with 1092 (85.6%) having 24-week outcome data. At 6 weeks, 88% were EBF, but the rate of EBF decreased to 17% at 24 weeks. The EBF infants at 6 weeks had improved length (difference of 0.9 mm/week; 95% CI 0.4 to 1.3; p < 0.001) and weight (difference of 40 g/week; 95% CI 24 to 53; p < 0.001) gains compared to the non-EBF infants. At 12 weeks, the EBF infants had improved weight (difference of 12 g/week; 95% CI 2 to 22; p = 0.024) gain. The EBF infants had lower mortality than the infants who were not EBF (hazard ratio of 0.39; 95% CI 0.18 to 0.84; p = 0.017). In summary, the infants who were EBF had greater weight and length gain and reduced mortality than those who were not EBF. Efforts to improve breastfeeding should thus be prioritized to improve infant health.
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Affiliation(s)
| | - Kevin B. Stephenson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Per O. Iversen
- Department of Nutrition, University of Oslo, 0317 Oslo, Norway;
- Department of Haematology, Oslo University Hospital, 0450 Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Tygerberg 7505, South Africa
| | - Mark J. Manary
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - David Taylor Hendrixson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA;
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Ahmed KY, Dadi AF, Kibret GD, Bizuayehu HM, Hassen TA, Amsalu E, Ketema DB, Kassa ZY, Bore MG, Alebel A, Alemu AA, Shifa JE, Leshargie CT, Thapa S, Omar SH, Ross AG. Population modifiable risk factors associated with under-5 acute respiratory tract infections and diarrhoea in 25 countries in sub-Saharan Africa (2014-2021): an analysis of data from demographic and health surveys. EClinicalMedicine 2024; 68:102444. [PMID: 38333537 PMCID: PMC10850409 DOI: 10.1016/j.eclinm.2024.102444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/24/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Background Identifying the critical modifiable risk factors for acute respiratory tract infections (ARIs) and diarrhoea is crucial to reduce the burden of disease and mortality among children under 5 years of age in sub-Saharan Africa (SSA) and ultimately achieving the Sustainable Development Goals (SDGs). We investigated the modifiable risk factors of ARI and diarrhoea among children under five using nationally representative surveys. Methods We used the most recent demographic and health survey (DHS) data (2014-2021) from 25 SSA countries, encompassing a total of 253,167 children. Countries were selected based on the availability of recent datasets (e.g., DHS-VII or DHS-VIII) that represent the current socioeconomic situations. Generalised linear latent mixed models were used to compute odds ratios (ORs). Population attributable fractions (PAFs) were calculated using adjusted ORs and prevalence estimates for key modifiable risk factors among ARI and diarrhoeal cases. Findings This study involved 253,167 children, with a mean age of 28.7 (±17.3) months, and 50.5% were male. The highest PAFs for ARI were attributed to unclean cooking fuel (PAF = 15.7%; 95% CI: 8.1, 23.1), poor maternal education (PAF = 13.4%; 95% CI: 8.7, 18.5), delayed initiation of breastfeeding (PAF = 12.4%; 95% CI: 9.0, 15.3), and poor toilets (PAF = 8.5%; 95% CI: 4.7, 11.9). These four modifiable risk factors contributed to 41.5% (95% CI: 27.2, 52.9) of ARI cases in SSA. The largest PAFs of diarrhoea were observed for unclean cooking fuel (PAF = 17.3%; 95% CI: 13.5, 22.3), delayed initiation of breastfeeding (PAF = 9.2%; 95% CI: 7.5, 10.5), household poverty (PAF = 7.0%; 95% CI: 5.0, 9.1) and poor maternal education (PAF = 5.6%; 95% CI: 2.9, 8.8). These four modifiable risk factors contributed to 34.0% (95% CI: 26.2, 42.3) of cases of diarrhoea in SSA. Interpretation This cross-sectional study identified four modifiable risk factors for ARI and diarrhoea that should be a priority for policymakers in SSA. Enhancing home-based care and leveraging female community health workers is crucial for accelerating the reduction in under-5 mortality linked to ARI and diarrhoea in SSA. Funding None.
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Affiliation(s)
- Kedir Y. Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Abel F. Dadi
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Getiye Dejenu Kibret
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Habtamu Mellie Bizuayehu
- First Nations Cancer and Wellbeing (FNCW) Research Program, School of Public Health, The University of Queensland, Australia
| | - Tahir A. Hassen
- Center for Women’s Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, NSW, Australia
| | - Erkihun Amsalu
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Australia
- St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Daniel Bekele Ketema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, College of Medicine and Health Science, Debre Markos University, Ethiopia
| | - Zemenu Yohannes Kassa
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, Australia
| | - Meless G. Bore
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, Australia
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Animut Alebel
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Addisu Alehegn Alemu
- School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
- College of Medicine and Health Science, Debre Markos University, Ethiopia
| | - Jemal E. Shifa
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, Australia
| | - Cheru Tesema Leshargie
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW, Australia
- School of Public Health, College of Medicine and Health Science, Debre Markos University, Ethiopia
| | - Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Syed Haris Omar
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW 2800, Australia
| | - Allen G. Ross
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
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Glaubius R, Stover J, Johnson LF, Mahiane SG, Mahy MI, Eaton JW. Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2024; 95:e81-e88. [PMID: 38180741 PMCID: PMC10769179 DOI: 10.1097/qai.0000000000003317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Breastfeeding improves child survival but is a source of mother-to-child HIV transmission among women with unsuppressed HIV infection. Estimated HIV incidence in children is sensitive to breastfeeding duration among mothers living with HIV (MLHIV). Breastfeeding duration may vary according to maternal HIV status. SETTING Sub-Saharan Africa. METHODS We analyzed pooled data from nationally representative household surveys conducted during 2003-2019 that included HIV testing and elicited breastfeeding practices. We fitted survival models of breastfeeding duration by country, year, and maternal HIV status for 4 sub-Saharan African regions (Eastern, Central, Southern, and Western). RESULTS Data were obtained from 65 surveys in 31 countries. In 2010, breastfeeding in the first month of life ("initial breastfeeding") among MLHIV ranged from 69.1% (95% credible interval: 68-79.9) in Southern Africa to 93.4% (92.7-98.0) in Western Africa. Median breastfeeding duration among MLHIV was the shortest in Southern Africa at 15.6 (14.2-16.3) months and the longest in Eastern Africa at 22.0 (21.7-22.5) months. By comparison, HIV-negative mothers were more likely to breastfeed initially (91.0%-98.7% across regions) and for longer duration (median 18.3-24.6 months across regions). Initial breastfeeding and median breastfeeding duration decreased during 2005-2015 in most regions and did not increase in any region regardless of maternal HIV status. CONCLUSIONS MLHIV in sub-Saharan Africa are less likely to breastfeed initially and stop breastfeeding sooner than HIV-negative mothers. Since 2020, UNAIDS-supported HIV estimates have accounted for this shorter breastfeeding exposure among HIV-exposed children. MLHIV need support to enable optimal breastfeeding practices and to adhere to antiretroviral therapy for HIV treatment and prevention of postnatal mother-to-child transmission.
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Affiliation(s)
- Robert Glaubius
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - John Stover
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Severin G. Mahiane
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | | | - Jeffrey W. Eaton
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; and
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Maltby AE, Odhiambo BC, Nyaura M, Shikari R, Tuthill EL. Feasibility, acceptability and lessons learned from an infant feeding intervention trial among women living with HIV in western Kenya. BMC Public Health 2023; 23:1930. [PMID: 37798696 PMCID: PMC10557183 DOI: 10.1186/s12889-023-16794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The World Health Organization recommends mothers breastfeed exclusively for the first six months of their infant's life. However, women living with HIV in low resource settings face many barriers to recommended infant feeding practices such as fear of HIV transmission and perceived milk insufficiency. Moreover, current support for breastfeeding in this context is often insufficient to overcome these barriers. To support women's infant feeding experience, we tested a personalized infant feeding support program among perinatal women living with HIV in Kenya. METHODS Supporting Healthy Mothers is a theory and evidence-based multilevel intervention designed to address the mental health burden associated with financial and food insecurity and provide personalized support for optimal infant feeding postpartum. As part of the Supporting Healthy Mothers intervention feasibility trial, between February 23, 2022 and November 9, 2022, twenty mothers received five personalized infant feeding support sessions delivered by a local professional lactation specialist from pregnancy until three months postpartum. Through detailed observations of these sessions, clinical notes and repeated team discussions, we aimed to describe and provide a limited evaluation of these sessions. We identified the strengths and limitations of the lactation support sessions as well as areas for future development. RESULTS Participation in the sessions was high and at three months postpartum all participants reported exclusive breastfeeding as recommended despite experiencing a myriad of challenges. Having face-to-face and frequent early postpartum sessions, being available to field participant concerns between sessions and measuring infant weights at each session were key strengths. Continuing sessions beyond three months postpartum and incorporating family planning and general maternal health counseling topics would enhance these supportive sessions. CONCLUSIONS The personalized professional infant feeding support sessions were highly acceptable and feasible to implement. In-person sessions, in a clinic setting provided opportunities to evaluate and adjust breastfeeding technique and led to successful exclusive breastfeeding practice. Future interventions should consider integrating with other perinatal care services and offering support on demand and immediately postpartum. TRIAL REGISTRATION Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, posted on February 2, 2022. Identifiers: NCT05219552 Unique Protocol ID: K23MH116807.
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Affiliation(s)
- Ann E Maltby
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Belinda C Odhiambo
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Maureen Nyaura
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | | | - Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.
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Caldwell C, Salihu HM, Dongarwar D, Mercado-Evans V, Batiste A, Beal T, Valladares E. Breastfeeding Practices of Women with HIV in Sub-Saharan Africa. Nurs Womens Health 2023; 27:354-361. [PMID: 37579921 DOI: 10.1016/j.nwh.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/23/2023] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To identify sociodemographic factors that could enhance breastfeeding uptake among women with HIV in sub-Saharan Africa. DESIGN This was a secondary analysis from a retrospective cohort study using the Demographic Health Surveys (DHS) on women and HIV data from 14 sub-Saharan African countries during the period from 2010 to 2018. Our study sample encompassed women aged 15 to 49 years with HIV, with childbearing history within the 3 to 5 years preceding the survey, living in any of the countries in sub-Saharan Africa for whom breastfeeding information was available. We used an adjusted survey log binomial regression model to examine factors associated with breastfeeding among participants. SETTING Sub-Saharan Africa. PARTICIPANTS Breastfeeding women with HIV from 15 sub-Saharan African countries. RESULTS Of 138,920 women with HIV in sub-Saharan Africa, 49,479 (35.6%) breastfed their infants. Young women, aged 15 to 19 years (90.5%, n = 2,422) were more likely to breastfeed than those aged 25 to 29 years (13.7%, n = 5,266). Breastfeeding was more common among women who lived in rural areas (38.1%, n = 26,000) than among those in urban areas (33.2%, n = 23,479) (p < .01). The wealthiest women (43.3%, n = 13,710) breastfed more than those with the lowest economic resources (30.8%, n = 4,750) (p < .01). CONCLUSION Recognizing the breastfeeding issues in this individualized sub-Saharan population of women with HIV can influence the creation of more accessibility to education, resources, supplies, counseling, and support throughout the region and beyond through policy changes in health care.
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Marroda KR, Berti C, La Vecchia A, Agostoni C, Baroni BN, Bettocchi S, Baglioni M. Infant and Young Child Feeding practices up to 23 months in Namuno District, Cabo Delgado, Mozambique. Ital J Pediatr 2023; 49:110. [PMID: 37658407 PMCID: PMC10474656 DOI: 10.1186/s13052-023-01517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Inadequate breastfeeding and complementary feeding practices are key determinants of child malnutrition and impact one-third of the under-five mortality rate worldwide. The district of Namuno in Cabo Delgado (Mozambique) has been long registering a high prevalence of acute malnutrition. To date, no data exists about Infant and Young Child Feeding (IYCF) practices in the area. The current pilot study explores the feeding practices among children aged 0-23 months in Namuno and sets out its main drivers. METHODS This cross-sectional study was realized between August and September 2019 and drew on questionnaires for mothers/caregivers of children aged 0 to 23 months. We computed IYCF indicators and correlated them with mothers'/caregivers' school attendance, delivery setting, and distance between home and the place where livelihood activities took place (workplace), using univariate and multivariate (age-adjusted) logistic regression analysis. RESULTS The survey was data derived from a sample of 632 mothers/caregivers. 62% of 0-23-month-old children received colostrum whilst only 31% of 0-5 months babies were on exclusive breastfeeding (EBF). Among 6-23 months old children, 17% consumed foods and beverages from at least five out of eight defined food groups, 31% received a minimum frequency of meals, and 23% had a minimum acceptable diet. Data revealed a positive correlation between early initiation of breastfeeding and delivery in a maternity ward (OR 6.9, CI 3.2-16.1, p-value < 0.001). No difference in the IYCF indicators between female and male babies was detected. CONCLUSIONS In the Namuno district, IYCF practices did not fulfill WHO/UNICEF's indicators and recommendations. This suggests that efforts should be focused on EBF-enabling interventions to improve children's dietary consumption patterns.
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Affiliation(s)
| | - Cristiana Berti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adriano La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Olude O, Vlassoff C, Niyikora J, Krentel A. A systematic review of participatory approaches to empower health workers in low- and middle-income countries, highlighting Health Workers for Change. Int Health 2023; 15:462-473. [PMID: 36349618 PMCID: PMC10318970 DOI: 10.1093/inthealth/ihac070] [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: 02/14/2022] [Revised: 09/26/2022] [Accepted: 10/21/2022] [Indexed: 07/20/2023] Open
Abstract
This systematic review assesses participatory approaches to motivating positive change among health workers in low- and middle-income countries (LMICs). The mistreatment of clients at health centres has been extensively documented, causing stress among clients, health complications and even avoidance of health centres altogether. Health workers, too, face challenges, including medicine shortages, task shifting, inadequate training and a lack of managerial support. Solutions are urgently needed to realise global commitments to quality primary healthcare, country ownership and universal health coverage. This review searched 1243 titles and abstracts, of which 32 were extracted for full text review using a published critical assessment tool. Eight papers were retained for final review, all using a single methodology, 'Health Workers for Change' (HWFC). The intervention was adapted to diverse geographical and health settings. Nine indicators from the included studies were assessed, eliciting many common findings and documenting an overall positive impact of the HWFC approach. Health workers acknowledged their negative behaviour towards clients, often as a way of coping with their own unmet needs. In most settings they developed action plans to address these issues. Recommendations are made on mainstreaming HWFC into health systems in LMICs and its potential application to alleviating stress and burnout from COVID-19.
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Affiliation(s)
| | - Carol Vlassoff
- School of Epidemiology and Public Health, University of Ottawa, Ottawa K1G 5Z3, Canada
- Bruyère Research Institute, Ottawa K1N 5C8, Canada
| | | | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa K1G 5Z3, Canada
- Bruyère Research Institute, Ottawa K1N 5C8, Canada
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Yakubu MI, Odesanya RU, Abbas MY, Lawal BK. Exclusive breastfeeding knowledge and practice among nursing mothers in selected healthcare facilities in Kaduna Metropolis, Nigeria. Afr Health Sci 2023; 23:682-693. [PMID: 38223610 PMCID: PMC10782353 DOI: 10.4314/ahs.v23i2.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Exclusive breast feeding (EBF) in the first six months of life is recognized as an indispensable component of survival, physical and mental development of children. Despite the enormous benefits of EBF, only 39% of infants less than 6 months of age are exclusively breastfed globally. Objectives This study assessed EBF knowledge, practice and associated factors among nursing mothers attending health facilities in Kaduna metropolis. Methods Descriptive and cross-sectional study carried out with the aid of a structured questionnaire at the Barau Dikko Teaching Hospital and Gwamna Awwal General Hospital in Kaduna. The participants were recruited by simple random sampling technique with the assistance of trained research assistants for four consecutive weeks in each of the hospital. Data were analysed using SPSS version 16. Results Majority of the participants were in the age range of 21-30 years. Their main source of information on breastfeeding was from ante-natal clinics (78.3%). Most (86.6%) of the participants had a good knowledge and awareness about EBF, 69.1% of them initiated breastfeeding immediately after birth (within an hour) and 70% of the participants practiced EBF. Insufficient milk, belief that infants require extra fluid, fear of alteration in the breast figure, cultural practice and societal beliefs were identified as the most common barriers to the practice of EBF. Conclusions Findings from this study showed that most of the participants had a very good knowledge of EBF and are practicing it.
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Affiliation(s)
- Musa I Yakubu
- Department of Pharmacology and Toxicology, Kaduna state University, Kaduna, Nigeria
| | - Rachael U Odesanya
- Department of pharmacy, Jos University Teaching Hospital, Plateau state, Nigeria
| | - Medinat Y Abbas
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
| | - Basira K Lawal
- Department of Clinical Pharmacy and Pharmacy management, Kaduna state University, Kaduna, Nigeria
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12
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Roberts D, Jackson L, Davie P, Zhao C, Harrold JA, Fallon V, Silverio SA. Exploring the reasons why mothers do not breastfeed, to inform and enable better support. Front Glob Womens Health 2023; 4:1148719. [PMID: 37122597 PMCID: PMC10132506 DOI: 10.3389/fgwh.2023.1148719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Infant and maternal breastfeeding benefits are well documented, globally. Despite efforts to increase global breastfeeding rates, the majority of high-income settings fall short of recommended targets. Breastfeeding rates in the UK are especially poor, and physiological difficulties (e.g., inverted nipples), fail to account for the observed breastfeeding intention-behaviour gap. Method The current online study sought to investigate the infant feeding experiences of 624 UK formula feeding mothers, through open text survey responses. Results A content analysis identified the following clusters of reasons for formula feeding: Feeding Attitudes, Feeding Problems, Mental Health, and Sharing the Load. Discussion Feeding Attitudes explained a large percentage of reasons given for formula feeding. Recommendations are made to improve antenatal breastfeeding education and to develop an intervention with an aim to improve maternal breastfeeding attitudes and subsequent practice. Feeding Problems also explained a large portion of combination feeding and started but stopped infant feeding accounts. The current paper calls for more comprehensive and tailored antenatal breastfeeding education to refine practical breastfeeding skills necessary for successful breastfeeding establishment and maintenance. Mental Health explained relatively small coverage. Suggestions are therefore made to train mental health practitioners on infant feeding with an aim to provide more extensive support, which may serve to disrupt the bidirectional relationship between poor mental health and poor breastfeeding outcomes. Finally, Sharing the Load explained moderate coverage across never breastfed, combination fed, and started but stopped feeding groups. Recommendations are made, in light of these findings, to tighten workplace legislation to protect breastfeeding women.
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Affiliation(s)
- Dean Roberts
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Leanne Jackson
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Correspondence: Leanne Jackson
| | - Philippa Davie
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Catherine Zhao
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Joanne A. Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
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van Immerzeel TD, Diagne M, Deme/Ly I, Murungi AE, Diouf S, Kerac M, Grijalva-Eternod CS, Day LT. Implementing a Care Pathway for small and nutritionally at-risk infants under six months of age: A multi-country stakeholder consultation. MATERNAL & CHILD NUTRITION 2023; 19:e13455. [PMID: 36373777 PMCID: PMC9749585 DOI: 10.1111/mcn.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
Nutritional vulnerability under the age of 6 months is prevalent in low- and middle-income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders' views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed-methods study: an online survey plus in-depth interviews with country-level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at-risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community-specific needs and health care seeking barriers, health workers' lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients' preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale-up.
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Affiliation(s)
- Tabitha D van Immerzeel
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Indou Deme/Ly
- University Cheick Anta Diop, Dakar, Senegal.,Centre Hospitalier National D'Enfants Albert Royer, Dakar, Senegal
| | | | | | - Marko Kerac
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Carlos S Grijalva-Eternod
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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14
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Mukuria‐Ashe A, Klein A, Block C, Nyambo K, Uyehara M, Mtengowadula G, Nyirongo G, Mansimov A, Okenov S, Alvey J. Implementing two national responsibilities of the revised UNICEF/WHO Baby-Friendly Hospital Initiative: A two-country case study. MATERNAL & CHILD NUTRITION 2022; 19:e13422. [PMID: 36176183 PMCID: PMC9749588 DOI: 10.1111/mcn.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty-eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance-based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty-seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.
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Affiliation(s)
- Altrena Mukuria‐Ashe
- USAID Advancing NutritionArlingtonVirginiaUSA,Save the Children USAWashingtonDistrict of ColumbiaUSA
| | - Alyssa Klein
- USAID Advancing NutritionArlingtonVirginiaUSA,John Snow, Inc. (JSI) Research & Training Institute, Inc.ArlingtonVirginiaUSA
| | - Charlotte Block
- USAID Advancing NutritionArlingtonVirginiaUSA,NCBA CLUSAWashingtonDistrict of ColumbiaUSA
| | | | - Malia Uyehara
- USAID Advancing NutritionArlingtonVirginiaUSA,John Snow, Inc. (JSI) Research & Training Institute, Inc.ArlingtonVirginiaUSA
| | | | | | | | | | - Jeniece Alvey
- Public Health Institute/USAID Global Health Technical ProfessionalsWashingtonDistrict of ColumbiaUSA
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Philemon RN, Mmbaga BT, Bartlett J, Renju J, Mtuy TB, Mboya IB, Msuya SE. Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania. Patient Prefer Adherence 2022; 16:841-852. [PMID: 35387257 PMCID: PMC8977531 DOI: 10.2147/ppa.s343213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years. Patients and Methods We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother's practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding. Results EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had >2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age. Conclusion Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.
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Affiliation(s)
- Rune Nathaniel Philemon
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
| | - Blandina T Mmbaga
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
- Department of Research, Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jenny Renju
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Tara B Mtuy
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Faculty of Public Health and Policy and the Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Innocent B Mboya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Sia E Msuya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
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16
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Flax VL, Ipadeola A, Schnefke CH, Ralph-Opara U, Adeola O, Edwards S, Bose S, Brower AO. Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria. J Nutr 2022; 152:1316-1326. [PMID: 35015869 PMCID: PMC9071272 DOI: 10.1093/jn/nxab450] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although most health facilities in urban Nigeria are privately owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented. OBJECTIVES We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria. METHODS The intervention included training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging. We used logistic regression models adjusted for clustering to measure intervention impact in a cohort of women (n = 1200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum. RESULTS The intervention significantly increased the percentage of infants who were exclusively breastfed at 6 weeks (83% intervention; 76% comparison; P = 0.02) and 24 weeks (66% intervention; 52% comparison; P < 0.001), but had no impact on early initiation of breastfeeding (35% intervention; 33% comparison; P = 0.65). Among infants who were exclusively breastfed at 6 weeks, the odds of continued exclusive breastfeeding at 24 weeks were higher in the intervention arm than in the comparison arm (OR, 1.6; 95% CI: 1.2-2.1). Infants had increased odds of being exclusively breastfed at 6 weeks if their mothers discussed breastfeeding with a private health provider (OR, 2.3; 95% CI: 1.5-3.4), received text or WhatsApp messages about breastfeeding (OR, 1.7; 95% CI: 1.0-2.7), or heard breastfeeding radio spots (OR, 4.2; 95% CI: 1.2-14.7). Infants had increased odds of exclusive breastfeeding at 24 weeks if their mothers participated in a WhatsApp breastfeeding support group (OR, 1.5; 95% CI: 1.0-2.2). CONCLUSIONS A breastfeeding intervention in private health facilities in Lagos increased exclusive breastfeeding. Implementation of breastfeeding interventions in private facilities could extend the reach of breastfeeding promotion programs in urban Nigeria. This trial was registered at clinicaltrials.gov as NCT04835051.
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Affiliation(s)
| | | | | | | | | | | | - Sujata Bose
- Alive & Thrive, FHI Solutions, Washington, DC, USA
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