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Xie T, Huang YY, Huang WP. Development of a breastfeeding co-parenting intervention program for couples with primiparas: a program development process study. BMC Pregnancy Childbirth 2024; 24:590. [PMID: 39251971 PMCID: PMC11385832 DOI: 10.1186/s12884-024-06750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/09/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND The exclusive breastfeeding rates is low in some countries. Low breastfeeding rates results in higher healthcare expenses and adverse health outcomes for individuals and society. Co-parenting is effective in promoting breastfeeding as it involves shared responsibility and collaboration between parents in raising children. However, the current breastfeeding co-parenting intervention programs exhibits significant variations in components, timing, and duration across studies. An evidence-based breastfeeding co-parenting intervention program is essential for enhancing breastfeeding-related outcomes. OBJECTIVE To develop an evidence-based breastfeeding co-parenting intervention program for healthcare providers to guide parents with primiparas on breastfeeding. METHOD To form an initial version of the intervention program, a systematic literature review was conducted to consolidate information on current intervention programs. Two rounds of Delphi method were followed to gather expert comments for the program modification to establish the formal version. RESULTS Fourteen articles published between 1995 and 2022 were screened. Details of these researches, including starting and ending time, duration and specific contents, were integrated to developed the initial program. Then, six experts completed the two rounds consultation with a positive coefficient of 85.71%, coefficient judgment basis of 0.93, familiarity coefficient of 0.87, authority coefficient of 0.90 and the Kendall's W of 0.62. Finally, an evidence-based breastfeeding co-parenting intervention program was constructed in this study, consisting of breastfeeding co-parenting courses, individual counselling and a father's support group. CONCLUSION This research developed a breastfeeding co-parenting intervention program for healthcare providers to guide primiparous parents to improve breastfeeding rates. Through a systematic literature review and Delphi method with good reliability, the program integrates breastfeeding courses, individual counseling, and a father's support group. Future research will focus on evaluating its impact and scalability to benefit maternal and infant health globally. TRIAL REGISTRATION ChiCTR.org.cn (ChiCTR2300069648). Registration date: 2023-03-22.
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Affiliation(s)
- Tan Xie
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Yan Huang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- School of Nursing, Wuhan University, 115 Donghu Rd., Wuchang District, Wuhan, China.
| | - Wei-Peng Huang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Katmawanti S, Paramita F, Kurniawan A, Sharoni SKA, Fauzi R, Pratiwi IG, Samah DA, Audina YT, Wahyuni OS, Adisa MD, Rahmani A. The effects of exclusive breastfeeding booklets on mothers’ knowledge in providing exclusive breastfeeding in Mataram City, Indonesia. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.11211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction: Exclusive breastfeeding is the simplest and healthiest infant feeding method that, directly or by extraction, uses only breast milk with the exception to drops or syrups containing vitamins, mineral supplements or medicines. This practice helpprevents malnutrition among toddlers and provide essential dietary values for subsequent growth and development, especially in the first 6 months. However, Mataram has the lowest coverage of exclusive breastfeeding in West Nusa Tenggara province in 2018. This exposure increased by 70.30% from 2017-2018, but has not achieved the 80% national target. The low coverage was caused by mothers’ inadequate knowledge. Therefore, the present research aims to demonstrate the effectiveness of booklets as a promotional medium for exclusive breastfeeding towards increasing the knowledge of breastfeeding mothers.
Design and Methods: The research method involved the conduction of pre- and post tests (before and after the booklet was distributed) on 50 respondents by voluntary sampling. This sampling refers to a probability technique that provides equal opportunities for each population element selected as a member of the sample, while the participants were chosen using consecutive sampling technique
Results: The results showed the average values of the pre- and post- tests at 72 and 77, respectively.
Conclusions: Therefore, it is concluded that the booklet is effective in increasing mothers' knowledge on exclusive breastfeeding.
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Liu J, Li J, Zhang X, Song J, Li W, Wu J. Does the mainland China-Hong Kong exchange program change the views of local university students in Hong Kong on regional cooperation? A randomized control-group pre-test post-test experiment. Front Psychol 2023; 14:1078437. [PMID: 36949923 PMCID: PMC10025535 DOI: 10.3389/fpsyg.2023.1078437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
The Chinese central government has been running an intensive exchange program called the Mainland China-Hong Kong Ten Thousand Student Exchange Program since 2012 to support local Hong Kong university students' visits to mainland China, with the aim of promoting exchange and regional cooperation between Hong Kong and mainland China. However, little is known about local Hong Kong university students' views on regional cooperation and whether the program is effective in changing their views. Using a randomized experimental design, we find that most students hold positive views on regional cooperation between Hong Kong and mainland China, but a considerable percentage of students oppose integration with mainland China. We also find that the program is effective in positively changing students' views on certain aspects of regional cooperation related to the free trade zones and the Hong Kong-Zhuhai-Macau Bridge, but is not significantly effective on other aspects of regional cooperation. This study provides the first causal quantitative evidence regarding the impact of the mainland China-Hong Kong exchange program on local university students' views regarding regional cooperation. The findings help inform the public about the prospect of regional cooperation and offer policy implications on youth exchange between mainland China and Hong Kong.
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Affiliation(s)
- Jianzheng Liu
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Jie Li
- School of Tourism Management, Sun Yat-sen University, Zhuhai, China
| | - Xiwen Zhang
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou, China
| | - Jing Song
- School of Urban Planning and Design, Peking University Shenzhen Graduate School, Shenzhen, China
| | - Weifeng Li
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen, China
- *Correspondence: Weifeng Li,
| | - Jiansheng Wu
- School of Urban Planning and Design, Peking University Shenzhen Graduate School, Shenzhen, China
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Mahumud RA, Uprety S, Wali N, Renzaho AMN, Chitekwe S. The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta‐analysis. MATERNAL & CHILD NUTRITION 2022; 18:e13286. [PMID: 34842341 PMCID: PMC8710127 DOI: 10.1111/mcn.13286] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rashidul A. Mahumud
- NHMRC Clinical Trials Centre, School of Medicine and Health The University of Sydney Camperdown New South Wales Australia
- Centre for Health Research University of Southern Queensland Toowoomba Queensland Australia
- Department of Statistics Health Research Group Rajshahi Bangladesh
| | - Sophiya Uprety
- Former UNICEF Consultant and Public Health Nutritionist Kathmandu Nepal
| | - Nidhi Wali
- School of Social Sciences Western Sydney University Penrith New South Wales Australia
| | - Andre M. N. Renzaho
- Translational Health Research Institute School of Medicine Campbelltown New South Wales Australia
- Maternal, Child and Adolescent Health Program Burnet Institute Melbourne Victoria Australia
| | - Stanley Chitekwe
- Nutrition Section United Nations Children's Fund (UNICEF) Kathmandu Nepal
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Irmawati, Nugraheni SA, Sulistiyani, Sriatmi A. Finding The Needs of Breastfeeding Mother Accompaniment for Successful Exclusive Breastfeeding Until 6 Months in Semarang City: A Mixed Method. BIO WEB OF CONFERENCES 2022. [DOI: 10.1051/bioconf/20225400004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Exclusive breastfeeding for the first 6 months of life is important to prevent nutritional problems. WHO has recommended that all babies should be exclusively breastfed for the first 6 months of life. However, its practice in Indonesia is not optimal yet (38%). The aim of this study to assess the characteristics of breastfeeding accompaniment needed by exclusive breastfeeding mothers for the success of exclusive breastfeeding until 6 months. This study used mixed methods, both a cross-sectional survey of 148 mothers breastfeeding infants aged over six months in five PHCs with low level of exclusive breastfeeding coverage and unstructured interviews were conducted by ten PHC midwives in five PHC areas. Most of breastfeeding mothers were housewives, multipara, secondary education, and only (33,8%) breastfeed exclusively. The characteristics of accompaniment needed included scheduled home visits by companion (73.0%), providing information with direct practice by companion and according to the problems experienced by the mothers (77.8%), and accompaniment conducted 0-6 postpartum (85.8%). The qualitative findings that home visits to postpartum mothers by companion carried out only once or twice during the postpartum period with a focus on infant health. In conclusion, most of breastfeeding mothers still need accompaniment during the breastfeeding exclusive period or until 6 months postpartum.
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Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13158. [PMID: 34241961 PMCID: PMC8269148 DOI: 10.1111/mcn.13158] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/20/2022]
Abstract
The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.
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Affiliation(s)
- Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Juliet K. McCann
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Emily Gascoigne
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Diana Allotey
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Dadirai Fundira
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Syam A, Musni M, Amin AN, Iskandar I. Potential Loss among Infant Feeding Options. JURNAL NERS 2021. [DOI: 10.20473/jn.v16i1.23285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The conceptual relationship between economics and breastfeeding is still mathematically invaluable, while the family's economic burden increases along with babies born. Indicating potential loss when a family chooses other than breastmilk is a progressive way to manage campaign messages about exclusive breastmilk and prolonged breastfeeding. Descriptive studies are needed to magnify all of these indicators and transform them into measuring instruments generalized to assess family expenditures related to infant feeding.Methods: This study uses a quantitative descriptive design, questionnaire draft upon qualitative open questions containing all micro indicators impacted financially during the baby’s first year. Data collection was carried out in Makassar based on telephone surveys with 330 preliminary samples. After structural analysis and data reduction, the expenditure indicators were divided into medical and non-medical expenses.Results: The study show there is a difference in the average amount of family expenses of those who provide formula milk compared to breastmilk. This outcome is 21.1 times higher in non-medical components and 2.5 times higher in the medical component. One of the highest contributions in medical expenses is the cost of a recurrent visit to a pediatrician due to a history of illness such as allergies, respiratory infections, and diarrhea.Conclusion: This empirical fact stated the strong affirmation of how families should consider wisely to choose the best feeding pattern for babies aged 0-12 months.
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Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017. BMC Public Health 2020; 20:1112. [PMID: 32669120 PMCID: PMC7362438 DOI: 10.1186/s12889-020-09194-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Improving breastfeeding practice is important for reducing child health inequalities and achieving several Sustainable Development Goals. Indonesia has enacted legislation to promote optimal breastfeeding practices in recent years. We examined breastfeeding practices among Indonesian women from 2002 to 2017, comparing trends within and across sociodemographic subgroups. Methods Data from four waves of the Indonesia Demographic and Health Surveys were used to estimate changes in breastfeeding practices among women from selected sociodemographic groups over time. We examined three breastfeeding outcomes: (1) early initiation of breastfeeding; (2) exclusive breastfeeding; and (3) continued breastfeeding at 1 year. Multivariate logistic regression was used to assess changes in time trends of each outcome across population groups. Results The proportion of women reporting early initiation of breastfeeding and exclusive breastfeeding increased significantly between 2002 to 2017 (p < 0.05), with larger increases among women who: were from higher wealth quintiles; worked in professional sectors; and lived in Java and Bali. However, 42.7% of women reported not undertaking early initiation of breastfeeding, and 48.9% of women reported not undertaking exclusive breastfeeding in 2017. Women who were employees had lower exclusive breastfeeding prevalence, compared to unemployed or self-employed women. Women in Java and Bali had higher increase in early initiation of breastfeeding and exclusive breastfeeding compared to women in Sumatra. We did not find statistically significant decline in continued breastfeeding at 1 year over time for the overall population, except among women who: were from the second poorest wealth quintile; lived in rural areas; did not have a health facility birth; and lived in Kalimantan and Sulawesi (p < 0.05). Conclusions There were considerable improvements in breastfeeding practices in Indonesia during a period of sustained policy reform to regulate breastfeeding and community support of breastfeeding, but these were not distributed uniformly across socioeconomic, occupation and geographic subgroups. Concerted efforts are needed to further reduce inequities in breastfeeding practice through both targeted and population-based strategies.
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Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days. Curr Dev Nutr 2020; 4:nzaa085. [PMID: 32607463 PMCID: PMC7311193 DOI: 10.1093/cdn/nzaa085] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
Fathers, grandmothers, and other family members' influence on maternal, infant, and young child nutrition (MIYCN) is widely recognized, yet synthesis of the effectiveness of engaging them to improve nutrition practices during the first 1000 d is lacking. We examined the impact of behavioral interventions to engage family members in MIYCN in low- and middle-income countries through a mixed-methods systematic review. We screened 5733 abstracts and included 35 peer-reviewed articles on 25 studies (16 with quantitative and 13 with qualitative data). Most quantitative studies focused on early breastfeeding, primarily engaging fathers or, less often, grandmothers. Most found positive impacts on exclusive breastfeeding rates and family members' knowledge and support. The few quantitative studies on complementary feeding, maternal nutrition, and multiple outcomes also suggested benefits. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Interventions engaging family members can increase awareness and build support for MIYCN, but more rigorous study designs are needed. This systematic review is registered at PROSPERO as CRD42018090273, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90273.
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Affiliation(s)
- Stephanie L Martin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juliet K McCann
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Emily Gascoigne
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana Allotey
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dadirai Fundira
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Aldana-Parra F, Olaya G, Fewtrell M. Effectiveness of a new approach for exclusive breastfeeding counselling on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight or obese women: protocol for a randomized controlled trial. Int Breastfeed J 2020; 15:2. [PMID: 31921328 PMCID: PMC6945425 DOI: 10.1186/s13006-019-0249-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background Maternal overweight, infant feeding and early growth velocity are risk factors for obesity later in life. The first one thousand days are a window of opportunity to program health and disease. Exclusive breastfeeding may protect against obesity; however, it is not consistently practiced. Obesity rates have been increasing worldwide. Overweight or obese women have lower rates of breastfeeding and face mechanical, psychological and biological difficulties. Breastfeeding counselling is a successful strategy to support breastfeeding in normal weight women; but there is a lack of evidence on its effectiveness in overweight women. Our purpose is to evaluate a new approach to exclusive breastfeeding counselling based on Carl Rogers’ Centred-Client Theory in overweight women, and to examine effects on breastfeeding prevalence, infant growth velocity and maternal postpartum weight loss. Methods A two-arm simple randomized controlled trial will be conducted in overweight and obese women recruited in a Baby Friendly Hospital in Bogotá, Colombia. The intervention is exclusive breastfeeding counselling based on Rogers’ theory but adapted for overweight women; it will be performed during the last month of pregnancy, 24 h after delivery and during early infancy (1 and 3 months postpartum). The primary outcomes will be exclusive breastfeeding prevalence, infant growth velocity and maternal weight loss from birth up to 4 months after delivery; and the secondary outcomes will be prolactin and macronutrient levels in breast milk and serum prolactin levels. Intention to treat analysis will be performed to estimate the effect of the new counselling approach compared to standard management on the prevalence of exclusive breastfeeding, infant growth velocity and maternal weight loss. Discussion We hypothesize that the intervention will result in an increase in the initiation and maintenance of exclusive breastfeeding, allowing adequate infant growth velocity and maternal weight loss after delivery. It is hoped that the results of this trial will provide evidence to support public health policy on supporting breastfeeding in this vulnerable group of women. Trial registration (UTN) U1111–1228-9913 February 20th 2019; ISRCTN15922904 February 27th 2019, retrospectively registered.
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Affiliation(s)
- Fanny Aldana-Parra
- 1Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gilma Olaya
- 1Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mary Fewtrell
- 2UCL Great Ormond Street Institute of Child Health, London, UK
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Abbass-Dick J, Brown HK, Jackson KT, Rempel L, Dennis CL. Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature. Midwifery 2019; 75:41-51. [PMID: 30999255 DOI: 10.1016/j.midw.2019.04.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/23/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Support from fathers is consistently associated with improved breastfeeding duration and exclusivity rates. Additionally, there is growing evidence that fathers want to be included in breastfeeding interventions provided by health care professionals. The objective of this review was to determine the effect of partner-inclusive educational and psychosocial interventions on breastfeeding initiation, duration, and exclusivity. DESIGN A systematic review was conducted using a search strategy developed with an expert health sciences librarian. Electronic databases MEDLINE, EMBASE, CINAHL, and PsycINFO were systematically searched for randomized controlled trials and quasi-experimental studies from inception to August 4, 2018. Independent data extraction and quality assessments were conducted by authors using Cochrane Collaboration tools. Due to significant heterogeneity in intervention content, outcome measures, and follow-up time points, data were synthesized qualitatively. FINDINGS 3982 articles were identified, of which 12 studies in 15 publications met the inclusion criteria and were included. All of the studies improved at least one breastfeeding outcome, including duration (n = 5/9) and exclusivity (n = 8/10) up to 24 weeks postpartum. Six studies examined increasing paternal breastfeeding support and all found beneficial effects. Biases were identified in the studies with the most common bias relating to the randomization process and the blinding of outcome assessors. IMPLICATIONS FOR PRACTICE The inclusion of fathers/partners in breastfeeding interventions improves breastfeeding initiation, duration, and exclusivity rates. Interventions that include face-to-face information delivery, are designed in a culturally appropriate manner, and provide information on how partners can support breastfeeding are more likely to have a beneficial effect. Research is warranted to examine the underlying intervention mechanisms.
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Rahman A, Akter F. Reasons for formula feeding among rural Bangladeshi mothers: A qualitative exploration. PLoS One 2019; 14:e0211761. [PMID: 30807588 PMCID: PMC6391007 DOI: 10.1371/journal.pone.0211761] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
In Bangladesh the exclusive breastfeeding rate remains low and prelacteal, formula and bottle feeding is increasing. This study aims to explore reasons behind infant formula feeding practices from mothers, caregivers, and health care provider's perspective. This was a qualitative study carried out in four sub-districts of Sylhet and Jessore of rural Bangladesh. Data were collected through focus group discussions (12), in-depth interviews (4) and key informant interviews (12) from January to February 2014. The qualitative data collected and were analyzed using thematic content analysis. This study clearly showed the factor behind formula feeding by Bangladeshi rural women. One of the major findings was that women could not differentiate between formula and other milk. Main differences between formula and powder milk were the type of consumer where formula only was taken by infant and children less than 2 years. Other major reasons include; poor breastfeeding practices, lack of appropriate breastfeeding practices, superficial knowledge on harmful effect on infant formula; perceived insufficient breast milk production, the influence of family and society and authoritarian power of hospital staff. Rural mothers have intension to feed infant formula to their infants due to various factors including individual, social, cultural and institutional. These identified factors can contribute to policy making and develop more specific interventions targeting expected mother and their family members that can contribute to stop formula feeding and increase breastfeeding practices in rural Bangladesh.
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Affiliation(s)
- Atiya Rahman
- Research and Evaluation Division (RED), BRAC, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Akter
- Research and Evaluation Division (RED), BRAC, Mohakhali, Dhaka, Bangladesh
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Susiloretni KA, Hadi H, Blakstad MM, Smith ER, Shankar AH. Does exclusive breastfeeding relate to the longer duration of breastfeeding? A prospective cohort study. Midwifery 2018; 69:163-171. [PMID: 30522038 DOI: 10.1016/j.midw.2018.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/24/2018] [Accepted: 11/18/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Suboptimal breastfeeding contributes to morbidity and mortality in children. Studies in high-income countries (HICs) show that exclusive-breastfeeding (EBF) is associated with longer breastfeeding duration. The aim of this study was to determine whether maternal reports of EBF at six months are associated with longer duration of breastfeeding during the first two years of life in a low and middle-income country (LMIC) setting, and to identify determinants of breastfeeding duration. METHODS This prospective cohort includes data from an EBF promotion program in Demak District, Central Java Province, Indonesia, with a non-randomized pretest-posttest control group. Mothers and infants were followed through 26 months postnatal age. Data were analyzed using Cox proportional hazard regression with time to cessation of EBF as the outcome. RESULTS A total of 147 families were included in the study. Longer EBF duration was not associated with prolonged duration of breastfeeding. Longer breastfeeding duration was associated with mothers who disagreed with a statement of being ashamed to breastfeed (HR 0.035, 95%CI 0.003,0.44). Risk factors for shorter breastfeeding duration included mothers' plan to breastfeed for less than 24 months (HR 4.28 95%CI 1.91,9.60), mothers' belief that breastfeeding less than 24 months was the norm (HR 2.98 95%CI 1.31,6.77) and exposure to EBF promotion (HR:4.09 95%CI 2.14,7.82). CONCLUSIONS In a LMIC community where long breastfeeding duration is common, EBF is not associated with breastfeeding duration. However, modifiable behavioral factors were significant predictors of breastfeeding duration. We therefore recommend that prolonged breastfeeding duration can be achieved through programs that improve breastfeeding behavior.
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Affiliation(s)
- Kun A Susiloretni
- Department of Nutrition, Department of Applied Midwifery, Semarang Health Polytechnic, Ministry of Health of the Republic of Indonesia, Poltekkes Kemenkes Semarang, Jl. Wolter Monginsidi 115 Semarang 52192, Indonesia.
| | - Hamam Hadi
- Alma Ata Center for Healthy Life and Food (ACHEAF), Alma Ata University, Yogyakarta, Indonesia.
| | - Mia M Blakstad
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Emily R Smith
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Anuraj H Shankar
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
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Mahesh PKB, Gunathunga MW, Arnold SM, Jayasinghe C, Pathirana S, Makarim MF, Manawadu PM, Senanayake SJ. Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis. BMC Public Health 2018; 18:1140. [PMID: 30249216 PMCID: PMC6154400 DOI: 10.1186/s12889-018-6037-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/13/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Further research gaps exist in relation to the promotion of breastfeeding. Robust scientific evidence obtained by a meta-analysis would provide objectively summarized data while enabling the assessment of consistency of findings. This review includes the first documented meta-analysis done on the effectiveness of targeting fathers for promoting breastfeeding (BF). Assessments have been done for a primary outcome and for six more secondary outcomes. METHODS PubMed, EMBASE, Google Scholar, CENTRAL databases and unpublished researches were searched. Selections of randomized-controlled trials and quasi-experimental studies were done in three rounds. Heterogeneity and potential publication bias were assessed. Eight studies were included in meta-analysis and others in narrative synthesis of the outcomes. Pooling was done with the Mental- Haenszel method using risk ratio (RR). Summary-of-Findings table was composed by Review-Manager (version 5.3) and GRADEproGDT applications. Subsequent sensitivity analysis was done. RESULTS Selected eight interventional studies included 1852 families. Exclusive BF at six months was significantly higher (RR = 2.04, CI = 1.58-2.65) in the intervention groups. The RR at 4 months was 1.52 (CI = 1.14 to 2.03). Risk of full-formula-feeding (RR = 0.69, CI = 0.52-0.93) and the occurrence of lactation-related problems were lower in the intervention groups (RR = 0.24, CI = 0.10-0.57). More likelihood of rendering support in BF-related issues was seen in intervention groups (RR = 1.43, CI = 1.22-1.68). Increase of maternal knowledge and favorable attitudes on BF were higher in the intervention groups (P ≤; 0.001). The quality of evidence according to GRADE was "low" (for one outcome), "moderate" (for four outcomes), and "high" (for two outcomes). CONCLUSIONS Targeting fathers in promotion of BF has provided favorable results for all seven outcomes with satisfactory quality of evidence. This review was registered in the PROSPERO-registry (ID: 2017-CRD42017076163) prior to its commencement.
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Siregar AYM, Pitriyan P, Walters D. The annual cost of not breastfeeding in Indonesia: the economic burden of treating diarrhea and respiratory disease among children (< 24mo) due to not breastfeeding according to recommendation. Int Breastfeed J 2018; 13:10. [PMID: 29507601 PMCID: PMC5833067 DOI: 10.1186/s13006-018-0152-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 02/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Indonesia, 96% of children (< 24mo) are breastfed. However, only 42% of children (< 6mo) are exclusively breastfed, as per World Health Organization recommendations. Breastfeeding provides protective benefits such as reducing the risk of morbidity and mortality associated with diarrhea and pneumonia/respiratory disease (PRD). This study estimates the potential economic impact of not breastfeeding according to recommendation in Indonesia based on infants suffering from attributable diarrhea and PRD. METHODS A cost analysis examined both the healthcare system costs and non-medical costs for children (< 24mo) with diarrhea and PRD. Data collection took place between 2015 and 2016 and healthcare expenditures were assessed in 13 facilities, in five sites including Bandung and Tomohon City. Costs from a provider perspective were estimated using healthcare records and 26 interviews with healthcare workers. A discount rate of 3% was used. A cross-sectional survey with caregiver-child pairs (n = 615) collected data related to out of pocket costs such transportation and opportunity costs such as wage loss. These figures were combined with the national disease prevalence rates from Indonesia Demographic and Health Survey 2012, and the relative risk of disease of not breastfeeding according to recommendation from literatures to extrapolate the financial burden of treatment. RESULTS The healthcare system cost due to not breastfeeding according to recommendation was estimated at US$118 million annually. The mean healthcare system cost and out of pocket costs was US$11.37 and US$3.85 respectively. This cost consists of US$88.64 million of provider costs and US$29.98 million of non-medical patient costs. CONCLUSIONS The cost of not breastfeeding according to recommendation is potentially high, therefore the Indonesian government needs to invest in breastfeeding protection, promotion and support as the potential healthcare system cost savings are significant. As suggested by other studies, the long term cost due to cognitive losses of providing not breastfeeding according to recommendation should also be taken into account to provide a complete understanding of the economic impact of not breastfeeding according to recommendation.
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Affiliation(s)
- Adiatma Y. M. Siregar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Jl. Cimandiri no. 6-8, Bandung, West Java 40115 Indonesia
| | - Pipit Pitriyan
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Jl. Cimandiri no. 6-8, Bandung, West Java 40115 Indonesia
| | - Dylan Walters
- Canadian Centre for Health Economics, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
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Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications. Public Health Nutr 2017; 20:3120-3134. [PMID: 28965508 DOI: 10.1017/s1368980017002531] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low- and middle-income countries and discuss implications for programmes. DESIGN A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. SETTING Low- and middle-income countries. SUBJECTS Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. RESULTS Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h post-delivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from cross-sectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. CONCLUSIONS Improving the counselling skills of health workers to address breast-feeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low- and middle-income countries.
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McGinnis S, Lee E, Kirkland K, Miranda-Julian C, Greene R. Let’s Talk About Breastfeeding: The Importance of Delivering a Message in a Home Visiting Program. Am J Health Promot 2017; 32:989-996. [DOI: 10.1177/0890117117723802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high-risk population. Design: A secondary analysis of program data from a statewide home visitation program. Setting: Thirty-six Healthy Families New York sites across New York State. Subjects: A total of 3521 pregnant mothers at risk of poor child health and developmental outcomes. Intervention: Home visitors deliver a multifaceted intervention that includes educating high-risk mothers on benefits of breastfeeding, encouraging them to breastfeed and supporting their efforts during prenatal and postnatal periods. Measures: Home visitor-reported content and frequency of home visits, participant-reported breastfeeding initiation and duration, and covariates (Kempe Family Stress Index, race and ethnicity, region, nativity, marital status, age, and education). Analysis: Logistic regression. Results: Breastfeeding initiation increased by 1.5% for each 1-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally, if a participant receives 1 more home visit during the third month, her likelihood of breastfeeding at 6 months increases by 11%. Effect sizes varied by months postpartum. Conclusions: Delivering a breastfeeding message consistently during regular home visits is important for increasing breastfeeding rates. Given that home visiting programs target new mothers least likely to breastfeed, a more consistent focus on breastfeeding in this supportive context may reduce breastfeeding disparities.
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Affiliation(s)
- Sandra McGinnis
- Center for Human Services Research, School of Social Welfare, University at Albany, Albany, NY, USA
| | - Eunju Lee
- School of Social Welfare, University at Albany, Albany, NY, USA
| | - Kristen Kirkland
- Bureau of Research, Evaluation and Performance Analytics, New York State Office of Children and Family Services, Rensselaer, NY, USA
| | - Claudia Miranda-Julian
- Bureau of Research, Evaluation and Performance Analytics, New York State Office of Children and Family Services, Rensselaer, NY, USA
| | - Rose Greene
- Center for Human Services Research, School of Social Welfare, University at Albany, Albany, NY, USA
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Talukder S, Farhana D, Vitta B, Greiner T. In a rural area of Bangladesh, traditional birth attendant training improved early infant feeding practices: a pragmatic cluster randomized trial. MATERNAL & CHILD NUTRITION 2017; 13:e12237. [PMID: 26775711 PMCID: PMC6865915 DOI: 10.1111/mcn.12237] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 09/24/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
In rural Bangladesh, most births take place at home. There is little evidence regarding the influence of traditional birth attendants (TBAs) or community volunteers (CVs) on early infant feeding practices. We conducted a pragmatic cluster randomized controlled trial in Panchagarh District to examine the effects of training and post-training supervision of TBAs/CVs on early breastfeeding practices. Nine unions were randomized into three groups of three unions. We compared outcomes between mothers in a control group (CG), those living in unions where TBAs/CVs had received a 5-day training in early feeding practices (TG) and those living in unions where TBAs/CVs were both trained and supervised (SG). A total of 1182 mothers of infants aged 0-6 months were interviewed at baseline. After 6 months of intervention, an endline survey was conducted on a different sample of 1148 mothers of infants aged 0-6 months in the same areas. In both intervention areas, TBAs/CVs made regular home visits and attended births whenever possible. Rates of early initiation of breastfeeding, avoidance of prelacteal feeds and exclusive breastfeeding were compared between groups using cluster-controlled mixed model logistic regression. At endline, both intervention groups had significantly higher proportions of mothers who reported early initiation of breastfeeding (CG: 88%, TG: 96%, SG: 96%) and avoidance of prelacteal feeds (CG: 48%, TG: 80%, SG: 88%) compared with the control group; there were no significant differences between the two intervention groups. The endline rates of reported exclusive breastfeeding were not significantly different among groups (CG: 67%, TG: 76%, SG: 83%).
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Affiliation(s)
| | | | - Bineti Vitta
- Program in International and Community NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Ted Greiner
- formerly Department of NutritionHanyang UniversitySeoulKorea
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What Works to Improve Duration of Exclusive Breastfeeding: Lessons from the Exclusive Breastfeeding Promotion Program in Rural Indonesia. Matern Child Health J 2014; 19:1515-25. [DOI: 10.1007/s10995-014-1656-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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