Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia

Introduction

Improper positioning, attachment, and suckling are constructs for ineffective breastfeeding technique (IBT). IBT results in inadequate intake of breast milk, which leads to poor weight gain, stunting, and declines immunity. Besides, IBT increases the risk of postpartum breast problems. Despite its impact on maternal and child health, breastfeeding technique is not well studied in Ethiopia. Hence, the purpose of this study was to assess the prevalence of IBT and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia.

Materials and methods

An institution-based cross-sectional study was conducted among 415 lactating mothers attending public health facilities of South Ari district from March 1-29, 2019. A structured observational checklist and interviewer-administered questionnaires were used. Bivariable and multivariable analyses were carried out using binary logistic regression to assess the association between explanatory variables and IBT. Statistical significance was declared at p-value < 0.05.

Results

Overall, the prevalence of IBT was 63.5% [95% confidence interval (CI); 59.0%, 68.0%]. Having no formal education [adjusted odds ratio (AOR): 5.0, 95% CI: 2.3, 10.5], delivering at home [AOR: 4.5; 95% CI; 1.6, 13.1], having breast problems [AOR: 2.5, 95% CI: 1.1, 5.7], being primiparous [AOR: 1.8, 95% CI: 1.0, 3.2], not receiving counseling during pregnancy and postnatal period [AOR: 2.3, 95% CI: 1.4, 3.9 and AOR: 2.5, 95% CI: 1.3, 5.1 respectively] were significantly associated with IBT.

Conclusion

IBT was very high in the study area. Thus, empowering women, increasing institutional delivery, and providing continuous counseling about breastfeeding throughout the maternal continuum of care is invaluable to improve breastfeeding techniques.

Women's Quality of Life at 6 Weeks Postpartum: Influence of the Discomfort Present in the Puerperium

Background: Discomfort during the puerperium period is very frequent in the lives of women but the influence of this discomfort on the women’s quality of life has been little studied. The objective of this study is to establish the association between discomfort and frequent problems of women in the puerperium and their quality of life score. Methods: A cross-sectional study on postpartum Spanish women was performed. Women older than 18 years and who had had a live birth were included. Less than 1% of women refused to participate in the study. Data were collected on socio-demographic, obstetric and newborn variables, on maternal problems/ discomfort in the postnatal period and on parameters that are quality of life indicators. An ad hoc online questionnaire which included the SF-36 Health Survey was used. Crude mean difference (cMD) and adjusted mean difference (aMD) were calculated through multiple linear regression. Results: 2990 women participated in the study. The greater problems causing quality of life loss were depressive symptoms (aMD = −12.40, CI 95%: −10.79, −14.01), lactation problems (aMD = −4.30, CI 95%: −2.97, −5.63), problems for sexual intercourse after childbirth (aMD = −6.34, CI 95%: −5.07, −7.60) and urinary incontinence (aMD = −4.97, CI 95%: −6.30, −3.65), among others. These have been detected as risk factors that affect the quality of life of the postpartum woman. Conclusions: The discomfort and problems manifested in the 6 weeks after childbirth have an influence that deeply affects the quality of life of postpartum women.

Determinants of breastfeeding discontinuation in an Italian cohort of mother-infant dyads in the first six months of life: a randomized controlled trial

BACKGROUND

Among breastfeeding determinants, the marketing of breast milk substitutes might contribute to suboptimal breastfeeding rates. The aim of this study was to investigate the effect of receiving information on breast milk substitutes on breastfeeding rates.

METHODS

We conducted a randomized, single-blind, controlled trial from 2012 to 2014 in a northern Italian maternity ward. We enrolled 802 Caucasian mothers who gave birth to healthy, full-term singletons with a birth weight > 2500 g and who were exclusively breastfeeding from delivery to discharge. Mothers who gave birth to infants with congenital diseases, chromosomal abnormalities, perinatal infections and/or cardio-respiratory instability and/or mothers being affected by endocrine and/or metabolic and/or gastrointestinal and/or renal diseases were excluded. Mothers were randomized to either receive (group A, n = 405) or not (group B, n = 397) written information on a breast milk substitute at discharge. Breastfeeding was promoted and supported in all mother-infant pairs equally. The mode of feeding for up to 6 months after delivery was determined by phone interview. To detect a 10% difference between groups in the discontinuation rate of exclusive breastfeeding at three months of age at 5% significance and 80% power, a total of 356 mother-infant pairs per group were needed.

RESULTS

The exclusive breastfeeding prevalence was 91% and 92% at 7 days, 79% and 70% at 1 month, 75% and 66% at 2 months, 72% and 62% at 3 months, and 3% and 2% at 6 months in groups A and B, respectively. The relative risk (95% confidence interval) of exclusive breastfeeding (group A vs B) at 7 days and at 1, 2, 3 and 6 months was as follows: 0.99 (0.95-1.03), 1.12 (1.03-1.21), 1.13 (1.03-1.24), 1.15 (1.04-1.27), and 1.49 (0.62-3.61). Nutritional, lifestyle and lactational factors were the primary contributing determinants to early breastfeeding discontinuation.

CONCLUSIONS

The present findings indicate that receiving written information on breast milk substitutes at hospital discharge, provided that breastfeeding support and education are offered, does not negatively affect breastfeeding rates.

TRIAL REGISTRATION

NCT03208114. Registered 5 July 2017.

[Evaluation of risk factors for Mastitis-Metritis-Agalactia in pig farms in Switzerland]

Mastitis-Metritis-Agalactia (MMA), also known as postpartum dysgalactia syndrome (PPDS) is the most important disease complex in sows after birth. The present study compared 30 MMA problem herds (over 12% of farrowing sows affected) with 30 control farms (less than 10% of farrowing sows affected) to identify risk factors and treatment incidence. Important risk factors identified were in gilts the integration into the herd after the first farrowing, in gestating sows firm fecal consistency as well as in lactating sows soiled troughs, a low flow rate (<2 liters per minute) in drinking nipples and a high prevalence of lameness. The treatment incidence was also significantly different between the two groups. The MMA prevalence could be reduced through optimization of husbandry, feeding and management, which could essentially diminish the use of antibiotics.

Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review

AIM

To determine if women with diabetes in pregnancy have a delayed onset of lactation through a systematic review of the literature.

METHODS

We searched databases including MEDLINE, Web of Science, PubMed, CINAHL Plus and PsychINFO for articles assessing diabetes in pregnancy and lactogenesis. Thirty-one articles were screened and 10 articles were included in the systematic review. We extracted data on diabetes in pregnancy and onset of lactation (secretory activation or lactogenesis II).

RESULTS

The 10 studies examining the association between women with diabetes in pregnancy and delayed onset of lactation reported a significant delay in women with diabetes compared with women without diabetes. Two studies assessed the impact of metabolic control on lactogenesis, and found an association between poorer metabolic control and delayed onset of lactation.

CONCLUSIONS

Although this review has found evidence of an association between women experiencing diabetes during pregnancy and delayed onset of lactation, the presence of many potential confounding factors need to be acknowledged.

Sheehan's syndrome in Xinjiang: Clinical characteristics and laboratory evaluation of 97 patients

OBJECTIVE

To evaluate the clinical and hormonal characteristics of patients with Sheehan's syndrome in Xinjiang, China.

METHODS

97 cases diagnosed as Sheehan's syndrome in our hospital from 1999 to 2013 were retrospectively reviewed. The medical history, physical examination findings and hormonal profiles were documented and analyzed.

RESULTS

The mean age at diagnosis was 43.7±12.4 years, with a mean diagnostic delay of 9.1±9.5 years (range, 1 month-35 years). 10 of our patients (10.3%) had a home birth. 96 of our patients (99.0%) had a history of obstetric hemorrhage. The most common clinical presentation included amenorrhea (80/97, 82.5%), agalactia (2/97, 74.2%) and loss of axillary or pubic hair (83/97, 85.6%). Seventy two of our patients (74.2%) failed to lactate and 80 of our patients (82.5%) failed to resume menstruation. Hypothalamic dysfunction included the hypothalamic-pituitary-gonadal axis (HPG) (LH deficiency: 77/83 patients, 92.8%; FSH deficiency: 73/83 patients, 88%; E2 deficiency: 62 of 82 patients,75.6%), the hypothalamic-pituitary-thyroid (HPT) axis (TSH deficiency: 77/93 patients, 82.8%, TT3 deficiency: 70/ 87 patients, 80.5%, TT4 deficiency: 72/87 patients, 82.8%) and the hypothalamus-pituitary-adrenal (HPA) axis (ACTH deficiency: 19/37 patients, 51.4%, cortisol deficiency: 49/64, 76.6%).

CONCLUSIONS

Sheehan's syndrome is still common in Xinjiang, especially in rural areas. Long diagnosis delay in most of the patients indicates that women might be lacking correct diagnosis and treatment. Physicians need to be aware of the most important clues for diagnosis such as lack of lactation in the postpartum period and failure to resume menstruation.

Breastfeeding is natural but not always easy: intervention for common medical problems of breastfeeding mothers - a review of the scientific evidence

Natural processes do not always function perfectly. In breastfeeding, problems are encountered in up to 80% of mother-infant dyads. Altogether, in Western societies, the difficulties reduce the breastfeeding rate within the first months drastically. To deal with the problems of breastfeeding efficiently requires a profound understanding of its physiology, as well as of its psychological and social determinants. This review focuses on the current knowledge of breastfeeding physiology, only touching the psychosocial factors, which are included in the promotion strategies. Subsequently, it scrutinizes definitions, incidences, prevention, and treatment of breastfeeding problems faced most frequently by nursing mothers and their consultants. Not all measures used in counseling mothers and not all treatments for the most common medical problems withstand a careful evaluation on the basis of current scientific data. However, applying proven prevention strategies will significantly improve the well being of mothers and their infants, and may contribute to an affective attitude that increases the success, frequency, and duration of breastfeeding.

Reasons for failure of exclusive breastfeeding in children less than six months of age

BACKGROUND

Human milk is the natural food for full term infants and is the most appropriate milk for the human infants. The objective of the study was to determine the frequency of common reasons of failure of exclusive breastfeeding in children less than six months of age.

METHODS

It was a cross-sectional study conducted at Rawal institute of health sciences (RIHS) from March to October 2013. Three hundred and ten infant-mother pairs not receiving exclusive breastfeeding were included.

RESULTS

The mean infants' age was 99.2 +/- 57.9 days and 185 (59.7%) were male infants. The average number of children in the family was 2.74 +/- 1.86, the mean monthly income was 16,542 +/- 12,761 rupees: 169 (54.5%) infants belonged to urban areas, 122 (39.3%) babies were low birth weight: 241 (77.7%) infants were born in the hospital; majority. i.e.. 135 (43.5%) mothers were illiterate majority, i.e.. 282 (91%) mothers were housewives. In only 2 (0.6%) babies the breast feeding was started within < 1 hour after birth. Among the study group 246 (79.4%) were partially breastfed and 64 (20.6%) were completely bottle-fed, 90 (29%) were already started on complementary feeding and the mean age of starting complementary feeding was 4.54 +/- 0.783 months. The commonest reason of failure of exclusive breastfeeding was insufficient milk production in 289 (93.2%), working mother in 13 (4.2%) mothers, illness of baby in 2 (0.65%), illness of mother in 6 (1.9%) cases.

CONCLUSION

The commonest reason of failure of exclusive breastfeeding was insufficient milk production in over 90% cases and was followed by working mother, illness of baby and illness of mother in the remaining.

Failed lactation and perinatal depression: common problems with shared neuroendocrine mechanisms?

In the early postpartum period, mother and infant navigate a critical neuroendocrine transition from pregnancy to lactation. Two major clinical problems that occur during this transition are failed lactation and perinatal mood disorders. These disorders often overlap in clinical settings. Failed lactation is common. Although all major medical organizations recommend 6 months of exclusive breastfeeding, only 13% of women in the United States achieve this recommendation. Perinatal mood disorders affect 10% of mothers, with substantial morbidity for mother and child. We hypothesize that shared neuroendocrine mechanisms contribute to both failed lactation and perinatal mood disorders. In this hypothesis article, we discuss data from both animal models and clinical studies that suggest neuroendocrine mechanisms that may underlie these two disorders. Research to elucidate the role of these underlying mechanisms may identify treatment strategies both to relieve perinatal depression and to enable women to achieve their infant feeding goals.

Reasons for giving up breastfeeding and support during problems with lactation in the north-western part of Poland

INTRODUCTION

Breastfeeding is the optimal way of feeding for neonates and infants. Its duration is of vital importance for the child's development and health. The World Health Organization recommends exclusive breastfeeding until the end of the sixth month of life. Many mothers give up breastfeeding earlier than recommended. Professional and non-professional support plays a great role in motivation to start and continue breastfeeding. The aim of this study was to determine how long infants from Szczecin, the capital city of the North-Western region of Poland, are breastfed, what are the reasons for giving up breastfeeding, and whether mothers obtain support in case of problems with lactation.

METHODS

One hundred randomly chosen mothers with children aged 12-18 months, living in Szczecin, were examined. A questionnaire was administered to the mothers during a direct interview. Prior to the interview, consent of the mothers to participate in the study was obtained.

RESULTS

More than 8% of the mothers gave up breastfeeding during the first month after delivery, 68% were breastfeeding till the end of the third month, 31.5% were breastfeeding till the end of the sixth month, and only 2% continued to breastfeed for one year or longer. The most frequent reasons for giving up breastfeeding were: return to work (43.4%), small volume of milk (29.3%) and child's reluctance to suck (18.5%). 62% of breastfeeding women benefited from support during lactation problems but only 6% visited an outpatient breastfeeding service or joined a breastfeeding mothers support group. Support was obtained from the family midwife (37%), pediatrician (32%), and midwife at an outpatient clinic (25.8%). Most women (74.2%) were satisfied with the support.

CONCLUSIONS

(1) It is necessary to promote breastfeeding so that all women could decide to start breastfeeding after childbirth. 2. As the percentage of women who continue breastfeeding after the sixth month of the infant's life is unsatisfactory, mothers should be encouraged to breastfeed longer. (3) A system of professional lactation support for breastfeeding mothers should be developed.

Predictors of delayed onset of lactation

The objective of this study was to identify biomedical and hospital-related factors associated with the delayed onset of lactation (>72 h postpartum) in a population of Australian women. Subjects were 453 women participating in the second Perth Infant Feeding Study. Information on mothers' perception of the timing of the onset of lactation and associated explanatory factors was collected in a questionnaire completed by women prior to or shortly after discharge from hospital. Multivariate logistic regression was used to identify those factors independently associated with delayed lactation. Risk factors for delayed lactation were being primiparous (adjusted OR 3.16, 95% CI 1.58-6.33) and having delivered by caesarean section (adjusted OR 2.40, 95% CI 1.28-4.51). We failed to find a negative association with maternal body mass index reported in previous studies. While a greater proportion of women who experienced delayed lactation were overweight or obese compared with those who did not experience delayed lactation (40.8% vs. 32.1%), this difference was not statistically significant.

Lessons from the latest infant feeding survey

The 2005 Infant Feeding Survey showed that in the U.K., despite promotion of breast-feeding by Government and professionals and an improving initiation rate, there is a sharp fall in the numbers of mothers exclusively breastfeeding during the early weeks and months after the birth. Early discharge from hospital, before breast-feeding is established, may be a factor Nine out of 10 mothers wh gave up breast-feeding in the first six weeks reported wanting to continue longer More support is needed to help these mothers, through a combination of professional and lay support. Most mothers turn to their midwife and health visitor for information and advice but the numbers of these professionals in the health service have been failing in recent years.

Is Maternal Obesity a Cause of Poor Lactation Performance?

Several investigators have reported a relationship between maternal obesity and low rates of initiation and duration of breast-feeding. Recent research findings suggest that poor infant feeding behavior and reduced hormonal responses in the early postpartum period result in delayed lactogenesis and early cessation of breast-feeding among overweight/obese women.

Genetic Basis and Risk Factors for Infectious and Noninfectious Diseases in US Holsteins. I. Estimation of Genetic Parameters for Single Diseases and General Health

Health data collected from 1996 to 1999 from 177 herds in Minnesota and Wisconsin were analyzed to establish genetic basis for infectious and noninfectious diseases. Three types of health traits were targeted. First, available infectious conditions were used to identify animals that are superior in their general immunity (including innate immunity) for infectious diseases. Generalized immunity may be thought of as a combination of immune responses to a variety of immune system challenges. Second, single infectious and noninfectious diseases were analyzed separately. Third, infectious reproductive diseases as one category of related conditions, and cystic ovary disease as one category of 3 related noninfectious ovary disorders were studied. Data were analyzed using a threshold model that included herd, calving year, season of calving, and parity as cross-classified fixed factors; and sire and cow within sires as random effects. Days at risk and days in milk at the beginning of a record were included by fitting the days as continuous covariates in the model. A heritability value of 0.202 +/- 0.083 was estimated for generalized immunity. Heritability values of 0.141 and 0.161 were estimated for uterine infection and mastitis, respectively. Heritability of single noninfectious disorders ranged from 0.087 to 0.349. The amount of additive genetic variance recovered in the underlying scale of noninfectious disorders tended to zero when combining multiple conditions. The study supports combining infectious diseases into categories of interest but we do not recommend the same approach for noninfectious disorders.

Serological study of contagious agalactia in herds of goats in the Canary Islands

An indirect ELISA, using local strains of Mycoplasma agalactiae and Mycoplasma mycoides subspecies mycoides large colony (MmmLC), was applied to evaluate the seroprevalence of M agalactiae and MmmLC in flocks of goats on each of the Canary Islands. In total 3890 samples of serum were collected from 204 flocks. The results indicated that the seroprevalence of both organisms is high on all the islands; average values of 55 per cent and 67 per cent were recorded, respectively, for M agalactiae and MmmLC.

The impact of peripartum factors on the onset and duration of lactation

Knowledge of peripartum indicators of those mother-infant pairs that are at increased risk of early failure of lactation may improve specific support of breastfeeding. Mode of delivery, labor complications, hyperbilirubinemia, milk intake and weight development were evaluated in healthy term infants in a hospital (n = 338). Delayed onset of lactation was observed in primiparae and in study participants with peripartum complications. The quantitative intake of human milk, assessed by test weighing 0-24 h and 24-48 h after the onset of lactation, was not significantly different between these groups. In addition, volume intake, weight gain and lactation success were tracked in 77 infants. Partial feeding of infant formula or an intake of <150 g of human milk per day 24-48 h after the onset of lactation was linked to weaning within 4 weeks. Ninety-one percent of the infants were exclusively breastfed at discharge; this value had declined to 49, 35 and 20% at 4, 12 and 20 weeks, respectively. Peripartum factors may contribute to early lactation failure; the long-term success of breastfeeding was predominantly determined outside the hospital.

Genital Lesions in an Outbreak of Caprine Contagious Agalactia Caused by Mycoplasma agalactiae and Mycoplasma putrefaciens

This paper reports on the genital lesions observed in adult male and female goats from a commercial flock in the Extremadura region of southwestern Spain, following an outbreak of contagious agalactia syndrome caused by Mycoplasma agalactiae and M. putrefaciens. Although both species were isolated from several organs, M. putrefaciens was the only agent isolated from the genital lesions reported here, characterized by desquamative salpingitis and cystic catarrhal metritis in females and by testicular degeneration in males. Mycoplasma putrefaciens was isolated from the testes of only one of the males examined.

Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss

OBJECTIVE

Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed.

METHODS

All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was >or=10% of birth weight by day 3.

RESULTS

Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >27 kg/m(2) (day 7) and birth weight <3600 g (day 7). Delayed onset of lactation (>72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m(2), flat or inverted nipples, and birth weight >3600 g (in primiparas). Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth. The risk of excess infant weight loss was 7.1 times greater if the mother had delayed onset of lactation, and 2.6 times greater if the infant had SIBB on day 0.

CONCLUSIONS

Early lactation success is strongly influenced by parity, but may also be affected by potentially modifiable factors such as delivery mode, duration of labor, labor medications, use of nonbreast milk fluids and/or pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be evaluated at 72 to 96 hours' postpartum.

Neospora caninum serostatus and milk production of Holstein cattle

OBJECTIVE

To determine whether Neospora caninum serostatus was associated with milk production among Holstein cattle in Ontario.

DESIGN

Case-control study and cross-sectional observational study.

ANIMALS

3,702 Holstein cows in 83 herds (case-control study) and 3,162 Holstein cows in 57 herds.

PROCEDURE

Herds in the case-control study were grouped on the basis of N. caninum abortion status. Herds in the observational study were considered representative of Ontario dairy herds. The N. caninum serostatus of individual cows was determined with a kinetic ELISA. Milk production was modeled to compare seropositive with seronegative animals while controlling for parity, days since parturition, and herd clustering.

RESULTS

In the case-control study, 305-day milk production of seropositive cows was significantly less than milk production of seronegative cows in herds with abortions attributable to N. caninum infection and in herds with abortions attributable to pathogens other than N. caninum, but not in herds without abortion problems. In the observational study, 305-day milk production for seropositive cows was not significantly different from milk production of seronegative cows.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that the association between N. caninum serostatus and milk production in Ontario Holstein dairy cattle may depend on abortion status of the herd. In herds with abortion problems, regardless of cause, N. caninum-seropositive cattle produced less milk, whereas in herds without abortion problems, N. caninum-seropositive cattle produced the same amount of milk as seronegative cattle.

Effect of periparturient diseases accompanied by excessive vulval discharge and weaning to mating interval on sow reproductive performance

OBJECTIVE

To evaluate the effect of periparturient disease accompanied by vulval discharge, and weaning-to-mating intervals, on sow fertility and litter size.

DESIGN REPRODUCTIVE

data were collected and analysed from 19 Hungarian swine herds over a 4 year period. Conception rates, farrowing rates and litter sizes of sows with periparturient disease accompanied by vulval discharge were used to evaluate the relationship between duration of vulval discharge and subsequent fertility and litter size. The possibility of interactions between weaning-to-mating intervals and duration of vulval discharges was investigated to determine if there was any effect on subsequent fertility and litter size.

RESULTS AND CONCLUSIONS

Both parity 1 and parity 2 to 8 sows having had periparturient disease accompanied by vulval discharge in excess of 6 days duration had significantly (P < 0.001) lower subsequent fertility (conception, farrowing and adjusted farrowing rates) compared with sows of similar parity where the duration of vulval discharge was < 4 or 4 to 6 days. There was no difference in fertility rates between sows, in both parity categories, with vulval discharge for < 4 days compared with 4 to 6 days. A duration of vulval discharge in excess of 6 days in parity 1 sows significantly reduced litter size (total born and live-born) in subsequent farrowings, but not in parity 2 to 8 sows. There was no interaction between the duration of vulval discharge and post-weaning to mating intervals. However sows with weaning to mating intervals between 7 and 10 days had smaller (P < 0.001) subsequent litter sizes compared with 3 to 6 or 11 to 14 day intervals. It was concluded that the duration of vulval discharge in excess of 6 days was an indication of a severe persistent endometritis adversely affecting fertility of sows.

Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States

In 1994-1998, the authors followed 946 breastfeeding women from Michigan and Nebraska for the first 3 months postpartum or until they stopped breastfeeding to describe mastitis incidence, mastitis treatment, and any associations between mastitis occurrence and hypothesized host characteristics and behaviors. Participants were interviewed by telephone at 3, 6, 9, and 12 weeks postpartum or until they ceased breastfeeding. A total of 9.5% reported provider-diagnosed lactation mastitis at least once during the 12-week period, with 64% diagnosed via telephone. After adjustment in a logistic regression model, history of mastitis with a previous child (odds ratio (OR) = 4.0, 95% confidence interval (CI): 2.64, 6.11), cracks and nipple sores in the same week as mastitis (OR = 3.4, 95% CI: 2.04, 5.51), using an antifungal nipple cream (presumably for nipple thrush) in the same 3-week interval as mastitis (OR = 3.4, 95% CI: 1.37, 8.54), and (for women with no prior mastitis history) using a manual breast pump (OR = 3.3, 95% CI: 1.92, 5.62) strongly predicted mastitis. Feeding fewer than 10 times per day was protective regardless of whether or not feeding frequency in the same week or the week before mastitis was included in the model (for the same week: 7-9 times: OR = 0.6, 95% CI: 0.41, 1.01; < or =6 times: OR = 0.4, 95% CI: 0.19, 0.82). Duration of feeding was not associated with mastitis risk.

Identification of risk factors for delayed onset of lactation

OBJECTIVE

To identify infant feeding, socioeconomic, demographic, and delivery-related factors that affect women's self-reported timing of the onset of lactation.

DESIGN

Longitudinal survey of women from day 1 postpartum until self-reported onset of lactation. Subjects were interviewed in person on day 1 postpartum, then surveyed daily by telephone regarding infant feeding method, breast symptoms, and perception of whether the onset of lactation had occurred. Medical records were reviewed.

SUBJECTS/SETTING

Data were collected from 192 women after they gave birth to a healthy, term singleton.

STATISTICAL ANALYSES PERFORMED

chi 2 Analyses were used to identify variables associated with delayed onset of lactation (onset of lactation > or = 72 hours postpartum). Multivariate logistic regression was used to identify the independent association of each significant variable with delayed onset of lactation.

RESULTS

Risk factors for delayed onset of lactation included white/Hispanic ethnicity, heavy/obese body build, delivery of offspring by unscheduled cesarean delivery, vaginal delivery with prolonged stage 2 labor, infant birth weight less than 8 lb, and exclusive formula-feeding before the onset of lactation.

APPLICATIONS/CONCLUSIONS

Women who are at risk for delayed onset of lactation need additional breast-feeding support during the first week postpartum. During their hospitalization, these women should be instructed about the normal lactation process and the possibility that onset of lactation may occur later than 72 hours postpartum. Frequent nursing should be recommended, as delayed onset of lactation was associated with the lack of infant suckling.

Incidence risk and aetiology of mammary abnormalities in dry ewes in 10 flocks in southern Greece

In a field investigation of 10 flocks in Southern Greece, 3367 dairy ewes were examined twice, in order to estimate the incidence risk and the aetiology of mammary abnormalities during the dry-period. Abnormal secretion, lumps, nodules, diffuse hardness, abscesses and cysts were the abnormalities detected. The cumulative incidence of mammary abnormalities during the dry-period was 5.1% (95% confidence interval: 4.4-5.8%); 47% of the cases detected developed during the first three weeks after cessation of lactation. Despite variation in the flock size, there was no between-flock variation in the risk of a ewe developing mammary abnormalities. Staphylococci (Staphylococcus aureus and coagulase-negative isolates) were the most frequently isolated bacteria from mammary samples; Actinomyces pyogenes, Clostridium perfringens, streptococci and Escherichia coli were also isolated. Resistance was encountered among the staphylococcal isolates.

Characteristics of lactation mastitis in a Western Australian cohort

This study followed a prospective cohort of 306 breastfeeding mothers for the first three months postpartum and identified a cumulative incidence rate for lactation mastitis of 27.1% and a cumulative recurrence rate of 6.5%. Mastitis was given as the reason for cessation of breastfeeding by 18% of women who ceased to breastfeed. It was the third most commonly stated reason given for cessation of breastfeeding. Fifty-one percent of cases occurred within the first two weeks postpartum. Early onset mastitis and the severity of localised symptoms were associated with bilateral mastitis and protracted outcomes.

Risk factors for culling and deaths in eight dairy herds

OBJECTIVES

To identify risk factors for culling of dairy cows from eight New South Wales dairy herds.

DESIGN

A longitudinal population study of dairy cow culling in eight non-seasonally calving dairy herds in the Camden district of New South Wales. Cox's proportional hazards model was used to evaluate various risk factors for culling for a specific reason (sales, deaths, reproductive failure, disorders of the udder and low milk production).

RESULTS

Age at first calving was not a significant risk factor for culling. Milk production in the first lactation greater than the population mean did not influence length of productive life overall, but was associated with a greater hazard of removal for disorders of the udder. Risk of culling for reproductive failure differed significantly between farms, and was not related to events in the previous lactation such as calving-to-first service interval or calving-to-conception interval. Shorter calving intervals were associated with increased risk of removal for low milk production and disorders of the udder.

CONCLUSION

Longitudinal surveys to accurately identify reasons for removal from a wide range of herds, identification of herds with low culling rates (especially for reproductive failure and udder disorders), and the identification of practices associated with these culling rates would be worthwhile to the Australian dairy industry.

Disease occurrence and risk factor analysis in Finnish Ayrshire cows

Disease occurrences and risk factors for the most common diseases among 39,727 Finnish Ayrshire dairy cows belonging to 2338 herds were studied. All the cows calved during 1993 and were followed until the next calving or culling. Lactational incidence risks, recurrence of, and number of treatments required for one episode of a disease are described for 17 different veterinary diagnoses. The 5 most common diseases and their lactational incidence risks were: acute mastitis (17.0%), anestrus (8.1%), ovarian cysts (7.3%), milk fever (5.4%), and ketosis (4.9%). The highest recurrence probability (14.2%) was observed for acute mastitis, followed by fertility disorders. Milk fever was the one disease that required the most repeated treatments, i.e., almost 30% of the cows were treated at least twice, whereas for most of the other diseases about 10% of the cows required more than one treatment per first episode of the disease. Logistic regression models were fitted to study the effect of milk yield and other risk factors on the occurrence of the 5 most common diseases. Increasing milk yield was found to be a risk factor for acute mastitis, ovarian cysts, and for anestrus among older cows (parity > 2), and for milk fever among younger cows (parity = 2). Several diseases were found to be risk factors for other diseases.

Contagious agalactia of small ruminants: current knowledge concerning epidemiology, diagnosis and control

Contagious agalactia of small ruminants is a syndrome which principally affects the mammary glands, joints and eyes. The main causal agents are Mycoplasma agalactiae in sheep, and M. agalactiae, M. mycoides subsp. mycoides large colony type and M. capricolum subsp. capricolum in goats. In addition, M. putrefaciens can produce a similar clinical picture, particularly in goats. Contagious agalactia occurs on all five continents and is often enzootic. The evolution of the infection tends to be chronic in affected animals and herds. Symptomless shedding of mycoplasmas, mainly in the milk, may persist for a long time. These insidious infections, associated with carriage in the ears of healthy animals, are difficult to diagnose and to control. The main mode of transmission between flocks is related to the sale of carrier animals and contact during transhumance, whereas transmission within a flock occurs through contact, suckling and milking. This review discusses the clinical features, epidemiology, treatment, prevention and control of the disease.

Safety and efficacy of a mutagen-attenuated Rift Valley fever virus vaccine in cattle

OBJECTIVE

To examine safety and efficacy of a mutagen attenuated Rift Valley fever virus (RVFV) vaccine (RVF MP-12) in cattle.

ANIMALS

38 pregnant cows, 14 steers, and 10 lactating dairy cows.

PROCEDURE

Pregnant cows in their third, fifth, or eighth month of gestation were vaccinated (1 ml of RVF MP-12 containing 5 log10 plaque-forming units [PFU] of virus) and were monitored daily through parturition for signs of disease, viremia, and immunologic response. Additionally, 10 vaccinated pregnant cows were challenge inoculated with virulent RVFV at post-vaccination day (PVD) 30 and were monitored daily for untoward effects. Ten unvaccinated pregnant cows also were challenge inoculated with virulent RVFV and served as challenge controls. Vaccinated lactating dairy cows were monitored for viremia and virus shedding in the milk through PVD 14. Yearling steers were vaccinated to assess their immunologic response to various doses of vaccine and were challenge inoculated with virulent RVFV at PVD 28 to assess protection.

RESULTS

10 of 38 (26.3%) cows vaccinated during pregnancy developed transient postvaccination viremia titer > or = 2.5 log10 PFU/ml of serum. All vaccinated cows delivered live, healthy calves that were RVFV seronegative at birth, but which quickly acquired colostral antibodies. Vaccinated cows and their fetuses were protected when challenge exposed with virulent RVFV at PVD 30, whereas unvaccinated pregnant cows inoculated with RVFV became febrile and viremic, and aborted. Vaccine virus was unsuccessfully sought from milk of lactating dairy cows after vaccination, suggesting that shedding of vaccine virus through milk should not be a concern. Steers, inoculated with tenfold escalating vaccine doses, beginning with 1.0 log10 PFU, were protected against virulent RVFV challenge exposure.

CONCLUSIONS

RVF MP-12 may be safe and efficacious for use in pregnant or lactating bovids, and a minimal dose of vaccine may provide suitable protection against viremia.

Lactation and breast cancer risk

Breast cancer is a common disease with few practical preventive measures. The recent evidence that lactation, like other reproductive experiences, is associated with a modest reduction in breast cancer risk is therefore of great interest. Overall, the reduction in risk appears to be about 20% for ever breast feeding and is even greater for women with histories of prolonged lactation, or who initiate breast feeding at young ages. In many studies this risk reduction seems to be limited to premenopausal women. It appears unlikely that this inverse association is attributable either to higher risk among women who use lactation suppressants or who have difficulty either starting or continuing breast feeding. While a strong or consistent protective effect of lactation on breast cancer risk has not been observed in some large and well conducted studies, this likely reflects the limited breast feeding practices among modern women. If early, exclusive and extended breast feeding is necessary to achieve a breast cancer risk reduction, future studies among U.S. women may be unable to clarify this association.

[Contagious agalactia of small ruminants: epidemiology, diagnosis and control]

Contagious agalactia of small ruminants is a syndrome which affects mainly the mammary glands, joints and eyes. The principal causal agents are Mycoplasma agalactiae in sheep and M. agalactiae, M. mycoides subsp. mycoides large colony type and M. capricolum subsp. capricolum in goats. In addition, M. putrefaciens can produce a similar clinical picture, particularly in goats. Contagious agalactia occurs on all five continents and is often enzootic. These infections are chronic in animals and in flocks. Symptomless shedding of mycoplasmas, mainly in the milk, may persist for a long time. Associated with carriage in the ears of healthy animals, these insidious infections are difficult to diagnose and control. The sale of carrier animals and contact during transhumance are the main modes of transmission between flocks, while transmission within a flock occurs through contact, suckling and milking. This review discusses clinical features, epidemiology, treatment, prevention and control.

Lactation after augmentation mammoplasty

OBJECTIVE

To compare the lactation outcomes of breast-augmented women and nonaugmented women.

METHODS

This study used a retrospective, comparative design. Demographic and descriptive data were obtained from client records maintained by a lactation support program at a large children's hospital in the southwest United States. The association between breast augmentation and lactation outcome in the two groups was investigated by obtaining data from these existing records.

RESULTS

A significantly greater incidence of lactation insufficiency was found in augmented women compared with nonaugmented women (P < .001). Among 42 augmented women, 27 (64%) had insufficient lactation, compared with only three (less than 7%) of the 42 nonaugmented women. Augmented women who experienced sufficient lactation were equivalent in age, ethnicity, type of delivery, smoking, previous breast-feeding experience, and lactation course compared to augmented women with lactation insufficiency. However, the type of breast incision was significantly associated with lactation outcome. More specifically, it was the periareolar approach that was most significantly associated with lactation insufficiency (P < .01). The incidence of lactation insufficiency with the submammary-axillary approach was only statistically significant when compared with nonaugmented women.

CONCLUSION

A significantly greater incidence of insufficient lactation was found among augmented women compared with nonaugmented women. The periareolar approach was most significantly associated with lactation insufficiency.

Recurrence odds ratios for periparturient diseases and reproductive traits of dairy cows

The recurrence odds ratios were calculated for a number of periparturient diseases and reproductive traits from 1490 pairs of successive lactations in dairy cattle. Vulval discharge, oestrus not observed and mastitis diagnosed before service had summary recurrence ratios of 1.39, 1.37 and 1.49 respectively, all statistically significant at the 5% level. Retained foetal membranes and calf mortality had higher summary risk ratios of 1.84 and 1.76 respectively, but were not significant at the 5% level. Whilst the number of services per conception did have a recurrence ratio above 1, the result was not significant at the 5% level.

Factors associated with perceived insufficient milk in a low-income urban population in Mexico

Survival analysis and logistic regression were used to identify factors associated with the onset of perceived insufficient milk among 165 healthy mothers who planned to breast-feed and gave birth by vaginal delivery, without complications, to a healthy term infant in either a nursery (n = 58) or a rooming-in-hospital where formula supplementation was not allowed (n = 107). Women were interviewed in the hospital and at 1 wk, 2 mo and 4 mo postpartum. Women from both hospitals were similar in socioeconomic, demographic, anthropometric, previous infant feeding experience and prenatal care variables. Eighty percent of the women reported perceived insufficient milk at some point during the study. The cue interpreted most often as indicating insufficient milk was the crying of the infant. Multivariate analyses indicated that lack of confidence in breast-feeding, delayed onset of milk production, maternal education, multiparity, sore nipples, early introduction of formula to the previous child and mother breast-fed as a child were significantly associated (P < 0.05) with perceived insufficient milk. Among women who reported perceived insufficient milk before 1 wk, breast-feeding confidence and maternal education interacted with the hospital in which they delivered.

Experiences of primiparous breast-feeding mothers in the first days following birth

This study describes the breast-feeding patterns of 59 neonates and the experiences of their primiparous mothers during the early postpartum period. The results showed that most mothers and babies in this group had significant difficulties during the first 2 days after birth and that 33% of the mother-baby pairs were still having problems latching or sucking on discharge from hospital (fourth to fifth postpartum days). Of the mothers who were still having problems on leaving the hospital, 84% had given up breast-feeding by 8 weeks, most of them by 2 weeks following hospital discharge.

Prevalence and severity of lameness in lactating dairy cows in a sample of Minnesota and Wisconsin herds

An epidemiologic study investigating the prevalence of lameness in lactating dairy cows was performed in 17 dairy herds in Minnesota and Wisconsin. The mean herd size was 50 cows. Cows from 14 herds were housed in stanchions or tie stalls, and cows from 3 herds in free stalls or dry lot. During visits to each farm in the summer and subsequent spring, 2 investigators simultaneously but independently evaluated the ambulation of lactating cows by use of a standardized scoring system. The lameness scoring system was reliable at the 2 visits, with 92.7 and 91.3% agreement between the 2 observers and kappa coefficients of 0.60. The prevalence of lameness detected by the investigators ("clinical" lameness) was 13.7% (117/853) in summer and 16.7% (134/801) in spring in lactating dairy cows. These prevalences were 2.5 times higher than those estimated by the herd managers. Parity was significantly (P < or = 0.03) associated with lameness, with higher prevalence of clinical lameness found in cows of higher parity.

The reasons for early weaning among mothers in Teheran

In order to identify the reasons for early weaning in Teheran, we interviewed 900 mothers using a systematic randomized sampling method. A total of 15% of the mothers were illiterate, 93% were housewives, and 97% had given birth in hospitals. Only 3% of the newborns benefited from rooming-in facilities in hospital, and 68% were bottle-fed while still in hospital. In 3.1% of cases the mother had not breast-fed her newborn at all. Of those who had breast-fed their infant, 38% used only their own milk, whereas 62% used a combination of breast milk and infant formula. The median duration of breast-feeding was 16 months (mean, 14 months). A total of 74% of mothers who used supplementary formula and 39% of those who had completely stopped breast-feeding blamed milk insufficiency, although 67% of these mothers had reached this conclusion only because their infants cried or were irritable. The following factors had a negative influence on the duration of breast-feeding: use of supplementary formula and of estrogen-containing oral contraceptives; fathers with high incomes; and mothers with a high educational level. In contrast, the mother's religious motive to breast-feed and her insistence on breast-feeding had a positive impact. Unfortunately, 21% of the mothers started using supplementary formula during the first month postpartum, and two-thirds before the end of the fourth month. Every month that bottle-feeding was started prematurely shortened the duration of breast-feeding by 20 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of Staphylococcus species during the periparturient period in primiparous and multiparous cows

During a 14-mo period, 77 multiparous and 36 primiparous cows were sampled to determine the prevalence of staphylococci during the periparturient period. Distal streak canal swabs were taken at 14 d prepartum, and foremilk was sampled the first 5 consecutive wk of lactation. Staphylococcus aureus was isolated from 7.6% of quarters of primiparous cows but from only .6% of quarters of multiparous cows at parturition. Prevalence in primiparous cows declined to 3.5% by the wk-1 sampling. Quarter prevalence of coagulase-negative Staphylococcus species prepartum, at parturition, and wk 1 to 5 in primiparous cows was 38.9, 27.8, 15.3, 14.6, 13.2, 15.3, and 14.6%, respectively. In multiparous cows, prevalence at these times was 50.3, 12.3, 6.2, 8.1, 10.7, 7.1, and 8.1%. Staphylococcus chromogenes was the predominant species isolated, accounting for over 50% of the staphylococci isolated at each sampling time. Results suggest that high prevalence of staphylococci isolated prepartum is a reflection of natural skin flora and that a higher postpartum prevalence of these organisms was observed in primiparous cows than in multiparous cows. These data suggest also that the peripartum heifer could be a source of Staphylococcus aureus in the lactating herd.

Lactation performance of rural Mesoamerindians

Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.

Nursing sickness in lactating mink (Mustela vison). I. Epidemiological and pathological observations

In a retrospective survey, the epidemiological characteristics of nursing sickness in Standard Black and Pastel mink (Mustela vison) were examined in a Danish fur research farm. Based on the clinical diagnosis of the disease, the overall morbidity in a total of 1774 lactating females amounted to 14.4% and the case fatality rate to 7.8%. Apparently healthy females weaned an average of 5.0 kits per litter, while dams suffering from nursing sickness raised and weaned an average of 5.4 kits per litter (p less than 0.01). Based on logistic regression analysis, the increasing age of the lactating dam, followed by littersize and female weight loss, appeared to be major determinants for the development of nursing sickness. The impact of additional covariates such as litter weight gain and female color type were remarkably low. At weaning (day 43) the mean individual live weight of the kits of either sex did not differ between healthy and sick dams. In Standard Black, the total biomass of the offspring raised by sick dams was significantly larger than that of the healthy controls (p less than 0.01). During the final two weeks of lactation, apparently healthy dams lost on average 14% of their body mass, whereas those affected by nursing sickness had a mean weight loss of about 31% (p less than 0.001). Postmortem examination of 25 dams with severe nursing sickness verified the clinical findings of progressive dehydration and emaciation. The gastrointestinal tract was empty and gastric ulcers and melaena were frequently present. Other common findings included small livers,enlarged adrenals and pitted kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

A 12-month lactation clinic experience in Uganda

A review of case histories of mother-infant pairs who attended a lactation clinic between January and December, 1989 is presented. The results show that the majority of mothers consulting the clinic perceive their lactation problems as 'insufficient breast milk production'. Factors which might have contributed to early lactation failure include: delayed initiation of breast feeding, use of prelacteal feeds, infrequent breast feeds by day and night, and early supplementation. The latter was especially common in this clinic sample: 69.6 per cent of infants were on regular supplementation by 4 months of age. The need is stressed for research into such breast feeding failures, revitalize community-based breast feeding support, as well as assessing the knowledge, attitude, and practices of health workers concerning breast feeding.

Interaction between physiological status in N'Dama cows and trypanosome infections and its effect on health and productivity of cattle in Gambia

Data collected for three years on incidence of trypanosome infections, degree of anaemia as assessed by packed red cell volume (PCV) and live weights of four groups of cows of varying physiological status were analysed. The animals were not harbouring trypanosomes during a period of two to three months before exposure to periods of increasing density of tsetse flies (Glossina morsitans submorsitans) while grazing in savannah woodlands. The groups of cows were formed on the following basis: pregnant and lactating (lactating-pregnant) (Group 1, n = 143); pregnant and not lactating (dry-pregnant) (Group 2, n = 69); non-pregnant and lactating (lactating-open) (Group 3, n = 160); non-pregnant and not lactating (dry-open) (Group 4, n = 49). Monthly trypanosome prevalence was highest (17.5%) in the cows with the highest physiological stress (Group 1), followed by Group 3 (11.1%) and Group 2 (10.0%) with the lowest prevalence found in the least stressed cows, Group 4 (1.6%). Average PCV values for dry-pregnant cows (Group 2; 27.0%) and dry-open cows (Group 4; 26.2%), whether infected or not, were higher than those lactating (Group 1; 25.3% and Group 3; 23.6%). A body weight gain of 4.3 kg between the month of October and the following June was recorded for dry-pregnant cows (Group 2) whereas a weight loss of 16 kg occurred in the lactating-pregnant and lactating-open cows (Groups 1 and 3), with more severe losses recorded in infected than uninfected cows. Dry-open cows (Group 4) maintained their weight during the observation period.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of Giardia lamblia antibodies in serum and milk in lactating women from different social classes in Egypt

Prevalence and levels of systemic and milk antibodies to G. lamblia in the different social classes of the population were studied using the IFAT and nor-partigen immunoglobulin plates. Blood and milk samples were collected simultaneously from lactating women in urban (Cairo) and rural (Benha) areas. Serum IgG was present in 90% of rural low standard mothers, 58% of urban moderate standard mothers, and 25% or urban high standard mothers (P less than 0.01, P less than 0.001 and P less than 0.01). Antilog of mean of antibody titers was significantly higher in the low standard rural mothers than in the urban moderate and high standard ones. Specific secretory IgA antibody in milk was found in 71% of rural low standard mothers, 31% of urban moderate standard mothers, and 16.6% of urban high standard mothers (P less than 0.001, P less than 0.01 and P greater than 0.05). The antilog of mean S-IgA titers was also higher in the low standard rural mothers. The titer levels of S-IgA in the three classes did not show any correlation with the quantitative levels of total IgA in milk, while specific IgG showed a positive correlation with the total serum IgG in the low standard rural mothers only (P less than 0.05). This study documented the widely different antibody response to G. lamblia in individuals living in different social classes.

Studies on perceived breast milk insufficiency. A prospective study in a group of Swedish women

A prospective investigation of the course of breast-feeding was carried out in a group of 51 healthy, well educated Swedish women during the period three days to 18 months after delivery. The aims were to investigate the incidence, causes and consequences of perceived breast milk insufficiency (transient lactation crises), by relating this phenomenon to the infant's breast milk consumption and growth, and to the course of breast-feeding. It was found that every second mother experienced transient lactation crises on at least one occasion (the crisis group). The crises were mostly caused by emotional disturbances in the mothers (e.g. anxiety, stress and discomfort), or by the infant's refusal to suckle, by unmotivated crying, or by illness. Within the crisis group no significant difference was found between the infants' intake of breast milk during the crises compared with control measurements one week later. Nor had the crises any immediate impact on the growth of the infants. A comparison between the mothers with crises and those who did not experience any crises, revealed that the breast milk consumption among the infants in the crisis group was lower throughout with significant differences at three and five months. The infants in the crisis group also had a significantly lower weight at two, three, four and nine months, although both groups were above the NCHS mean. The reasons for initiating breast-feeding differed between the two groups. The crisis group tended to give infant-related reasons to a higher degree than the mothers in the non-crisis group who more frequently mentioned mother-related motives. The mothers with crises also showed a greater ambivalence during the lactation period and terminated the breast-feeding somewhat earlier. Consequently they also introduced taste portions and started the weaning significantly earlier. Some general findings revealed a wide variation in breast milk consumption, not only between infants but also in the same infant from one occasion to another. The total energy intake was almost the same for the partially breast-fed infants, receiving breast milk plus supplementary food, and those who were exclusively breast-fed. Although most mothers in both groups initiated the weaning in accordance with general recommendations, a wide variation was also found in the length of the weaning period. In some cases it lasted for more than five months.

Potential indicators of insufficient milk supply syndrome

Insufficient milk supply syndrome is a complex phenomenon that has not been adequately investigated. Insufficient milk supply (IMS) is a major reason reported by mothers for early termination of breast-feeding in both developed and developing countries. Using the IMS conceptual framework by Hill and Humenick (1989), a survey was conducted to determine which set of predictors distinguished between mothers who reported an inadequate supply of breast milk (n = 100) from those who reported an adequate supply of milk (n = 284) during the first 8 weeks postpartum. Factor analysis suggested that Potential Determinant factors Maternal Confidence, Paternal Support, Maternal Health, Mother-in-Law Disapproval, and Infant Birthweight accounted for 56.7% of the variance while Potential Indicator factors Baby Behavior, Solid Foods, and Formula accounted for 70.4% of the variance. Using discriminant analysis, factors Maternal Confidence, Maternal Health, Mother-in-Law Disapproval, Baby Behavior, Solid Foods, and Formula predicted 78.04% of the cases accurately. The Potential Indicator factors alone predicted 76.58% of the cases accurately. These findings suggest that the IMS model is valid but additional variables may need to be considered.