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Miller JD, Collins SM, Boateng GO, Widen E, Natamba B, Achoko W, Achidri D, Young SL, Martin SL. Pathways linking social support, self-efficacy, and exclusive breastfeeding among women in northern Uganda. Glob Public Health 2022; 17:3506-3518. [PMID: 35960598 PMCID: PMC9898077 DOI: 10.1080/17441692.2022.2110918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon.
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Affiliation(s)
- Joshua D. Miller
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Shalean M. Collins
- Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Lousiana, US
| | - Godfred O. Boateng
- School of Global Health, York University, Toronto, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
| | - Elizabeth Widen
- Department of Nutritional Sciences & Population Research Center, University of Texas at Austin, Austin, Texas, US
| | - Barnabas Natamba
- Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Entebbe, Uganda
| | | | | | - Sera L. Young
- Department of Anthropology, Northwestern University, Evanston, Illinois, US
- Institute for Policy Research, Northwestern University, Evanston, Illinois, US
| | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
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Habte MH, Seid SJ, Alemu A, Hailemariam HA, Wudneh BA, Kasa RN, Bitew ZW. The effect of unemployment and post-natal care on the exclusive breast-feeding practice of women in Ethiopia: a systematic review and meta-analysis. Reprod Health 2022; 19:94. [PMID: 35428313 PMCID: PMC9013047 DOI: 10.1186/s12978-022-01404-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Promoting exclusive breastfeeding (EBF) is a major child survival strategy in developing countries like Ethiopia. Studies in EBF are found in a fragmented and inconclusive way in Ethiopia. Therefore, the aim of this study was to examine evidences on the effect of post natal care counseling and maternal employment status on exclusive breastfeeding practice of women in Ethiopia. METHODS A systematic literature search was conducted from PubMed (contains MEDLINE), CINAHL (EBSCO), Global Health, Food Science and Technology Abstracts (FSTA) (EBSCO) and Grey literature sources such as Google and Google scholar. All primary studies on the effects of employment status and/or post-natal care utilization on EBF practices of women in Ethiopia were included. Data analyses were performed using STATA software. Forest plot, I2 test and the Cochrane Q statistics were used to detect heterogeneity among studies. Heterogeneity was considered significant when the I2 value was ≥ 50%, with p-value < 0.05. Publication bias was checked by looking the asymmetry of funnel and confirmed by Egger's regression test at a 5% significant level. The pooled odds ratio (POR) with 95% confidence interval (CI) was used to report the measures of associations. RESULT A total of 622 studies were identified in the initial search of which 42 articles were included this systematic review and meta-analysis. A meta-analysis of 24 studies indicated that maternal employment status was significantly associated (POR = 0.51, 95% CI 0.16, 0.86) EBF practice in that employed mother were less likely to practice to practice EBF. Post-natal care service utilization significantly increases (POR = 1.76, 95% CI 1.32, 2.34) the EBF practice in Ethiopia and it was computed using 25 eligible articles. Besides, the pooled estimates of EBF practice was found to be 62.58% (95% CI 56.98, 68.19, I2 = 96.4%, p < 0.001). CONCLUSION This review found that post-natal care service utilization and maternal employment status has a significant effect on EBF practice. The findings from this review may be used to inform for better supportive and promotive strategies for EBF practice in Ethiopia.
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Affiliation(s)
| | - Seada Jemal Seid
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Rahel Nega Kasa
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Nyondo-Mipando AL, Kinshella MLW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Hiwa T, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb DM, Kawaza K. Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi. Int Breastfeed J 2021; 16:72. [PMID: 34565391 PMCID: PMC8474749 DOI: 10.1186/s13006-021-00418-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. Methods The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. Results The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. Conclusions Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Sangwani Salimu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Brandina Chiwaya
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Chikoti
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lusungu Chirambo
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ephrida Mwaungulu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mwai Banda
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Laura Newberry
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tamanda Hiwa
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Queen Dube
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Elizabeth Molyneux
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi.,Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
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Silva-Tubio JR, Oliver-Roig A, Perpiñá-Galvañ J, Richart-Martínez M. Reliability and validity of the reduced Spanish version of the Prenatal Breastfeeding Self-Efficacy Scale. Res Nurs Health 2021; 44:979-991. [PMID: 34437707 DOI: 10.1002/nur.22179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/28/2021] [Accepted: 08/07/2021] [Indexed: 01/14/2023]
Abstract
Breastfeeding self-efficacy is a relevant predictor of exclusive breastfeeding during the first six months of life. The Prenatal Breastfeeding Self-Efficacy Scale (PBSES) is a 20-item tool developed to determine breastfeeding self-efficacy during pregnancy. Our study aimed to assess the structural validity and psychometric characteristics of the PBSES and to explore item reduction according to the statistical criteria for parsimony and incremental validity. In this study, conducted in six hospitals in eastern Spain, we recruited 1183 women with healthy, full-term, single-birth newborns. Data on sociodemographic, breastfeeding-related variables, and the PBSES, were obtained from self-administered questionnaires during the third trimester of pregnancy, at postpartum discharge, and 5 months postpartum, and from a phone survey 12 months postpartum. Item reduction was conducted after revising the PBSES item floor and ceiling effects, interitem correlations, and item-score relationships with breastfeeding-status variables during follow-up. The factorial structure of the short form of the PBSES (PBSES-SF) was tested using both exploratory and confirmatory approaches. After item reduction, the confirmatory factor analysis of the 12 remaining items of the PBSES-SF revealed adequate fit statistics for a three-factor structure and a second-order factor. Internal consistency was measured using the Cronbach's α coefficient of the PBSES-SF (0.86). We provided evidence on the discriminant validity of the PBSES-SF by comparing its scores between known groups, convergent validity by examining its correlations with other variables, and predictive validity by assessing the association of PBSES-SF scores with breastfeeding behavior at critical points in time during the first postpartum year.
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Affiliation(s)
- José R Silva-Tubio
- Department of Midwifery, Health District for Alicante, Hospital Vega Baja, Alicante, Spain.,Department of Nursing, University of Alicante, Alicante, Spain
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Wu W, Zhang J, Silva Zolezzi I, Fries LR, Zhao A. Factors influencing breastfeeding practices in China: A meta-aggregation of qualitative studies. MATERNAL AND CHILD NUTRITION 2021; 17:e13251. [PMID: 34355869 PMCID: PMC8476444 DOI: 10.1111/mcn.13251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022]
Abstract
The World Health Organization recommends that women exclusively breastfeed until their babies are 6 months old and continue to breastfeed while introducing complementary foods. A meta‐aggregation methodology was used to systematically review and synthesise the qualitative studies on factors influencing breastfeeding practices of healthy Chinese women in Greater China. English and Chinese databases were searched to identify peer‐reviewed qualitative studies (published 2008–2019). Relevant data were extracted, and key themes related to factors influencing breastfeeding practices were identified. Of 7587 articles identified, 22 qualitative studies met inclusion criteria for the review, 10 of which were published in Chinese. A total of 87 themes were extracted from all included studies and classified into 9 subcategories: government enactment of policies, implementation of policies in workplaces, social expectations, social support, medical and health services, services with Chinese characteristics, breastfeeding and pumping facilities, maternal perceptions of breastfeeding and self‐efficacy to breastfeed. The nine subcategories were then grouped into four categories. Potential effect associations among these influence factors of breastfeeding practices emerged from categories and subcategories. Family members' influence on breastfeeding motivation and self‐efficacy suggest a potential benefit of breastfeeding promotion interventions targeting the whole family. The role of primary care should be fully exploited in breastfeeding promotion, including both prenatal education and post‐partum visits. Standardising the training and qualifications of maternity matrons (yuesao) and folk breastfeeding specialists (cuirushi) can promote evidence‐based approaches to facilitating breastfeeding during the confinement period. Increased availability of breastfeeding and pumping facilities in the workplace would facilitate continuing breastfeeding after returning to work.
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Affiliation(s)
- Wei Wu
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | | | | | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Gebremariam KT, Zelenko O, Mulugeta A, Gallegos D. A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners' support among expectant couples in Mekelle, Ethiopia. Int Breastfeed J 2021; 16:3. [PMID: 33397410 PMCID: PMC7784251 DOI: 10.1186/s13006-020-00355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Breastfeeding is considered the biological norm and essential to reduce infant morbidity and mortality. Mothers are responsible for breastfeeding but the support of others, including their partners is an influential determinant. The aim of this study was to compare antenatal breastfeeding knowledge, attitudes, and perceived breastfeeding support of expectant couples in Mekelle, Ethiopia. Methods As part of a randomised controlled trial of an mHealth intervention, 128 couples in their third trimester from three selected health centres in Mekelle city were recruited to participate between September and October 2018. Couples who each had a personal mobile phone, read and spoke Tigrigna, and lived together were included. Baseline data on breastfeeding knowledge, attitudes, and perceived support (breastfeeding savvy, help, appreciation, presence and responsiveness) were collected using previously validated tools through interview by health workers. Results Compared to mothers, male partners were more likely to indicate their intention to provide breastfeeding appreciation (p = 0.02), breastfeeding presence (p = 0.002), and breastfeeding responsiveness (p = 0.04). The mothers’ prenatal perception of their partners’ intended breastfeeding support was lower than fathers’ perceptions to support their partners. Multiparous mothers had more positive perceptions regarding their partners’ breastfeeding savvy (p = 0.03), and breastfeeding help (p = 0.02) compared to primiparous mothers. Conclusions Fathers in Ethiopia are potentially strong supporters of breastfeeding practice. Future breastfeeding interventions should promote the involvement of fathers in breastfeeding and encourage mothers to increase their partners’ involvement in breastfeeding.
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Affiliation(s)
- Kidane Tadesse Gebremariam
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Oksana Zelenko
- School of Design, Queensland University of Technology, Brisbane, Australia
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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Türkdoğan M, Akcan A. Prospective Monitoring of Breastfeeding Behaviors in Primiparous Mothers with Risky and Non-risky Age Groups. Florence Nightingale Hemsire Derg 2020; 28:276-286. [PMID: 34263207 PMCID: PMC8134013 DOI: 10.5152/fnjn.2020.19088] [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] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022] Open
Abstract
AIM This study aimed at monitoring breastfeeding behaviors in primiparous mothers with risky and non-risky age groups prospectively. METHOD This is a kind of comparative and prospective study that was carried out in 306 mothers who were registered at seven family health centers. The study sample comprised 68 primiparous mothers who were in the risky age group and 238 primiparous mothers who were not in the risky age group. It was interviewed with the mothers twice when their babies were one and six months old. Personal Information Form, Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and LATCH Breastfeeding Assessment Tool were used for data collection. RESULTS The mothers in the risky age group had a lower breastfeeding rate when their babies were one month old and a higher formula feeding rate when their babies were six months old than the rates observed in case of the mothers in the non-risky age group. Mothers in the non-risky age group breastfed 14.8 times more in the first month and 5.4 times more in the sixth month than those in the risky age group. The mean scores of LATCH and BSES-SF in the first month and the mean scores of BSES-SF in the sixth month of mothers in the non-risky age group were higher than those of the mothers in the risky age group. CONCLUSION It was determined that primiparous mothers in the non-risky age group exhibited more positive behaviors in terms of breastfeeding. Close monitoring of breastfeeding behaviors of mothers in the risky age group could be recommended.
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Affiliation(s)
- Münevver Türkdoğan
- Çiğli Regional Training and Research Hospital, Pediatric Service, İzmir, Turkey
| | - Arzu Akcan
- Department of Public Health Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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Ahmed KY, Page A, Arora A, Ogbo FA. Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: A propensity score matching approach. PLoS One 2020; 15:e0230978. [PMID: 32236145 PMCID: PMC7112197 DOI: 10.1371/journal.pone.0230978] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/12/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Acute respiratory infection (ARI) and diarrhoea are the leading causes of childhood morbidity and mortality in Ethiopia. Understanding the associations between infant and young child feeding (IYCF) and ARI and diarrhoea can inform IYCF policy interventions and advocacy in Ethiopia. This study aimed to investigate the relationship between IYCF practices and ARI and diarrhoea in Ethiopian children. METHODS This study used the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037), and 2016 (n = 3861). The association between IYCF practices and (i) ARI and (ii) diarrhoea were investigated using propensity score matching and multivariable logistic regression models. The IYCF practices include early initiation of breastfeeding, exclusive breastfeeding (EBF), predominant breastfeeding, introduction of complementary foods, continued breastfeeding at two years and bottle feeding. RESULTS Infants and young children who were breastfed within 1-hour of birth and those who were exclusively breastfed had a lower prevalence of ARI. Infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhoea. Early initiation of breastfeeding (Odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72, 0.92) and EBF (OR: 0.65; 95% CI: 0.51, 0.83) were associated with lower risk of ARI. Bottle-fed children had higher odds of ARI (OR: 1.36; 95% CI: 1.10, 1.68). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhoea (OR: 0.88; 95% CI: 0.79, 0.94 for Early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39, 0.65 for EBF). Infants who were predominantly breastfed were less likely to experience diarrhoea (OR: 0.69; 95% CI: 0.53, 0.89). CONCLUSION The recommended best practices for preventing ARI and diarrhoeal diseases in infants and young children namely: the early initiation of breastfeeding, EBF and avoidance of bottle feeding should be institutionalized and scale-up in Ethiopia as part of implementation science approach to cover the know-do-gaps.
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Affiliation(s)
- Kedir Y. Ahmed
- College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Science and Health, Western Sydney University, Campbelltown, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- General Practice Unit, Prescot Specialist Medical Centre Makurdi, Makurdi, Benue State, Nigeria
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Gebremariam KT, Zelenko O, Hadush Z, Mulugeta A, Gallegos D. Exploring the challenges and opportunities towards optimal breastfeeding in Ethiopia: a formative qualitative study. Int Breastfeed J 2020; 15:20. [PMID: 32228718 PMCID: PMC7104505 DOI: 10.1186/s13006-020-00265-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/19/2020] [Indexed: 01/06/2023] Open
Abstract
Background Breastfeeding, particularly exclusive breastfeeding, is essential to ensure the short- and long-term health of infants and mothers. Sub-optimal breastfeeding practices currently take place in low income countries contributing to morbidity and mortality. This research explored the challenges and opportunities around exclusive breastfeeding in a large city in Ethiopia to inform a larger breastfeeding intervention. Methods Fathers and mothers who had children less than 2 years of age, and who could speak, and understand Tigrigna were recruited from two health centres located in Mekelle, Ethiopia. Two focus group discussions (FGDs) with fathers and two FGDs with mothers (n = 42) were conducted using a semi-structured interview guide to explore the challenges and opportunities related to breastfeeding. Discussions were audio-recorded and transcribed in Tigrigna and translated to English. The data were manually analysed using thematic analysis, generating open codes which were grouped to form themes. Results Four themes with 11 sub-themes emerged. The themes identifies were: conflicted emotions on the birth of baby (feeling happy and feeling worried); perspectives on intergenerational approaches (old-fashioned beliefs of grandparents and the power of science, breastfeeding in public, breastfeeding knowledge); gender roles as barriers and enablers (the burden on women, changes in men’s roles and the financial status of the household); the role of healthcare (delivery of health information to parents, the role of health care providers and perceptions of inadequate milk supply). Conclusion Parents reported a range of opportunities with respect to breastfeeding, including the power of a scientific approach, the positive role of healthcare, and shifts within gender roles that maximized the potential support from fathers. However, there remains a tension between the beliefs of older generations and current best-practice. Parents continue to need ongoing support in order to practice optimal breastfeeding.
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Affiliation(s)
- Kidane Tadesse Gebremariam
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane City, QLD, Australia. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Oksana Zelenko
- School of Design, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Znabu Hadush
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane City, QLD, Australia.,Centre for Child Health Research, Institute of Health and Biomedical Innovation, Brisbane City, QLD, Australia
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Lahiri A, Chakraborty A. Predictors of Weight Velocity in the First 6 Months of Life in a Rural Block of West Bengal: A Longitudinal Study. Indian J Community Med 2019; 44:92-96. [PMID: 31333283 PMCID: PMC6625261 DOI: 10.4103/ijcm.ijcm_150_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Monthly weight gain (weight velocity) is important in early infancy, with several factors affecting and interacting within the healthy-born children. The current study aims to estimate on the effects of different factors on the trend of weight gain during the first 6 months of life. METHODS A longitudinal (repeated-measures) study was conducted on the 42 nonlow birth weight healthy children born in selected rural areas during December 2016. Infant feeding attitude, effective breastfeeding, timely feeding, and episodes of diarrheal illnesses were the major predictors along with the age of the children on the weight velocity in a sex-dependent repeated-measures analysis using Generalized Estimating Equations. RESULTS Mothers of the children were mostly below the mean age of 20.1 years (60.905%), majority being homemakers (71.429%). Majority (73.809%) had a better infant feeding attitude. The mean birth weight for male infants was 2.941 (±0.299) kg and females 2.938 (±0.352) kg. Age of the child, birth weight, timely feeding, and episodes of diarrheal illnesses had statistically significant effect on monthly weight gain. Feeding breast milk only proved advantageous for males. CONCLUSIONS Effectively, only breastfeeding, timely feeding, and prevention of diarrheal episodes were the most important recommendations at the field level.
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Affiliation(s)
- Arista Lahiri
- Department of Community Medicine, Medical College, Kolkata, West Bengal, India
| | - Arup Chakraborty
- Department of Community Medicine, Medical College, Kolkata, West Bengal, India,Address for correspondence: Dr. Arup Chakraborty, 240, Golpukur Road, P.O - Baruipur, Distt-24 Parganas (South), Kolkata, West Bengal, India. E-mail:
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Horwood C, Jama NA, Haskins L, Coutsoudis A, Spies L. A qualitative study exploring infant feeding decision-making between birth and 6 months among HIV-positive mothers. MATERNAL AND CHILD NUTRITION 2018; 15:e12726. [PMID: 30338632 DOI: 10.1111/mcn.12726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 01/10/2023]
Abstract
Despite efforts to support breastfeeding for HIV-positive mothers in South Africa, being HIV-positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision-making about infant feeding practices among HIV-positive mothers in a rural and urban settings in KwaZulu-Natal, South Africa. HIV-positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in-depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV-positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health School of Clinical Medicine Nelson R Mandela School of Medicine, University of KwaZulu-Natal Durban, Durban, South Africa
| | - Lenore Spies
- Department of Health, Nutrition Directorate, Pietermaritzburg, South Africa
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Habtewold TD, Mohammed SH, Endalamaw A, Akibu M, Sharew NT, Alemu YM, Beyene MG, Sisay TA, Birhanu MM, Islam MA, Tegegne BS. Breast and complementary feeding in Ethiopia: new national evidence from systematic review and meta-analyses of studies in the past 10 years. Eur J Nutr 2018; 58:2565-2595. [PMID: 30229308 DOI: 10.1007/s00394-018-1817-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/07/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this systematic review and meta-analysis was to provide a national estimate of breast and complementary feeding practices and its predictors in Ethiopia. METHODS PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases were searched for all available literature published until April 2018. Observational studies including cross-sectional, case-control and cohort studies were included. Newcastle-Ottawa Scale was used to assess the quality of studies. Heterogeneity of studies was quantified using Cochran's Q χ2 statistic and Higgins's method (I2). A meta-analysis using a weighted inverse variance method was performed. Subgroup analysis was carried out based on region and study area. RESULTS In total, 70 studies that involved > 55,000 women from nine regions and two chartered cities in Ethiopia were included. The pooled national prevalence for timely initiation of breastfeeding (TIBF), exclusive breastfeeding (EBF) and timely initiation of complementary feeding was 66.5%, 60.1% and 62.5%, respectively. Guidance and counselling on breastfeeding, vaginal delivery and health institution delivery significantly increased the odds of TIBF and EBF. In addition, TIBF significantly associated with high EBF practice. Maternal occupational status significantly associated with low EBF practice, but not TIBF. CONCLUSIONS Based on the WHO standard, the current breast and complementary feeding practice in Ethiopia is good and improving. Integrated intervention is still required for further improvement and minimizing the effect of occupational status.
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Affiliation(s)
- Tesfa Dejenie Habtewold
- Department of Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia. .,Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Shimels Hussien Mohammed
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences-International Campus (TUMS-IC), Tehran, Islamic Republic of Iran
| | - Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Akibu
- Department of Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Nigussie Tadesse Sharew
- Department of Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yihun Mulugeta Alemu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Tesfamichael Awoke Sisay
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulugeta Molla Birhanu
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Md Atiqul Islam
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Balewgizie Sileshi Tegegne
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Alebel A, Tesma C, Temesgen B, Ferede A, Kibret GD. Exclusive breastfeeding practice in Ethiopia and its association with antenatal care and institutional delivery: a systematic review and meta-analysis. Int Breastfeed J 2018; 13:31. [PMID: 30026786 PMCID: PMC6048887 DOI: 10.1186/s13006-018-0173-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite the World Health Organization recommendation of exclusive breastfeeding (EBF) for the first six months of life, the rate remains low both in developed and developing countries. In Ethiopia, findings regarding the prevalence of EBF have been highly variable. Antenatal care and institutional delivery are the most important factors contributing to the practice of EBF however; their effect has not been investigated in Ethiopia. Methods In this systematic review and meta-analysis, international databases were systematically searched. All observational studies reporting the prevalence of EBF and its association with antenatal care and institutional delivery in Ethiopia were considered. Two authors independently extracted all necessary data using a standardized data extraction format. A random effects meta-analysis model was computed to estimate the pooled prevalence of exclusive breastfeeding. Moreover, the association of antenatal care and institutional delivery with EBF was determined. Results After reviewing 619 studies, 32 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of EBF in Ethiopia was 59.3% (95% Confidence Interval [CI] 53.8, 64.8). The subgroup analysis indicated that the highest prevalence was observed in Afar region (65.6%), followed by SNNP (63.8%), and then by Oromia (61.8%). Additionally, mothers who attended antenatal visits were 2.1 times more likely to practice EBF compared to their counterparts (Odds Ratio [OR] 2.1; 95% CI 1.5, 2.8). Moreover, mothers who gave birth at a health institution were 2.2 times more likely to practice EBF compared to mothers who gave birth at home (OR 2.2; 95% CI 1.3, 3.5). Conclusions Exclusive breastfeeding in Ethiopia was significantly lower than the global recommendations. There was evidence that mothers who attended antenatal visits and who gave birth at health institutions had better EBF practices. Based on our findings, we strongly recommended that the utilization of antenatal care and institutional delivery should be improved through health extension workers.
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Affiliation(s)
- Animut Alebel
- 1Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesma
- 2Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | | | - Aster Ferede
- 2Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- 2Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Mohamed MJ, Ochola S, Owino VO. Comparison of knowledge, attitudes and practices on exclusive breastfeeding between primiparous and multiparous mothers attending Wajir District hospital, Wajir County, Kenya: a cross-sectional analytical study. Int Breastfeed J 2018; 13:11. [PMID: 29507602 PMCID: PMC5833066 DOI: 10.1186/s13006-018-0151-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is recommended for 6 months of age, with continued breastfeeding for 2 years of age or beyond. There is paucity of information on the disparity in Knowledge, Attitudes and Practices (KAP) on EBF between primiparous and multiparous mothers. This study compared the KAP on EBF between primiparous and multiparous mothers attending Wajir County Hospital, Wajir County, Kenya and investigated the association between maternal knowledge and attitudes and EBF. METHODS Information on maternal KAP on EBF was collected through structured researcher administered questionnaires for a total of 281 mothers, recruited from a maternal and child health centre in 2014; primiparous (n = 137) and multiparous (n = 144) with infants 0-5 months of age. Maternal knowledge and attitudes on various aspects of breastfeeding were determined. The knowledge and attitude scores were also calculated. The practice of EBF was determined based on a 24-h recall. RESULTS The prevalence of EBF among infants 0-5 months old was 45.5%. The rate of EBF among primiparous mothers was 39.4% and multiparous mothers 49.3%. The knowledge score on breastfeeding (out of a total of 10) for the primiparous mothers was 7.93 ± 2.10 and 7.49 ± 2.20 for the multiparous mothers. The mean attitude score (out of a total score of 40) for the primiparous mothers was 29.46 ± 5.65 and 28.65 ± 6.40 for the multiparous mothers. The prevalence of EBF and maternal knowledge and attitudes towards breastfeeding was similar among the two groups of mothers. Those mothers with positive attitudes towards breastfeeding were more likely to EBF (Fisher's exact test; p = 0.00) compared with those with lower scores. CONCLUSIONS Interventions to promote exclusive breastfeeding should be tailored to the needs of each population by identifying the factors that influence the practice in a given context. The findings of this study will be useful particularly for behavior change communication interventions by those organizations working in similar circumstances to the study area.
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Affiliation(s)
- Mahat Jimale Mohamed
- Department of Food, Nutrition and Dietetics, Kenyatta University, P.O BOX 438433, Nairobi, 00100 Kenya
| | - Sophie Ochola
- Department of Food, Nutrition and Dietetics, Kenyatta University, P.O BOX 438433, Nairobi, 00100 Kenya
| | - Victor O. Owino
- Department of Human Nutrition and Dietetics, Technical University, P.O. BOX 52428, Nairobi, 00200 Kenya
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