Breastfeeding Knowledge and Behavior Among Women Visiting a Tertiary Care Center in India: A Cross-Sectional Survey

Analysis of Breast Cancer Screening Results and Influencing Factors of Breast Cancer in Guangdong Province from 2017 to 2021

BACKGROUNDS

Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong.

METHODS

This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate.

RESULTS

The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05).

CONCLUSION

The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.

Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal

BACKGROUND

The World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon.

METHODS

A sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding.

RESULTS

Only 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers' breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers' breastfeeding attitudes, beliefs, and practices.

CONCLUSIONS

The findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.

A qualitative study to understand sociocultural beliefs around perinatal and neonatal health in rural areas of Mohali, Punjab, India

Introduction

Globally, 600,000 mothers (15-49 years) die every year due to pregnancy and childbirth-related complications. Wide variations are seen in cultural practices and beliefs surrounding this period of a woman's life. The present study explores the cultural beliefs and practices of women and families during pregnancy and the postnatal period in order to understand what behavioral management strategies are required to improve maternal and infant outcomes during pregnancy and the postpartum period.

Methods

The study was conducted in a rural area of Punjab, from December 2019 to March 2021. A total of 20 women (up to 3 months postpartum, age >18 years, were interviewed.

Results

In general, women described eating varied and fairly healthy diets during pregnancy, especially nutritious warm food, following traditional practices. Other cultural practices included restrictions on movement and mobile phone use and the use of unsafe home remedies to promote infant safety and wellbeing, such as using gripe water, applying black pencil to the baby's eyes, and feeding the baby honey. A few were not inclined to engage with these and other cultural expectations, preferring instead to follow contemporary practices influenced by social media. These practices included being accompanied by a family member during delivery, celebrating the baby's birth regardless of sex, and early bathing post-delivery.

Discussion

It can be concluded that while many traditional practices are still followed in India, there are new beliefs and behaviors arising from an intersection between culture and technology. Developing strategies that acknowledge older beliefs and modern approaches is essential to promoting better antenatal and postpartum care.

Knowledge, attitude and practice among mothers on the relationship between honey and botulism in Saudi Arabian infants: a cross-section study

BACKGROUND

Botulism is a rare disease, and infant botulism (IB) even rarer, especially when steering the condition to honey consumption. IB is considered a life-threatening disease as it leads to severe neurological symptoms. Exploring the knowledge, attitude, and practice (KAP) among mothers on the relationship between honey and IB will help public health professionals implement appropriate maternal health education materials targeting infant health and increase the awareness of the paediatric primary care providers, physicians, and nurse practitioners about the risk of IB among their patients.

OBJECTIVES

To determine the knowledge of mothers from Hail city in Saudi Arabia (SA) regarding IB and assess their attitude and practice towards feeding honey to their infants before 12 months of age.

METHODS

Using a comparative cross-sectional study, in February 2022, we broadcasted an online questionnaire through social networking and evaluated the KAP of 385 mothers.

RESULTS

Less than half (48%) of the mothers have heard about IB, 40% of them knew the relation between honey ingestion and IB and only 6.5% acknowledged that they knew the causative agent for IB. The prevalence of feeding honey to infants before 12 months was 52%. Mothers from Hail city were less likely to provide honey to their infants (p = 0.002).

CONCLUSION

The study revealed that mothers from Hail city have relatively low knowledge of IB and that they hold favourable perceptions of using honey as a food supplement and feeding honey to their infants before 12 months. Considering the high prevalence of honey feeding with the known low incidence of IB in SA, Medical professionals should consider IB in their differential diagnosis particularly in the presence of neurological symptoms.

Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India

Background

Maternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India.

Objective

This qualitative study aimed to: (1) examine pregnant women's experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption.

Methods

We conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework.

Results

For ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described receiving inaccurate counseling messages.

Conclusion

Key drivers of maternal nutrition behavior adoption were indicator specific and varied across the capability-opportunity-motivation behavior change spectrum. Findings from this study can help to strengthen future program effectiveness by identifying specific areas of program improvement.

Comparing the effects of breastfeeding in the laid-back and cradle position upon the experiences of primiparous women: a parallel randomized clinical trial

BACKGROUND AND AIM

Appropriate positioning is crucial to successful breastfeeding and its continuation. Positioning can create, prevent, or correct breastfeeding problems. This study aimed to determine and compare the effects of both the laid-back and cradle positions upon the breastfeeding experiences of primiparous (cisgender) women.

METHODS

A parallel randomized clinical trial was conducted with a sample of primiparous women (n = 168) with a gestational age of between 31 and 34 weeks, referring to the perinatal clinic of Shahid Gharazi Hospital in Malayer (Hamadan Province, Iran). Participants were recruited via convenience sampling and allocated to one of two groups: intervention (laid-back position) (n = 85) and control (cradle position) (n = 83) using the random block method. Breastfeeding education was given to both groups during two sessions (weeks 31-34 and 35--37 of pregnancy) by "baby-friendly" accredited hospitals in Iran. The intervention group was instructed on how to breastfeed using the laid-back position. The control group was instructed on how to breastfeed using the cradle position. In the immediate postnatal period, breastfeeding positions were assessed in both groups. Breastfeeding experiences were measured once at the time of participants returning home and again at both 1 week and 2 weeks following birth, using the breastfeeding experience scale. Data analysis was undertaken using the SPSS software version 21. A value of P < 0.05 was considered significant.

RESULTS

No statistically significant difference was observed between the two groups in terms of concerns relating to participants nor their breasts, milk insufficiency, neonate, process, or breastfeeding experience at any time point measured. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in intervention group were 26.07 (4.533), 26.85 (3.812), and 26.65 (4.632) respectively. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in control group were 25.42 (3.315), 26.68 (3.872), and 25.41 (4.05) respectively.

CONCLUSION

There is no difference in breastfeeding experiences whether the laid-back or cradle position is used. Thus, broader education on breastfeeding and the provision of comprehensive support may be more effective in optimizing one's experience of breastfeeding.

TRIAL REGISTRATION

Registration date: 2021 July 21, Code: IRCT20180427039436N10, https://irct.ir/user/trial/57054/view.

Cultural beliefs, attitudes and perceptions of lactating mothers on exclusive breastfeeding in The Gambia: an ethnographic study

BACKGROUND

WHO/UNICEF recommends that women in resource-poor developing countries- like the Gambia, should exclusively breastfeed their infants for the first six months of their lives because of its health benefits to both mother and infant. The study aimed to explore the cultural beliefs, attitudes, and perceptions of lactating mothers towards exclusive breastfeeding in The Gambia.

METHODS

This was a qualitative ethnographic study of culture-sharing groups of mothers with infants 4 to 6 months old. The study was conducted from July to October 2014 and data collection was done through a face-to-face, in-depth interview and moderate participant observation. The study recruited 22 breastfeeding mothers attending government health facilities in the Kanifing Municipality. The collected data were transcribed verbatim and analyzed through a constant comparison method generating six cultural themes, each with sub-themes.

RESULTS

Baby's welfare is traditionally based on the types of food mother's eat. To this end, mothers reportedly shunned eating green leafy vegetables, liquid and hot foods for their infants' wellbeing. Encounters such as weight loss, nipple inflammation, and backache, which mothers associated with hyper latching and sitting for prolonged breastfeeding, respectively, were among major undesirable physical effects revealed by the participants. Furthermore, the necessity of giving water to infants for their survival was illustrated as a barricade to exclusive breastfeeding practices. Likewise, the entrenched practice of giving charm water to instill the Islamic faith and shielding infants against evil spirits was another factor influencing exclusive breastfeeding practices. Finally, the belief that breast milk adequacy is based on breast size and nurturing men's physical strength by starting prelacteal feeds early in infancy also contributes to the meek exclusive breastfeeding rate among mothers.

CONCLUSION

This study could be a gazette piece for effective policy making and enhance nurses' cultural sensitivity while caring for lactating mothers. Cultural meanings of health care behaviors in lactating mothers challenge universally applying guidelines of exclusive breastfeeding to all societies. The study findings could benefit healthcare providers in informing policies and designing culturally adaptive and acceptable community-based breastfeeding intervention programs in resource-limited settings.

Factors associated with the knowledge about breastfeeding among antenatal and postnatal women in selected rural villages of Chengalpattu, Tamil Nadu: A community-based cross-sectional study

BACKGROUND

Addressing good breastfeeding practices among antenatal and postnatal mothers is important as it helps in bringing about a positive change in the behavior, attitude, and practice with appropriate health education. Hence, this study was done to determine the awareness level of antenatal and postnatal mothers about the breastfeeding practices and benefits and identify the factors associated with it in rural Chengalpattu, Tamil Nadu, India.

MATERIALS AND METHODS

We conducted this community-based cross-sectional study among 377 antenatal and postnatal mothers in the selected rural villages of Chengalpattu between October 2019 and September 2020. Details regarding the sociodemographic characteristics and awareness/knowledge about the breastfeeding were collected using pretested semistructured questionnaire. Knowledge adequacy was summarized as proportion with 95% confidence interval (CI), and factors associated with knowledge were interpreted as adjusted prevalence ratio (aPR) with 95% CI using log-binomial regression.

RESULTS

About 19.6% (95% CI: 15.7%-24.0%) mothers had inadequate knowledge about breastfeeding. Women who were unemployed (aPR = 1.60; 95% CI: 1.02-2.51), belonging to the lower socioeconomic status (aPR = 2.62; 95% CI: 1.80-3.82), belonging to Muslim religion (aPR = 1.63; 95% CI: 1.14-2.35), and living in joint family (aPR = 1.58; 95% CI: 1.12-2.21) had significant higher risk of inadequate knowledge about breastfeeding practices compared to those who were employed, belonging to puper socioeconomic status, Hindu religion, and living in nuclear family.

CONCLUSION

We found that almost one-fifth of the antenatal and/or postnatal mothers had inadequate knowledge about the breastfeeding benefits and practices. Health education sessions are required to promote the awareness about breastfeeding during antenatal and postnatal check-ups.

Comparison of L-Shape and Side-Lying Positions on Breastfeeding Outcomes among Mothers Delivered by Cesarean Section: A Randomized Clinical Trial

Introduction: Ineffective breastfeeding techniques is one of the factors contributing to poor breastfeeding outcomes in post-cesarean mothers. To assist post-cesarean mothers to find a comfortable breastfeeding position, a trial was conducted to compare different positions of breastfeeding in these individuals.

Methods: A randomized clinical parallel trial was carried out on primipara post-cesarean mothers admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Participants were enrolled by convenience sampling technique, which was further randomized (block size= 4) and allocated to receive either "L" shape (n= 30) or side-lying (n= 30) position for breastfeeding. The assigned intervention was provided at least six times a day for four consecutive days. Data were collected using breastfeeding assessment Tool, maternal breastfeeding evaluation scale and numeric pain rating scale. Data were analyzed using SPSS software version 23.

Results: The baseline characteristics of participants in both groups were similar. The mean comparison of breastfeeding outcome and maternal satisfaction indicated no significant difference between the two positions. However, the mean scores of maternal pain were statistically significant. Hence, it was inferred that the maternal pain was significantly less in post-cesarean mothers in "L" shape compared to side-lying.

Conclusion: There is significantly less pain in post-cesarean mothers during breastfeeding in "L" shape than side-lying. Furthermore, maternal satisfaction and breastfeeding outcomes were found to be similar in both positions.

Infant and young child feeding (IYCF) practices and their determinants in two Urban districts of India

Introduction:

It is essential to maintain optimal nutrition during the early years of life when the growth rate is maximum.

Aims and Objectives:

Our study investigated the prevalence of various feeding practices. We also explored their association with different sociodemographic, biomedical variables, and childhood morbidity.

Methodology:

This was a cross-sectional community-based study. Data were collected through a questionnaire-based survey of mothers of school-going children aged 2–6 years in the districts of Anand and Vadodara, Gujarat.

Results:

A total of 367 mothers participated in the study. About 78% of the mothers did early initiation of breastfeeding within 1 h of birth, and 68% gave colostrum to the newborn. Around 30% of the mothers practiced bottle feeding, and 25% gave prelacteal feeds. Most mothers received good family support for breastfeeding (93.73%). On univariate analysis, we found the following associations of feeding practices—breastfeeding initiation with the gender of the baby (P value—0.006) and type of delivery (P value < 0.001); the duration of exclusive breastfeeding with the time difference between two deliveries (P value—0.027) and maternal age (P value—0.004); prelacteal feeds with the type of delivery (P value—0.034); feeding difficulty with the time difference between two deliveries (P value < 0.001) and breastfeeding at night with maternal education (P value—0.002). The time of the initiation of breastfeeding was associated with cough and cold episodes. No other association was found between breastfeeding variables and health indicators.

Conclusion:

Maternal age, maternal education, the time difference between two deliveries, the type of delivery, and gender of the baby were significantly associated with different Infant and Young Child Feeding (IYCF) practices. Identifying these factors might help in the development of strategies for optimizing feeding practices.

Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.

Women's Empowerment and Determinants of Early Initiation of Breastfeeding: A Scoping Review

INTRODUCTION

Early initiation of breastfeeding (EIBF), the immediate provision of mothers' breast milk to infants within the first hour of life, has been recommended by the WHO. However, EIBF is not widely practiced, thereby increasing infant mortality risk. This review explored the available and published studies that identified interventions that empower mothers to practice EIBF.

METHOD

We conducted a scoping review to answer the aforementioned aims. Empowerment, Women, Breastfeed, and Initiation were used as initial keywords, which were further developed using Medical Subject Headings by the National Center for Biotechnology Information. Five databases, namely: Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature via EBSCO, ProQuest, and MedLine via PubMed, were searched for potential articles. We also searched the references in addition to the main search.

FINDINGS

We included 28 articles in this review. Education was mostly used as women's empowerment indicator in EIBF intervention. Additionally, we identified barriers (C-section and postoperative pain, lactation problems and pregnancy complications, mothers' social and demographic factors, mothers' lack of professional support, babies' condition preventing EIBF) and facilitators (mothers' positive behavior in relation to educational level, completion of antenatal care, poor economic situations of mothers, babies' size at birth) of EIBF.

DISCUSSION

Education is the widely used intervention to promote mothers' participation in improving EIBF rate. Furthermore, mothers' and babies' deferring conditions and traditional practices are barriers for EIBF. This review recommends future research and empowerment efforts that sensitively address the identified barriers.

Beyond Newborn Resuscitation: Essential Care for Every Baby and Small Babies

Helping Babies Breathe (HBB) addresses a major cause of newborn mortality by teaching basic steps of neonatal resuscitation and improving survival rates of infants affected by intrapartum-related events or asphyxia. Addressing the additional top causes of mortality (infection and prematurity) requires more comprehensive education, including content on thermal and nutritional support, breastfeeding, and alternative feeding strategies, as well as recognition and treatment of infection. Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) use educational principles developed with HBB as a model for teaching basic newborn care. These programs complement the content provided with HBB, further integrate counseling of families, and advance the agenda of providing quality care to all infants at birth. ECEB and ECSB have further demonstrated that engagement of individuals through active participation in their education empowers providers at all levels. With added experience teaching and implementing ECEB and ECSB, the next generation of newborn educational programs will likely incorporate bedside teaching and clinical exposure, multimedia platforms for demonstrating clinical content, and added efforts toward quality improvement. Through ECEB and ECSB, the attention brought to the newborn health agenda with HBB has only grown. Although current global health issues pose new challenges in implementing this agenda, these programs together provide a critical framework to both educate and advocate for optimal care of every newborn.

Knowledge, attitude, and breast-feeding practices of postnatal mothers in Jammu: A community hospital based cross sectional study

Context:

In spite of convincing evidence of the benefits of breastfeeding, breast feeding rates are less than satisfactory, thus pinpointing large gaps, which need to be identified and addressed.

Aims:

To examine the knowledge, attitude and practices of postnatal mothers towards breast feeding.

Settings and Design:

Community Hospital-based CrossSectional study.

Methods and Materials:

The study was done for a period of 4 months among 178 women attending outpatient department of paediatrics. Data collection was done with the help of face to face interview using pre-tested pre-designed structured questionnaire having information about demographic profile of study participants and knowledge, attitude and practices of breast feeding.

Statistical Analysis Used:

The data was presented as frequencies and percentages.

Results:

Majority (89.9%) of the mothers were breast feeding, however, only 42.7% of the mothers exclusively breast fed their kids. 82.5% of the mothers believe that cow's milk can be substituted for breast milk. All the mothers continue to breast fed their babies during sickness. Almost all respondents were aware of the importance of colostrum, while 80.3% had the misconception that they should stop breast feeding once when weaning was started.

Conclusions:

Mothers should be counselled during antenatal period and all the misconceptions regarding breast feeding should be appropriately addressed.

Exclusive breastfeeding among Saudi mothers: Exposing the substantial gap between knowledge and practice

Background:

Rates of exclusive breastfeeding are exceedingly low in the Arabic world. This study aims to estimate the local prevalence of, and knowledge about, exclusive breastfeeding in Saudi Arabia.

Method:

This is a cross-sectional survey of mothers of infants aged 6–12 months who attended Taif-based “well-baby clinic.” A structured questionnaire was developed to explore predictors of, and participants’ knowledge about, exclusive breastfeeding.

Results:

Participants in the study were 202 mothers. The rate for initiation of breastfeeding in the first hour after childbirth was 13.9%. The prevalence of exclusive breastfeeding was 16.3%. Knowledge level was great among participating mothers as 65.3% of mothers scored over 75% of the total knowledge score and 95% got more than half of the questions right. Only having 3–6 children (P = 0.023) and 1-year interpregnancy interval (P = 0.005) were associated with the positive likelihood of exclusive breastfeeding. Baby age (P = 0.0218), birth in a private facility (P = 0.00843), and university education (P = 0.0131) were associated with better knowledge.

Discussion and Conclusion:

Rates of exclusive breastfeeding practice are low in Saudi Arabia despite adequate knowledge about its benefits and necessity.