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Cunningham S, Penning J, Barboza S, Hansen B, Tonks T, Varnell K, Zhu A, Lobato de Faria J, Bright HS, Dahl-Popolizio S, Wolf RL. Breastfeeding in US working mothers: A systematic review. Work 2024; 78:851-871. [PMID: 38995742 DOI: 10.3233/wor-220645] [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] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Previous studies demonstrate that exclusive breastfeeding has positive long-term health effects on the mother and infant, but research has shown that nearly 50% of mothers do not breastfeed for the recommended amount of time. OBJECTIVE This article systematizes previous quantitative research on the impact of work on breastfeeding practices to identify the factors that correlate to the cessation of breastfeeding in working mothers. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements, we performed a systematic review that screened PubMed, CINAHL, PsycINFO, and Academic Search Complete databases for articles relating to maternal employment and breastfeeding. RESULTS Of the 13,106 articles assessed for eligibility, 21 studies met all requirements and were included in this systematic review. The 21 articles were divided into study type and methods, participant demographics, study outcomes, and additional factors that included stressors and stress levels, factors that increased or decreased rates of breastfeeding, and feeding methods. Articles outside of the United States were excluded due to differences in maternity leave policies of other countries impacting the data. CONCLUSION Cessation of breastfeeding and breastfeeding outcomes were seen to have a strong association with maternal employment, specifically with the policies and employer support in the workplace. Other factors such as race, level of education, and stress were also shown to relate to breastfeeding outcomes and are important to consider in future public health interventions and workplace policies.
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Affiliation(s)
| | - Jenna Penning
- Department of Occupational Therapy, A.T. Still University, Mesa, AZ, USA
| | - Sydnie Barboza
- Department of Occupational Therapy, A.T. Still University, Mesa, AZ, USA
| | - Brooklynn Hansen
- Department of Occupational Therapy, A.T. Still University, Mesa, AZ, USA
| | | | - Kacey Varnell
- Department of Occupational Therapy, A.T. Still University, Mesa, AZ, USA
| | - Angela Zhu
- School of Osteopathic Medicine, A.T. Still University, Mesa, AZ, USA
| | | | - Harold S Bright
- A.T. Still Memorial Library, A.T. Still University, Mesa, AZ, USA
| | - Sue Dahl-Popolizio
- Department of Occupational Therapy, A.T. Still University, Mesa, AZ, USA
| | - Rebecca L Wolf
- Department of Occupational Therapy, A.T. Still University, Mesa, AZ, USA
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Nanishi K, Green J, Shibanuma A, Hongo H, Okawa S, Tabuchi T. Challenging the utility of 24-hour recall of exclusive breast feeding in Japan. BMJ Glob Health 2023; 8:e013737. [PMID: 38084493 PMCID: PMC10711857 DOI: 10.1136/bmjgh-2023-013737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION WHO recommends exclusive breast feeding from birth to 6 months. However, to monitor populations, it recommends using the proportion of infants under 6 months who were exclusively breastfed during the previous 24 hours. To assess the usefulness of 24-hour recall, we (1) compared the prevalence of exclusive breast feeding measured by since-birth recall to the prevalence measured by 24-hour recall and (2) quantified each indicator's association with WHO-recommended, well-established methods for in-hospital breastfeeding support. METHODS We conducted two online surveys of mothers in Japan (total n=4247) who had a healthy singleton delivery in the previous 25 months. They reported on their breast feeding (a) from birth to 5 months; or (b) during the previous 24 hours, for those with infants under 5 months; or (c) both, for those who participated in the initial survey and also in the follow-up survey. All mothers also reported on their in-hospital support. The strength of each indicator's association with provision of in-hospital support was quantified as the area under the curve (AUC). RESULTS The prevalences of exclusive breast feeding by since-birth recall were 4.4% (first survey) and 2.5% (second survey). By 24-hour recall, the prevalence appeared to be 29.8%. More in-hospital support was moderately well associated with more exclusive breast feeding measured by since-birth recall: AUC 0.72 (95%CI 0.66 to 0.78). That association is consistent with the known benefits of in-hospital support. In contrast, when exclusive breast feeding was measured by 24-hour recall, its association with in-hospital support appeared to be extremely weak: AUC 0.59 (95% CI 0.54 to 0.65). CONCLUSION Using 24-hour recall substantially overestimates the prevalence of exclusive breast feeding since birth, and it conceals the benefits of in-hospital breastfeeding support. To monitor population achievement of exclusive breast feeding for the first 6 months, or to evaluate breastfeeding interventions, 24-hour recall of exclusive breast feeding should not be used alone.
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Affiliation(s)
- Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Joseph Green
- Office of International Academic Affairs, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroko Hongo
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sumiyo Okawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takahiro Tabuchi
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
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Isiguzo C, Documet P, Demirci JR, Youk A, Mendez G, Davis EM, Mendez DD. Comparative Assessment of Exclusive Breastfeeding Rates From 24-Hour Recall and Since Birth Methods in Southwestern Pennsylvania Using Ecological Momentary Assessment. J Hum Lact 2023; 39:584-594. [PMID: 37675868 PMCID: PMC11219032 DOI: 10.1177/08903344231193734] [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] [Indexed: 09/08/2023]
Abstract
BACKGROUND Accurate measurement of exclusive breastfeeding is important in maternal and child health research. Exclusive breastfeeding is often measured using the 24-hour recall or the since birth method for the first 6 months. These methods can produce different estimates, introducing problems in interpreting breastfeeding behavior and making accurate comparisons across settings or countries. RESEARCH AIM Our aim was to compare the exclusive breastfeeding rates between the 24-hour recall and since birth methods among a diverse cohort of birthing people using the ecological momentary assessments method. In addition, we compared the exclusive breastfeeding rates between the two methods across race and other maternal characteristics. METHODS This study is a secondary analysis using data from the Postpartum Mothers Mobile Study (PMOMS), a prospective longitudinal study which recruited participants during pregnancy and followed them for 12 months after delivery. Participants completed surveys in real-time via ecological momentary assessment. Individual exclusive breastfeeding rates from months 1-6 were computed using 24-hour recall and since birth methods for 284 participants. We calculated the percentage point difference between the two methods across child age and maternal characteristics. We used a two-sample test of proportions to determine if the differences observed in the proportions were significant. RESULTS Exclusive breastfeeding rates from the 24-hour recall were higher than the since birth rates across all ages and maternal characteristics. The difference between the two methods at 3 months was 25.7 percentage points and at 6 months was a 17.2 percentage points. Irrespective of the method used to measure exclusive breastfeeding, White participants had higher exclusive breastfeeding rates than Black participants. CONCLUSION The 24-hour recall and the since birth methods of assessing exclusive breastfeeding provided substantially different estimates. These findings highlight the importance of specificity in measuring and reporting exclusive breastfeeding.
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Affiliation(s)
- Chinwoke Isiguzo
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Palladium, Washington, DC, USA
| | - Patricia Documet
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jill R. Demirci
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ada Youk
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabriella Mendez
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Orthopedic Foot and Ankle Center, Worthington, Ohio, USA
| | - Esa M. Davis
- Department of Medicine, School of Medicine, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA
| | - Dara D. Mendez
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Pullum TW, Gribble K, Mihrshahi S, Borg B. Estimating the prevalence of exclusive breastfeeding with data from household surveys: Measurement issues and options. Front Nutr 2023; 10:1058134. [PMID: 37032782 PMCID: PMC10080117 DOI: 10.3389/fnut.2023.1058134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
The importance of breastfeeding for infant and maternal health is well established. The World Health Organization recommends that all infants be exclusively breastfed until they reach 6 months of age. The standard indicator to measure adherence to this criterion is the percentage of children aged 0-5 months who are currently being exclusively breastfed. This paper proposes supplementary measures that are easily calculated with existing survey data. First, for an accurate assessment of the WHO recommendation, we estimate the percentage of infants who are being exclusively breastfed at the exact age of 6 months. Second, an adjustment is proposed for prelacteal feeding. These two modifications, separately and in combination, are applied to data from 31 low-and middle-income countries that have participated in the Demographic and Health Surveys Program since 2015. There is considerable variation in the effects across countries. The modifications use existing data to provide a more accurate estimate than the standard indicator of the achievement of the exclusive breastfeeding until 6 months recommendation.
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Affiliation(s)
- Thomas W. Pullum
- ICF International, The Demographic and Health Surveys Program, Rockville, MD, United States
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Bindi Borg
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- *Correspondence: Bindi Borg,
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Zewdie A, Taye T, Kasahun AW, Oumer A. Effect of maternal employment on exclusive breastfeeding practice among mothers of infants 6–12 months old in Wolkite town, Ethiopia: a comparative cross-sectional study. BMC Womens Health 2022; 22:222. [PMID: 35690815 PMCID: PMC9188694 DOI: 10.1186/s12905-022-01816-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Exclusive breastfeeding (EBF) means providing only breast milk for infants for up to six months without the addition of solid or liquid matter. Even though EBF had great benefits for infants and mothers, the rate of EBF is so limited below the global target. In Ethiopia, the overall EBF practice is 59%. This low EBF practice had a great unexplained variation among employed and unemployed mothers. Therefore, this study aimed to compare EBF practice and associated factors among employed and unemployed mothers of infants aged 6–12 months in Wolkite town, Southern Ethiopia, 2020.
Methods
A community-based comparative cross-sectional study was conducted in March 2020. A total sample of 485 (241 employed and 244 unemployed) study subjects was involved in the study. A simple random sampling technique was used to recruit study subjects. A pre-tested structured interviewer-administered questionnaire was used. Multivariable logistic regression was used to identify associated factors of EBF practice for the whole study participants and then for employed and unemployed mothers independently.
Results
The pooled prevalence of exclusive breastfeeding practice was 63.9% [95% CI (59.8–68.2%)]. Exclusive breastfeeding practice was 54.8% [95% CI (48.5–61.4%)] and 73% [95% CI (66.8–78.7%)] among employed and unemployed mothers respectively. Three or more years of a birth interval [AOR = 4.03; 95% CI (1.80–8.99)], three or more ANC visits [AOR = 5.39; 95% CI (1.49–19.45)], and having PNC service [AOR = 4.56; 95% CI (2.0–9.4)] significantly associated to exclusive breastfeeding practice among employed mothers. No history of breastfeeding counseling during ANC visits [AOR = 0.15; 95% CI (0.06–0.41)], had history of breast disease [AOR = 0.28; 95% CI (0.08–0.99)], three or more ANC visits [AOR = 5.11; 95% CI (1.66–15.8)], and having social support [AOR = 3.05; 95% CI (1.23–7.6)] significantly associated to EBF practice among unemployed mothers.
Conclusion
Employment among mothers was found to discourage EBF practice. The predictors of exclusive breastfeeding practice are different for employed and unemployed. Therefore Policymakers and program planners are called to come together and create a conducive environment for lactating employees, and appropriate intervention at respective predictor variables is needed to enhance EBF practice.
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Alayón S, Varela V, Mukuria‐Ashe A, Alvey J, Milner E, Pedersen S, Yourkavitch J. Exclusive breastfeeding: Measurement to match the global recommendation. MATERNAL & CHILD NUTRITION 2022; 18:e13409. [PMID: 35997020 PMCID: PMC9480953 DOI: 10.1111/mcn.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life. To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0–5.9 months of age, as recommended by WHO and UNICEF. This measure tends to overestimate the percentage of infants that are exclusively breastfed for the entire recommended period. We compared five methods of measuring EBF, using data from three large‐scale cross‐sectional surveys. The five methods were: the WHO/UNICEF recommended method (EBF‐24H); an estimate of EBF for 6 months, using the 24‐h recall among infants 4–5.9 and 6–7.9 months (EBF‐24H‐Pul); a since birth recall (EBF‐SB); an estimate of EBF for 6 months, using the since‐birth recall among infants 4–5.9 and 6–7.9 months (EBF‐SB‐Pul); a retrospective measure of EBF collected from infants 6–11.9 months, based on the age of introduction of liquids and foods (EBF‐AI). EBF‐24H‐Pul and EBF‐SB‐Pul produced lower estimates of EBF than other measures, while also aligning better with the WHO recommendation, but may be difficult to estimate from multipurpose surveys due to sample size limitations. The EBF‐AI method produced estimates between these, aligns well with the WHO recommendation and can be easily collected in large‐scale household surveys. Additional validation of the EBF‐24‐Pul, EBF‐SB‐Pul, and EBF‐AI methods is recommended to understand how accurately they measure EBF for the recommended 6‐month period. Exclusive breastfeeding infants for the first 6 months of life is recommended by the World Health Organization and UNICEF for the benefits it provides to both the infant and the mother. The measure currently recommended for global monitoring of exclusive breastfeeding is the prevalence of exclusive breastfeeding among infants less than 6 months, based on a 24‐h recall. Though this measure is easy to collect in large‐scale household surveys, it is often misinterpreted as the percent of infants who are fed according to the recommendation, resulting in an overestimation. Other survey‐derived measures of exclusive breastfeeding are available, for example, such as calculating the midpoint prevalence among infants 4–5.9 and 6–7.9 months, a method developed by Pullum and a since birth recall among infants aged 6–11.9 months of age. These are similarly feasible to collect in household surveys and align better with the practice of exclusive breastfeeding for 6 months as recommended by the WHO.
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Affiliation(s)
- Silvia Alayón
- USAID Advancing Nutrition Arlington Virginia USA
- Save the Children US Washington District of Columbia USA
| | - Veronica Varela
- USAID Advancing Nutrition Arlington Virginia USA
- John Snow, Inc. Arlington Virginia USA
| | - Altrena Mukuria‐Ashe
- USAID Advancing Nutrition Arlington Virginia USA
- Save the Children US Washington District of Columbia USA
| | - Jeniece Alvey
- Public Health Institute/USAID Global Health Technical Professionals Washington District of Columbia USA
| | - Erin Milner
- Public Health Institute/USAID Sustaining Technical and Analytical Resources Washington District of Columbia USA
| | - Sarah Pedersen
- Credence/USAID Global Health Technical Professionals Washington District of Columbia USA
| | - Jennifer Yourkavitch
- USAID Advancing Nutrition Arlington Virginia USA
- Results for Development Washington District of Columbia USA
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Nasution SS, Eliana R, Aizar E, Pramita R. Effectiveness of Coleus Amboinicus Consumption Interventions in Increasing Breast Milk Production and Improving Maternal Health Status During COVID 19 Pandemic. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Insufficient milk production is a major problem for mothers who have just given birth and affects the health condition of postpartum mothers. One of the actions that can be taken to increase milk production and improve the health of postpartum mothers is to consume foods that can increase breast milk production, namely ingredients that contain galactagogue substances. Several types of herbal plants that are often consumed by postpartum mothers after giving birth to increase breast milk in North Sumatra, especially the city of Medan, are making vegetables from the bangun-bangun leaves. Bangun-bangun leaves contain the main ingredients, namely carvakrol, thymol, humulene, undecanal, terpinene, cymene, caryophyllene oxide, terpineol and salinene whose nutritional content and composition helps to stimulate breast milk production.during the Covid 19 pandemic. The intervention was carried out by giving 100 grams of bangun-bangun leaves and consumed 3 times a day starting from the time the mother gave birth until 7 days. Breast milk production was assessed from the time the first breast milk was released and the health condition of the postpartum mother was assessed by measuring vital signs and assessing health conditions while still adhering to health protocols. The study was conducted in Medan Johor, North Sumatra Province and the sample in this study consisted of 60 people consisting of 30 intervention groups and 30 control groups according to the inclusion criteria. Collecting data using a questionnaire consisting of demographic data, data on the first day of breastfeeding, and data on health conditions in postpartum mothers before and after the intervention. Data analysis was carried out using dependent and independent t-tests. The results of the study showed that there was an effect of intervention on consumption of bangun-bangun leaves on breast milk production using an independent t-test with a p value of 0.010 and an intervention for consumption of bangun-bangun leaves with postpartum mother's health condition with a p-value of 0.001. The results of this study are expected to be a solution and intervention in the care of postpartum mothers who have problems in spending milk production and are able to improve health conditions, especially during the Covid 19 pandemic.
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Andarge SD, Fenta EH, Gebreyesus SH, Belachew RY. One-week recall period gives a more accurate estimate of exclusive breastfeeding practice than 24-h recall among infants younger than six months of age. Int Breastfeed J 2021; 16:65. [PMID: 34454543 PMCID: PMC8403454 DOI: 10.1186/s13006-021-00411-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background The World Health Organization recommends a 24-h recall period to estimate breastfeeding practice of mothers of infants aged younger than six-months. Though 24-h recall was preferred for its low recall bias and for practical reasons, it can overestimate exclusive breastfeeding practice (EBF). Validating this indicator will help account for the deviation from the true estimate. This prospective cohort study measured accuracy of the 24-h recall method and validates a week recall as an alternative approach for use in a small sample population. Method The study was conducted from March to April 2018 involving 408 mother-infant pairs living in Butajira Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Participants were prospectively followed for 14 consecutive days; where their breastfeeding practice in the past 24 h was measured daily. Exclusive breastfeeding prevalence estimate obtained using the 24-h recall method and recall periods spanning a varying number of days (short period recalls) was compared against the cumulative of the responses from a prospectively measured repeated 24-h recalls over the course of 14 days. McNemar statistics was used to assess statistical significance of the difference in the EBF prevalence estimates of the single 24-h recall and the reference standard. Sensitivity, specificity, positive predictive value and negative predictive values were calculated to determine the level of accuracy. Receiver Operating Characteristics curve was used to measure the difference in performance between the two methods. Result The highest prevalence (71.4%) of exclusive breastfeeding practice was estimated using the single 24-h recall method whereas the lowest breastfeeding practice (47.1%) was obtained from a cumulative of 14 repeated 24-h recalls. A week recall (a recall over 7 days’ period), resulted in the smallest discrepancy in estimate (7.1%) as compared to cumulative estimate of 14 repeated 24-h recalls. Comparing against our reference standard, a week recall had 96.7% sensitivity and 83.5% specificity in estimating exclusive breastfeeding practice. Conclusions Using single 24-h recall method overestimated exclusive breastfeeding prevalence. However, a week recall gave an estimate close to the estimate from the standard method. A week recall has a potential to balance the tradeoff between the accuracy of EBF estimates and the resource implication of using multiple prospective measurements that have a proven superior accuracy.
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Affiliation(s)
- Sewitemariam Desalegn Andarge
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Esete Habtemariam Fenta
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seifu Hagos Gebreyesus
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robel Yirgu Belachew
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
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Tsegaw SA, Dawed YA, Amsalu ET. Individual level and community level factors affecting exclusive breast feeding among infants under-six months in Ethiopia using multilevel analysis. Ital J Pediatr 2021; 47:106. [PMID: 33952331 PMCID: PMC8097771 DOI: 10.1186/s13052-021-01062-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is the safest and healthiest option of feeding among infants in the first 6 months throughout the world. Thus, promotion of EBF is essential to prevent complex infant health problems even at the adulthood level. But majority of previous studies focused on individual level determinants of EBF by using basic regression models in localized areas. This study aims to identify individual level and community level determinants of EBF which would be helpful to design appropriate strategies in reducing infant mortality and morbidity. METHODS It is a secondary data analysis using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1185 infants under 6 months of age were included in the analysis. Multilevel logistic regression model was employed to investigate factors significantly associated with EBF among under-six month's infants in Ethiopia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to measure the association of variables whereas Intra cluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were used to measure random effects (variation). RESULT In multilevel logistic regression; 4-5 months age infant (AOR = 0.04, 95%CI:0.02-0.07), female infants (AOR = 2.51, 95%CI:1.61-3.91), infant comorbidities (AOR = 0.35, 95%CI: 0.21-0.57), household wealth index (AOR = 10.34, 95%CI: 3.14-34.03) and antenatal care (AOR = 2.25, 95%CI:1.32-3.82) were determinants of EBF at individual level. Whereas, contextual region (AOR = 0.30, 95% CI: 0.10-0.87), community level of postnatal visit (AOR = 2.77, 95% CI: 1.26-6.58) and community level of maternal employment (AOR = 2.8, 95% CI: 1.21-6.47) were determinants of EBF at community level. The full model showed up with higher PCV; that is, 46.8% of variation of exclusive breastfeeding was explained by the combined factors at the individual and community levels. Similarly, it showed that the variation in EBF across communities remained statistically significant (ICC = 8.77% and variance = 0.32 with P < 0.001). The MOR at final model indicates there was significant cluster difference for EBF indicating the heterogeneity was explained by both individual and community level factors. CONCLUSION AND RECOMMENDATION Our study showed that both individual and community level determinants were significantly associated with EBF practice. Based on our findings it is strongly recommended to promote and enhance antenatal and postnatal care services utilization of mothers and more emphasis should be given for infants with comorbid conditions and those who live in the pastoralist regions.
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Affiliation(s)
| | - Yeshimebet Ali Dawed
- Department of Nutrition, school of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Erkihun Tadesse Amsalu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Goon DT, Ajayi AI, Adeniyi OV. Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Int Breastfeed J 2021; 16:18. [PMID: 33593419 PMCID: PMC7885516 DOI: 10.1186/s13006-021-00366-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first 6 months among mothers on antiretroviral therapy in the Eastern Cape, South Africa. METHODS This was a cross-sectional study conducted between January to May 2018, on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice. RESULTS The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. E Exclusive breastfeeding's prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.08-2.56) and those with grade 12 or less level of education (AOR 2.76, 95% CI 1.02-7.49) had a higher likelihood of practising EBF for 6 months since birth while mothers who consumed alcohol (AOR 0.54, 95% CI 0.34-0.85) were less likely to practice EBF for 6 months. CONCLUSIONS The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.
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Affiliation(s)
- Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London, 5201 South Africa
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
- Sociology Department, University of Fort Hare, East London, 5201 South Africa
| | - Oladele Vincent Adeniyi
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London, 5201 South Africa
- Department of Family Medicine, East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa
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11
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Tsegaw SA, Ali Dawed Y, Tadesse Amsalu E. Exploring the determinants of exclusive breastfeeding among infants under-six months in Ethiopia using multilevel analysis. PLoS One 2021; 16:e0245034. [PMID: 33439886 PMCID: PMC7806157 DOI: 10.1371/journal.pone.0245034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Exclusive breastfeeding (EBF) is the safest and healthiest option of feeding among infants in the first 6 months throughout the world. Thus, the promotion of EBF is essential to prevent complex infant health problems even at the adulthood level. But the majority of previous studies focused on individual- level determinants of EBF by using basic regression models in localized areas. This study aimed to identify the determinants of EBF at the individual and community level which would be helpful to design appropriate strategies for improving the practice of EBF. METHODS It is a secondary data analysis using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1185 infants under 6 months of age were included in the analysis. A Multilevel logistic regression model was employed to investigate factors significantly associated with EBF among under-six infants in Ethiopia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to measure the association of variables whereas Intracluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were used to measure random effects (variation). RESULT In multilevel logistic regression; 4-5 months age infant (AOR = 0.04, 95%CI:0.02-0.07), female infants (AOR = 2.51, 95%CI:1.61-3.91), infant comorbidities (AOR = 0.35, 95%CI: 0.21-0.57), richest household wealth index (AOR = 10.34, 95%CI: 3.14-34.03) and antenatal care (AOR = 2.25, 95%CI:1.32-3.82) were individual- level determinants significantly associated with exclusive breastfeeding. Whereas, contextual region (AOR = 0.30, 95%CI: 0.10-0.87), community- level of postnatal visit (AOR = 2.77, 95%CI: 1.26-6.58) and community -level of maternal employment (AOR = 2.8, 95%CI: 1.21-6.47) were community level determinants significantly associated with EBF. The full model showed that46.8% of the variation of exclusive breastfeeding was explained by the combined factors at the individual and community levels. Similarly, it showed that the variation in exclusive breastfeeding across communities remained statistically significant (ICC = 8.77% and variance = 0.32 with P<0.001). CONCLUSION AND RECOMMENDATION Our study showed that both individual and community level determinants were significantly associated with EBF practice among under 6 infants. Based on our findings, it is recommended to promote and enhance antenatal and postnatal care services utilization of mothers to improve exclusive breastfeeding practice and more emphasis should be given to infants with comorbid conditions and those who were living in the pastoralist regions.
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Affiliation(s)
| | - Yeshimebet Ali Dawed
- Department of Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Erkihun Tadesse Amsalu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Haider R, Thorley V, Yourkavitch J. Breastfeeding practices after a counselling intervention for factory workers in Bangladesh. MATERNAL AND CHILD NUTRITION 2020; 17:e13113. [PMID: 33244867 PMCID: PMC7988857 DOI: 10.1111/mcn.13113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022]
Abstract
Breastfeeding may be particularly challenging for female factory workers who have long working hours and inadequate access to health information and care. In Chattogram, Bangladesh, a peer counselling intervention was undertaken to improve infant feeding practices of factory workers. Counselling started during pregnancy and continued until children were 18 months old. This article presents the results of a cross‐sectional survey undertaken during 2 weeks in March–April 2017, after the project's conclusion. The aim was to compare breastfeeding practices, specifically early breastfeeding initiation and exclusive breastfeeding (EBF), among factory workers who had received peer counselling in the intervention areas (IA) with those of non‐counselled factory workers in the nearby comparison areas (CA). Six female interviewers, trained over 3 days, conducted interviews at the workers' homes. Data were analysed to assess the association of peer counselling with infant feeding practices. Factory workers (N = 382) with infants between 0 and 18 months of age participated in the survey, in IA (n = 188) and in CA (n = 194). Although there were more health facility deliveries among the CA workers, only 43 (22%) of those workers had initiated breastfeeding within 1 h of birth versus 166 (88%) of the IA workers (p < .001). EBF prevalence on 24‐h recall in infants aged 0–6 months was only 7/83 (8%) for the CA workers versus 73/75 (97%) for IA workers (p < .001). The survey showed that breastfeeding practices of factory workers in the IA after the intervention were significantly better than those of factory workers in the CA.
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Affiliation(s)
- Rukhsana Haider
- MBBS, MSc, PhD, FABM; Training and Assistance for Health and Nutrition Foundation (TAHN), Dhaka, Bangladesh
| | - Virginia Thorley
- PhD, IBCLC, FILCA; School of Historical and Philosophical Inquiry, The University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer Yourkavitch
- MPH, PhD, IBCLC; Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, North Carolina, USA
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Adda L, Opoku-Mensah K, Dako-Gyeke P. "Once the child is delivered, he is no more your baby," Exclusive Breastfeeding experiences of first-time mothers in Kassena-Nankana Municipality, Ghana - a qualitative study. BMC Pregnancy Childbirth 2020; 20:575. [PMID: 32993563 PMCID: PMC7526357 DOI: 10.1186/s12884-020-03272-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive Breastfeeding (EBF), for the first 6 months of life, is globally accepted as the preferred method for infant feeding. In Ghana, an estimated 84% of children < 2 months old are exclusively breastfed. But by age 4 to 5 months, only 49% continue to receive EBF. This situation continues to deteriorate. Thus, the need to explore perceptions, practices as well as factors that influence EBF in Ghana. Methods Using a qualitative design, four focus group discussions were conducted among first-time mothers and eight in-depth interviews with health workers and traditional birth attendants. The study was conducted in four communities in the Kassena-Nankana municipality of Ghana. Discussions and interviews were recorded and later transcribed verbatim to English language. The transcribed data was then coded with the aid of analysis computer software (Nvivo version 10.0) and later analyzed for the generation of themes. Results Exclusive breastfeeding is practiced among first-time mothers due to its perceived benefits; which include nutritional advantage, ability to enhance growth whilst boosting immunity and its economic value. However misconceptions as well as, certain cultural practices (e.g. giving herbal concoctions, breastmilk purification rites), and relational influences, may threaten a mother’s intention to exclusively breastfeed. Relational influences are mainly from mother in-laws, traditional birth attendants, grandmothers, herbalists and other older adults in the community. Conclusions Although first time mothers attempt EBF, external influences make it practically challenging. The availability and utilization of information on EBF was found to positively influence perceptions towards EBF, leading to change in attitude towards the act. Thus, the practice of community-based health services may be strengthened to provide support for first-time mothers as well as continuous education to the mother in laws, female elders and community leaders who influence decision making on breastfeeding of infants.
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Affiliation(s)
- Louisa Adda
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Ghana
| | - Kwabena Opoku-Mensah
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Ghana.
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Lyellu HY, Hussein TH, Wandel M, Stray-Pedersen B, Mgongo M, Msuya SE. Prevalence and factors associated with early initiation of breastfeeding among women in Moshi municipal, northern Tanzania. BMC Pregnancy Childbirth 2020; 20:285. [PMID: 32393191 PMCID: PMC7216396 DOI: 10.1186/s12884-020-02966-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Early initiation of breastfeeding (EIBF) is a predetermining factor for exclusive breastfeeding, and thus a foundation for optimal breastfeeding practices. Rates of EIBF are low globally (42%) and in Tanzania (51%), yet few studies have been done on this issue in Tanzania. This study aimed to determine the prevalence and factors associated with early initiation of breastfeeding among women in northern Tanzania. Methodology This study extracted information from a cohort of 536 women who were followed from 3rd trimester period October 2013 to December 2015 in Moshi municipal, northern Tanzania. The data for this paper was collected by the use of questionnaires at enrolment, delivery and 7 days after delivery. The analysis is based on data from 413 women for whom complete information was obtained. Log binomial regression analysis was used to determine factors associated with early initiation of breastfeeding. Results The prevalence of EIBF was 83%. Overall, women had high knowledge on colostrum (94%), knowledge on exclusive breastfeeding (81%) and time of breastfeeding initiation (71%), but only 54% were counseled on breastfeeding during antenatal care. Knowledge on timely initiation of breastfeeding during pregnancy and vaginal delivery were associated with EIBF. Conclusion Early initiation of breastfeeding is high (83%) in Moshi Municipal but still below the universal coverage recommended by WHO and UNICEF. There is missed opportunity by health facilities to counsel and support early initiation of breastfeeding given high antenatal and facility delivery in this setting. There is a need to evaluate health facility bottle necks to optimal support of early initiation of breastfeeding in Tanzania.
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Affiliation(s)
- Hadija Y Lyellu
- Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Tamara H Hussein
- Better Health for African Mother and Child (BHAMC), P.O. Box 8418, Moshi, Tanzania.,Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
| | - Margareta Wandel
- Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
| | - Babill Stray-Pedersen
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Melina Mgongo
- Better Health for African Mother and Child (BHAMC), P.O. Box 8418, Moshi, Tanzania. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Sia E Msuya
- Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Institute of Public Health, Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.,Department of Community Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
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