Proper breastfeeding practices are effective ways for reducing childhood morbidity and mortality. While many mothers understand the importance of breastfeeding, others are less knowledgeable on the benefits of breastfeeding and weaning. The aim in here is to assess breastfeeding pattern, infant formula feeding pattern, and weaning introduction in Mauritius and to investigate the factors that influence infant nutrition. 500 mothers were interviewed using a questionnaire which was designed to elicit information on infant feeding practices. Statistical analyses were done using SPSS (version 13.0), whereby chi-square tests were used to evaluate relationships between different selected variables. The prevalence of breastfeeding practice in Mauritius has risen from 72% in 1991 to 93.4% as found in this study, while only 17.9% breastfed their children exclusively for the first 6 months, and the mean duration of EBF (exclusive breastfeeding) is 2.10 months. Complementary feeding was more commonly initiated around 4–6 months (75.2%). Despite the fact that 60.6% of mothers initiate breastfeeding and 26.1% of mothers are found to breastfeed up to 2 years, the practice of EBF for the first 6 months is low (17.9%). Factors found to influence infant feeding practices are type of delivery, parity, alcohol consumption, occupation, education, and breast problems.
In India, the practice of breastfeeding is almost universal, but initiation of breastfeeding is generally quite late and colostrum is discarded. Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy recommended systematic assessment of breastfeeding and emphasized counseling of the mother on proper positioning and attachment of infant to the breast.
To assess breastfeeding among mothers of below six months children in rural Wardha.
Materials and Methods
The present cross-sectional study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Center (KRHTC), Anji. Two Auxiliary Nurse Midwives (ANMs) trained in IMNCI paid house visits to 99 mothers during the study period and undertook the assessment of breastfeeding using IMNCI assessment form for young infants. Auxiliary Nurse Midwives observed and recorded the positioning and attachment of infant to the breast as per IMNCI guidelines. The data were entered and analyzed using Epi_Info (version 6.04d) software package.
Most of the deliveries 94 (94.9%) took place in the healthcare facilities. Majority 61 (61.6%) newborn babies had received breastfeeding within half an hour. About half of the mothers had any of the feeding problems like feeding less than eight times in 24 h, giving any other food or drinks or is low weight for age. Significantly more mothers with feeding problems had problems in positioning and attachment of infant to the breast as compared with those mothers who did not have any feeding problems.
In the settings, where practice of institutional delivery is high, the staff of healthcare facility should ensure education of the mothers regarding position and attachment of infant to the breast before discharge from the healthcare facility. At the village level, Village Health Nutrition Day (VHND) can be utilized for health education of future mothers and support for the breastfeeding mothers. The IMNCI assessment form for young infant should also include assessment of positioning of infant.
Breastfeeding; health education; IMNCI
Promotion of proper breastfeeding practices for the first six months of life is the most cost-effective intervention for reducing childhood morbidity and mortality. However, the adherence to breastfeeding recommendations in many developing countries is not satisfactory. The aims of the study were to determine breastfeeding and infant feeding patterns at nine months of age and to assess factors influencing exclusive breastfeeding practices.
In Bhaktapur, Nepal, we carried out a cross-sectional survey of 325 infants who came for measles vaccination at the age of nine months. Mothers were interviewed on details regarding feeding of their child and health since birth.
Three quarters of all mothers reported that they did not receive any information on breastfeeding during the antenatal visit. Two hundred and ninety five (91%) mothers gave colostrum and 185 (57%) initiated breastfeeding within one hour of delivery. The prevalence of exclusively breastfeeding at 1, 3 and 6 months were 240 (74%), 78 (24%) and 29 (9%), and partial feeding was initiated in 49 (15%), 124 (38%) and 257 (79%) babies, respectively. The main reason, according to the mother, for introducing other foods before six months of age was insufficient breast milk. In logistic regression analyses, mother's knowledge on how long child should be given only breast milk and not living in joint families were associated positively with exclusive or predominant breastfeeding for four months or beyond.
Despite the high proportion of mothers who initiated breastfeeding immediately after birth, continuation of exclusive breastfeeding for up to six months was not common. Very few mothers received any information on breastfeeding during the antenatal visit, indicating a need for counseling on exclusive breastfeeding. Possible options for this counseling could be during antenatal visits and at regular clinic visits for vaccination.
Exclusive breastfeeding; mixed feeding; infant; Nepal
Breastfeeding attitudes are known to influence infant feeding but little information exists on the prenatal breastfeeding attitudes of parents. The purpose of this study was to describe Finnish parents' prenatal breastfeeding attitudes and their relationships with demographic characteristics.
The electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed and 172 people (123 mothers, 49 fathers) completed the study. The data were analysed using factor analysis and nonparametric methods.
Breastfeeding was regarded as important, but 54% of the respondents wanted both parents to feed the newborn. The mean rank values of breastfeeding attitudes differed significantly when parity, gender, education, age, breastfeeding history and level of breastfeeding knowledge were considered. The respondents who were expecting their first child, were 18-26 years old or had vocational qualifications or moderate breastfeeding knowledge had more negative feelings and were more worried about breastfeeding than respondents who had at least one child, had a higher vocational diploma or academic degree or had high levels of breastfeeding knowledge. Respondents with high levels of breastfeeding knowledge did not appear concerned about equality in feeding.
Both mothers and fathers found breastfeeding important. A father's eagerness to participate in their newborn's life should be included in prenatal breastfeeding counselling and ways in which to support breastfeeding discussed. Relevant information about breastfeeding should focus on the parents who are expecting their first child, those who are young, those with low levels of education or those who have gaps in breastfeeding knowledge, so that fears and negative views can be resolved.
The study was conducted to evaluate the knowledge, attitudes and practices of breast-feeding in the West region of Cameroon.
A cross sectional descriptive study was conducted in two health facilities on 195 mother-infant pairs, seen at the out patient and vaccination units of the Bafoussam Regional Hospital over a period of one month from 1st to 30th September 2008. The socio-demographic characteristics of mothers, knowledge on breastfeeding and the practice of breastfeeding were studied. Data was analyzed using the SPSS software. The chi square and student t- test were used for comparison and results considered significant for P< 0.05.
Breastfeeding was practised by 99.48% of the mothers. Only 33.8% of the mothers knew that they had to exclusively breastfeed up to 6 months, and 20% effectively breastfed up to 6 months. The mean duration of breastfeeding was 5.06 months and negatively correlated with the number of children and the profession of the mother. In 69.74% of the women, nothing was given to the baby before the first breastfeed. Discontinuation of breastfeeding was done averagely around 15.24 months and earlier in married women and in those with a higher educational level.
Although the majority of parents practised breast feeding, only a minority understood its benefits, so more should be done to educate the community on the benefits of exclusive breast-feeding for up to six months.
Breastfeeding practices; Knowledge; Attitudes; Cameroon
This community-based cross-sectional study was undertaken to develop a complementary feeding index (CFI) to assess the adequacy of complementary feeding (CF) practices and determine its association with growth of infants, aged 6–12 months, in rural Indian population. The study was conducted in six villages of Ghaziabad district, Uttar Pradesh, India. A structured interview schedule was used for eliciting information from 151 mothers of infants, aged 6–12 months, on CF practices. Data on CF practices were scored using the CFI developed. Measurements of weight and length were taken. Bivariate and multivariate analyses were done using the SPSS software (version 13). The results revealed that the CF practices were suboptimal in the sample. The mean±standard deviation (SD) CFI scores ranged from a low value of 7.09±3.21 in 6–8 months old infants to a comparatively-higher value of 9.69±2.94 in 9–12 months old infants. Using the CFI it could be identified that infants (n=151) had poor dietary diversity, with only 31% and 18% of the infants reportedly being fed the recommended number of food-groups during 6–8 and 9–12 months respectively. The food-frequency scores of the CFI showed that cereals and diluted animal milk were the major food-groups fed to the infants in this setting. Analysis of nutritional status revealed that 24.5% of the infants were stunted (length-for-age [LAZ] <-2SD), 25% were underweight (weight-for-age [WAZ] <-2SD), and 17% were wasted (weight-for-age [WLZ] <-2SD). Significant associations (p<0.05) were observed between the meal-frequency and the dietary diversity of the CFs of infants aged 6–8 months and 9–12 months and the WAZ and LAZ indices of their nutritional status. On multivariate analysis of factors affecting the LAZ, WAZ and WLZ scores, the CFI was significantly associated (p<0.05) with LAZ whereas maternal education and breastfeeding frequency were significantly (p<0.01) associated with WAZ and WLZ. Per-capita income, parity, and birth-order were the significant (p<0.05) determinants of the CFI. The CFI developed is an exploratory attempt to summarize and quantify the key CF practices into a composite index, which would reflect the CF practices holistically. This index can be used as an easy tool by programme planners for identifying, targeting, and monitoring the deficient CF practices and also advocating the importance of the CF at policy level.
Community-based studies; Complementary feeding index; Complementary feeding practices; Cross-sectional studies; Infant nutritional status; India
Breastfeeding practices play an important role in reducing child mortality and morbidity. This study was aimed to describe the breastfeeding practices prevalent in rural areas.
The primary objective of this study was to describe the breastfeeding and newborn care practices in rural areas and the secondary objective was to describe the factors affecting the initiation and duration of breastfeeding.
Settings and Design:
The study was conducted in primary health care center (PHC) that is attached to a medical college in Kengeri, rural Bangalore, Karnataka.
Materials and Methods:
Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data was collected using the pre-tested questionnaire on breastfeeding and newborn practices.
Our study shows 97% of the mothers initiated breastfeeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries.
This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed.
Breastfeeding; duration; initiation; rural areas
Although research shows that healthcare professionals' support improves breastfeeding duration, many physicians do not believe they have adequate time to address breastfeeding concerns during office visits. This study evaluated the impact of a pediatric practice's postnatal lactation consultant intervention. To improve breastfeeding support, the study practice changed policy and began using a lactation consultant overseen by a physician, to conduct the initial postpartum office visit for all breastfeeding infants.
A retrospective chart review was performed on consecutive newborns before (n = 166) and after (n = 184) implementation of the program. Feeding method was assessed at each well child visit during the infant's first 9 months. χ2 and logistic growth curve analyses were used to test the association between implementation status and non-formula feeding (NFF).
Mothers and infants in 2007 and 2009 were similar with regard to type of insurance, parity, gestational age, multiple births, and cesarean sections. Overall, NFF improved after program implementation (odds ratio = 1.12, 95% confidence interval 1.02–1.23). In 2009, NFF rates at 2 months, 4 months, 6 months, and 9 months were greater than 2007 rates by 10%, 15%, 11%, and 9%, respectively. Logistic growth curve analysis indicated the difference across these time points was significant between 2007 and 2009.
A routine post-discharge outpatient lactation visit coordinated within a primary care practice improved breastfeeding initiation and intensity. This effect was sustained for 9 months.
Breastfeeding is accepted as the natural form of infant feeding. For mothers to be able to breastfeed exclusively to the recommended six months, it is important to understand the factors that influence exclusive breastfeeding. The aim of the study was to identify factors associated with exclusive breastfeeding in Peninsular Malaysia.
This was a cross-sectional study involving 682 mother-infant pairs with infants up to six months attending maternal and child health section of the government health clinics in Klang, Malaysia. Data were collected by face-to-face interviews using a pre-tested structured questionnaire over 4 months in 2006. Data on breastfeeding were based on practice in the previous one month period. Logistic regression was used to assess the independent association between the independent variables and exclusive breastfeeding adjusting for infant age.
The prevalence of exclusive breastfeeding among mothers with infants aged between one and six months was 43.1% (95% CI: 39.4, 46.8). In the multivariate model exclusive breastfeeding was positively associated with rural residence, Malay mothers, non-working and non-smoking mothers, multiparous mothers, term infants, mothers with husbands who support breastfeeding and mothers who practice bed-sharing.
Interventions that seek to increase exclusive breastfeeding should focus on women who are at risk of early discontinuation of breastfeeding.
We describe a programme for the prevention of mother-to-child transmission (PMTCT) of HIV that provided universal antiretroviral therapy (ART) to all pregnant women regardless of the CD4 lymphocyte count and formula feeding for children with high risk of HIV transmission through breastfeeding in a district of India. The overall rate of HIV transmission was 3.7%. Although breastfeeding added a 3.1% additional risk of HIV acquisition, formula-fed infants had significantly higher risk of death compared to breastfed infants. The cumulative 12-month mortality was 9.6% for formula-fed infants versus 0.68% for breastfed infants. Anthropometric markers (weight, length/height, weight for length/height, body mass index, head circumference, mid-upper arm circumference, triceps skinfold, and subscapular skinfold) showed that formula-fed infants experience severe malnutrition during the first two months of life. We did not observe any death after rapid weaning at 5-6 months in breastfed infants. The higher-free-of HIV survival in breastfed infants and the low rate of HIV transmission found in this study support the implementation of PMTCT programmes with universal ART to all HIV-infected pregnant women and breastfeeding in order to reduce HIV transmission without increasing infant mortality in developing countries.
According to newer AAP policies, smoking is not contraindicated with breastfeeding, yet smokers initiate and maintain breastfeeding less than non-smokers.
1) Describe maternal knowledge and 2) attitudes regarding concurrent breastfeeding and smoking or nicotine replacement therapy (NRT) and 3) evaluate the association between maternal smoking and infant feeding practices.
Mothers bringing children <13 months old for an appointment completed a 24-item, anonymous survey which addressed knowledge, attitudes and practices about concurrent breastfeeding and smoking/NRT.
Among 204 survey completers, 63% were African American, 52% had never breastfed and 54% had never smoked. Knowledge: Regardless of smoking status, 19% were aware of the recommendation to smoke after breastfeeding; most did not know that nicotine gum (42%) or patch (40%) transfers less or about the same amount of nicotine into breast milk than smoking a pack per day. Attitudes: Most mothers (80%) believe that women should not smoke any cigarettes if breastfeeding; current smokers (25%) were more likely than former (10%) or never smokers (11%) to find it acceptable to smoke one or more cigarettes per day (p=.03). Only 2% found it acceptable to use NRT while breastfeeding. Practice: Among ever breastfeeders, 10% stopped breastfeeding because of smoking. Over half of recent or current smokers reported that smoking impacted their infant feeding decision.
Mothers in this sample believe that women who smoke or take NRT should not breastfeed. Smoking status impacted women’s infant feeding practices. Correction of misinformation could increase breastfeeding rates.
Breastfeeding; Smoking; Tobacco
Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, with no addition of any liquid or solids apart from drops or syrups consisting of vitamins, mineral supplements or medicine, and nothing else. Several studies have shown that exclusive breastfeeding for the first six months plays a great role in preventing morbidity and mortality. However, in Ethiopia a large portion of infants are not exclusively breastfed according to the infant feeding recommendations. Understanding the factors that influence exclusive breastfeeding is crucial to promoting the practice. This study was carried out to identify factors predicting exclusive breastfeeding among mothers in Bale Goba district, south east Ethiopia.
A community-based cross-sectional study was conducted from March to February 2010 involving both quantitative and qualitative data. A total of 608 mothers were selected randomly. A convenience sampling technique was used to generate the qualitative data. The qualitative data were analyzed using thematic frameworks. A multivariable logistic regression analysis was used to identify independent predictors of exclusive breastfeeding after controlling for background variables.
The prevalence of exclusive breastfeeding in the last 24 hours preceding the survey was 71.3%. The median duration of exclusive breastfeeding was three months and mean frequency of breastfeeding was six times per day. Being unemployed [AOR: 10.4 (95% CI: 1.51, 71.50)] and age of infants of less than two months [AOR: 5.6 (95% CI: 2.28, 13.60)] were independently associated with exclusive breastfeeding.
A large proportion of infants are not exclusively breastfed during the first 6 months, despite what is recommended in the national and global infant and young child feeding (IYCF) guidelines. Employed mothers were less likely to practice exclusive breastfeeding, implying the need for promoting workplace breastfeeding practices and creating an enabling environment for exclusive breastfeeding. Extensions of maternity leave up to the first six month of child’s age to achieve optimal level of exclusive breastfeeding practices should also be looked into as an alternative solution.
Interventions to prevent mother to child transmission of human immunodeficiency virus (HIV) during childbirth and breastfeeding can reduce HIV infections in infants to less than 5% in low and middle income countries. The World Health Organization (WHO) recommends all mothers, regardless of their HIV status, practice exclusive breastfeeding for the first six months of an infant’s life. In line with these recommendations and to protect, promote and support breastfeeding, in 2009 the PNG National Department of Health revised their National HIV infant feeding guidelines, reinforcing the WHO recommendation of exclusive breastfeeding for the first six months followed by the introduction of other food and fluids, while continuing breastfeeding.
The overall aim of this paper is to explore health care workers’ knowledge regarding infant feeding options in PNG, specifically as they relate to HIV exposed infants.
As part of a study investigating women’s and men’s experiences of prevention of mother to child transmission (PMTCT) services in two sites in PNG, 28 key informant interviews were undertaken. This paper addresses one theme that emerged from thematic data analysis: Health care workers’ knowledge regarding infant feeding options, specifically how this knowledge reflects the Papua New Guinea National HIV Care and Treatment Guidelines on HIV and infant feeding (2009).
Most informants mentioned exclusive breastfeeding, the majority of whom reflected the most up-to-date National Guidelines of exclusive breastfeeding for six months. The importance of breastfeeding continuing beyond this time, along with the introduction of food and fluids was less well understood. The most senior people involved in PMTCT were the informants who most accurately reflected the national guidelines of continuing breastfeeding after six months.
Providing advice on optimal infant feeding in resource poor settings is problematic, especially in relation to HIV transmission. Findings from our study reflect those found elsewhere in identifying that key health care workers are not aware of up-to-date information relating to infant feeding, especially within the context of HIV. Greater emphasis needs to be placed on ensuring the most recent feeding guidelines are disseminated and implemented in clinical practice in PNG.
Prevention of mother to child transmission; Infant feeding practices; Exclusive breastfeeding; Health care worker knowledge
Despite growing evidence that supports the importance of 6-month exclusive breastfeeding, few Canadian mothers adhere to this, and early weaning onto solids is a common practice. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding to 3 and 6 months.
This prospective cohort study was part of the Alberta Pregnancy Outcomes and Nutrition study (APrON). From an initial sample of 600 pregnant women recruited from Edmonton and Calgary, 402 mothers provided complete details at 3 months postpartum; 300 stayed on to provide information at 6 months postpartum. During pregnancy and at 3 and 6 months postpartum, data on maternal and infant socio-demographic, behavior, and feeding were collected.
Even though there was a high rate of “ever having breastfed” (98.6%), exclusive breastfeeding rates for 3 and 6 months were 54.0% and 15.3%, respectively. After controlling for potential confounders, the study showed that mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree (95% CI: 1.30-10.92; p = 0.015). In addition, mother of previous children were more likely to breastfeed exclusively for 6 months (OR: 2.21, 95% CI: 1.08-4.52; p = 0.031). Mothers who were in the highest quartile of the Iowa Infant Feeding Attitude Score were 4.29 and 5.40 times more likely to breastfeed exclusively for 3 months (95% CI: 1.31-14.08; p-trend < 0.001) and 6 months (95% CI: 2.75-10.60; P-trend < 0.001), respectively.
The 6-month exclusive breastfeeding rate in Alberta is considerably below national and international breastfeeding recommendations. Professional advice that focuses on prenatal maternal knowledge, attitudes, and misperceptions may promote adherence to World Health Organization breastfeeding guidelines. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, primiparous women may help health practitioners focus their support and education for this group.
Exclusive breastfeeding; Predictors; Canada; Alberta pregnancy outcomes; Nutrition study
Background: Breastfeeding and weaning are strongly connected with infant–mother mutual autonomy, and hence are good touchstones to examine the characteristics of the mother–child relationship. Comparison of the weaning practice gives a framework to understand characteristics of the mother–infant relationship. Objective: The purpose of this study was to compare three industrialised countries concerning the relationship between feeding and weaning practices and its reasons, mother's perception of child care, and of breast milk and formula. Methods: A questionnaire study on weaning practice was conducted for 310 Japanese, 756 French, and 222 American mothers with 4- to 20-month-old infants. Results: French mothers expected and had accomplished weaning at an earlier age of the infant, compared to Japanese and American mothers. Perceived insufficiency of breast milk was the leading reason for the termination of breastfeeding for Japanese mothers at the earlier stages, whereas back to work was the more important reason for French mothers. Japanese mothers were more negative in their image of themselves as mothers, whereas French mothers felt more burdened by child-care. Japanese mothers who terminated breastfeeding because of perceived breast milk insufficiency were also those who were less motivated to breastfeed. Conclusion: Weaning is a significant framework to interpret cultural differences in mother–infant relationship. The perceived insufficiency is interpreted as a solution of conflict between the social pressure to breastfeed and its burden.
weaning; breastfeeding; formula feeding; Japan; France; USA
Although breastfeeding is universal in Ethiopia, ranges of regional differences in timely initiation of breastfeeding have been documented. Initiation of breastfeeding is highly bound to cultural factors that may either enhance or inhibit the optimal practices. The government of Ethiopia developed National Infant and Young Child Feeding Guideline in 2004 and behavior change communications on breast feeding have been going on since then. However, there is a little information on the practice of timely initiation of breast feeding and factors that predict these practices after the implementation of the national guideline. The objective of this study is to determine the prevalence and determinant factors of timely initiation of breastfeeding among mothers in Bale Goba District, South East Ethiopia.
A community based cross sectional study was carried out from February to March 2010 using both quantitative and qualitative methods of data collection. A total of 608 mother infant pairs were selected using simple random sampling method and key informants for the in-depth interview were selected conveniently. Descriptive statistics, bivariate analysis and multivariable logistic regression analyses were employed to identify factors associated with timely initiation of breast feeding.
The prevalence of timely initiation of breastfeeding was 52.4%. Bivariate analysis showed that attendance of formal education, being urban resident, institutional delivery and postnatal counseling on breast feeding were significantly associated with timely initiation of breastfeeding (P < 0.05). After adjust sting for other factors on the multivariable logistic model, being in the urban area [AOR: 4.1 (95%C.I: 2.31-7.30)] and getting postnatal counseling [AOR: 2.7(1.86-3.94)] were independent predictors of timely initiation of breastfeeding.
The practice of timely initiation of breast feeding is low as nearly half the mothers did not start breastfeeding with one hour after delivery. The results suggest that breast feeding behavior change communication especially during the post natal period is critical in promoting optimal practice in the initiation of breast feeding. Rural mothers need special attention as they are distant from various information sources.
A prelacteal feed is any food except mother’s milk provided to a newborn before initiating breastfeeding. Prelacteal feeding is a major barrier to exclusive breastfeeding. It is a prevalent practice in Nepal. Little is known about the factors associated with providing prelacteal feeds to the Nepalese newborn. This study explored the factors associated with providing prelacteal feeds to children under three years in Nepal using the Nepal Demographic and Health Survey (NDHS) 2011.
This study utilised the NDHS 2011 child dataset which is a nationally representative study. The rates of providing prelacteal feeds were reported as a proportion. Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multiple logistic regression were used to analyse the factors associated with providing prelacteal feeds.
A sample of 3948 mothers were included in the study. A total of 841 [26.5% (95% CI: 23.1%–30.3%)] weighted proportion) of mothers reported of providing prelacteal feeds to their newborn infants. Plain water (n = 75), sugar/glucose (n = 35), gripe water (n = 3), sugar/salt solution (n = 3), fruit juice (n = 3), infant formula (n = 96), tea (n = 3) and other milk other than breast milk (n = 556) were some of the types of prelacteal feeds reported. The multiple regression analysis showed that the mothers who had no education, were not working, were from the middle wealth quintile, who had not attended four antenatal care visits, were first time mothers and who were from the Terai/Plain region were more likely to provide prelacteal feeds.
Given that one in four infants were provided with prelacteal feeds, there is a need to implement breastfeeding promotion programs to increase the practice of exclusive breastfeeding and reduce prelacteal feeding practices. Breastfeeding counseling at antenatal clinics and peer support for exclusive breastfeeding should be included as part of breastfeeding promotion programs. Mobilisation of female community health volunteers for peer counseling is also a feasible option for Nepal.
Cross-sectional survey; Exclusive breastfeeding; Nepal; Prelacteal feeds
Exclusive breastfeeding in infants aged under six months is a simple and cost-effective feeding method that ensures better infant and child survival and boosts the achievement of child related Millennium Development Goals in the developing world. Identifying factors associated with good breastfeeding practice helps to increase its coverage and maximize its advantages through improved advocacy. The objective of this study was to identify the predictors of non-exclusive breastfeeding in the rural areas of eastern Ethiopia.
A community-based analytical cross-sectional study was conducted on mother/caregiver–child pairs in east Ethiopia from July to August 2011. Data on infant feeding practices were collected by trained interviewers who used a pretested and structured questionnaire. Odds ratio with a 95% confidence interval was estimated for the predictors of non-exclusive breastfeeding using the multivariable logistic regression.
The prevalence of non-exclusive breastfeeding in infants aged under six months, was 28.3%. Non-exclusive breastfeeding was more likely to be practiced by mothers who were not married at the moment [AOR (95% CI) = 2.6 (1.1, 6.0)], mothers who had no access to health facility [AOR (95% CI) = 2.9 (1.9, 4.3)], and mothers whose knowledge about infant and young child feeding practices was low [AOR (95% CI) = 3.4 (2.4, 4.7)].
Non–exclusive breastfeeding was more common among mothers with no marital relationships, poor access to health facilities, and inadequate knowledge about infant and young child feeding practices. Family support, education, and behavior change communication on infant feeding, especially on exclusive breastfeeding, at the community level may improve the knowledge, behavior, and practice of mothers on optimal infant and young child feeding practices.
Non-exclusive breastfeeding; Ethiopia; Predictors; Children under-two
Positive parental attitudes towards infant feeding are an important component in child nutritional health. Previous studies have found that participants in the Special Supplemental Women, Infants, and Children (WIC) Program have lower breastfeeding rates and attitudes that do not contribute towards healthy infant feeding in spite of breastfeeding and nutrition education programs targeting WIC participants. The objective of this study was to assess the frequency of exclusive breastfeeding in the early postpartum period and maternal attitudes towards breastfeeding in a population of mothers at two San Francisco hospitals and in relation to WIC participation status.
We interviewed women who had recently delivered a healthy newborn using a structured interview.
A high percentage (79.8%) of our sample was exclusively breastfeeding at 1–4 days postpartum. We did not find any significant differences in rates of formula or mixed feeding by WIC participant status. Independent risk factors for mixed or formula feeding at 1–3 days postpartum included Asian/Pacific Islander ethnicity (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.17–7.19). Being a college graduate was associated with a decreased risk of formula/mixed feeding (OR 0.28, 95% CI 0.10–0.79). We also found that thinking breastfeeding was physically painful and uncomfortable was independently associated with not breastfeeding (OR 1.41, 95% CI 1.06–1.89).
Future studies should be conducted with Asian-Americans and Pacific Islanders to better understand the lower rates of exclusive breastfeeding in this population and should address negative attitudes towards breastfeeding such as the idea that breastfeeding is painful or uncomfortable.
Studies have shown that sub-optimal breastfeeding is major contributor to infant and young child mortality in Ethiopia. To address this problem, infant and young child feeding guideline was developed in 2004 and interventions have been going on based on the guidelines. There is no study that assessed whether the infant and child feeding practices are according the guideline or not. This study was carried out to assess sub-optimal breastfeeding practices and associated factors among infants from birth to six months in rural communities of Jimma Arjo Woreda in the Southwest Ethiopia.
A cross-sectional study was carried out from December to January 2009. Quantitative data were collected from a sample of 382 respondents supplemented by qualitative data generated using in-depth interviews of 15 index mothers. Multivariable logistic regression model was used to identify predictors of timely initiation of breast feeding and non-exclusive breast feeding among mother-infant pairs.
More than three fourth of mothers breastfeed their infants sub-optimally. Thirty-seven percent of mothers initiated breastfeeding later than one hour after delivery, which was significantly associated with not attending formal education (AOR = 1.05[95%CI: 1.03, 1.94]) and painful breastfeeding experiences (AOR = 5.02[95%CI: 1.01, 10.08]). The majority (67.02%) of mothers had no knowledge about exclusive breastfeeding. Non-exclusive breastfeeding was negatively associated with child’s age of 0-2 months (AOR: 0.27[95%CI: 0.16, 0.47) and 3-4 months (AOR = 0.43 [95%CI: 0.25, 0.73) and ownership of radio (AOR = 0.56[95%CI: 0.37, 0.88]), but positively associated with the practice of discarding colostrums (AOR = 1.78[95%CI: 1.09, 4.94]).
The findings showed that the majority of mothers sub-optimally breastfeed their children in the study area. As most of the mothers do not have knowledge on the exclusive breast feeding. Enhancing community based behavior change communications using multiple channels including radio and folk media is recommended to reduce sub-optimal breast feeding practices and associated consequences among children in the study area.
When and how to wean breastfed infants exposed to HIV infection has provoked extensive debate, particularly in low-income countries where safe alternatives to breastfeeding are rarely available. Although there is global consensus on optimal infant-feeding practices in the form of guidelines, practices are sub-optimal in much of sub-Saharan Africa. Policy-makers and health workers face many challenges in adapting and implementing these guidelines.
This paper is based on in-depth interviews with five policy-makers and 11 providers of interventions to prevent mother-to-child transmission (PMTCT) of HIV, participant observations during clinic sessions and site visits.
The difficulties with adapting the global infant-feeding guidelines in Malawi have affected the provision of services. There was a lack of consensus on HIV and infant-feeding at all levels and general confusion about the 2006 guidelines, particularly those recommending continued breastfeeding after six months if replacement feeding is not acceptable, feasible, affordable, sustainable and safe. Health workers found it particularly difficult to advise women to continue breastfeeding after six months. They worried that they would lose the trust of the PMTCT clients and the population at large, and they feared that continued breastfeeding was unsafe. Optimal support for HIV-infected women was noted in programmes where health workers were multi-skilled; coordinated their efforts and had functional, multidisciplinary task forces and engaged communities. The recent 2009 recommendations are the first to support antiretroviral (ARV) use by mothers or children during breastfeeding. Besides promoting maternal health and providing protection against HIV infection in children, the new Rapid Advice has the potential to resolve the difficulties and confusion experienced by health workers in Malawi.
The process of integrating new evidence into institutionalised actions takes time. The challenge of keeping programmes, and especially health workers, up-to-standard is a dynamic process. Effective programmes require more than basic resources. Along with up-to-date information, health workers need contextualized, easy-to-follow guidelines in order to effectively provide services. They also require supportive supervision during the processes of change. Policy-makers should ensure that consensus is carefully considered and that comprehensive perspectives are incorporated when adapting the global guidelines.
Breastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infant's first year of life to determine the factors associated with early cessation.
A cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation.
At 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months.
Breastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer.
To monitor the progress in the practice of early breastfeeding of newborn babies within half an hour to one hour after delivery, and to identify the reasons for not breastfeeding the babies in the labor room.
Patients and methods:
This is a descriptive study conducted in the labor and delivery rooms of King Khalid University Hospital during the months(5) of Jumada I and (11) Dhulqada 1422H. A total of 602 women were included in the study. A structured form was used to assess the extent of feeding and the reasons for not breastfeeding in the first ½ to 1 hour after birth. The frequency and the percentage were used to compare the data.
It was encouraging to find that 60% of the women breastfed their babies within ½ an hour to 1 hour after birth. Of the reasons for not breastfeeding the babies early, two were of the greatest concern. The first is that 13% of the women were either too tired to breastfeed or refused to do so at this early stage. Secondly, the majority of the mothers who had had cesarean sections did not breastfeed their babies.
Mothers and their families play a very vital role in building the health of the nation. This can be achieved by early breastfeeding, which contributes to the rearing of healthy babies, increase in intelligence and the building of strong future generations. The health care professional must have continuous education and be frequently updated on breastfeeding standards.
Breastfeeding; newborn; King Khalid University Hospital; labor room
In Jordan, as in neighboring countries in the Middle East, higher education and higher employment rates in recent years among women have had an impact on traditionally based infant feeding. The objective of this study was to evaluate practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in the north of Jordan.
A cross sectional study was carried out between 15 July 2003 and 15 August 2003. A total of 344 women with children aged between 6 months and 3 years from five different villages in the north of Jordan were randomly selected and interviewed. Information regarding participants' demographics, infant feeding in first six months of life, knowledge and attitude towards breastfeeding was collected.
Full breastfeeding was reported by 58.3%, mixed feeding was reported by 30.3% and infant formula feeding was reported by 11.4%. Almost one third of the full breastfeeding group did so for 6–12 months, and almost two thirds did continue breastfeeding for more than one year. Employed women were more likely not to practice full breastfeeding compared to unemployed women (odds ratio 3.34, 95% CI 1.60, 6.98), and women who had caesarian delivery were more likely not to practice full breastfeeding compared to those who had vaginal delivery (odds ratio 2.36, 95% CI 1.17, 4.78). Jordanian women had a positive attitude but work place and short maternity leaves had a negative impact on breastfeeding.
This study showed that a high proportion of Jordanian women did breastfeed for more than one year. However, working women and those who deliver by caesarean section were less likely to breastfeed. It is speculated that adopting facilitatory measures at hospitals and work place could increase the rate of full breastfeeding.
State worksite breastfeeding statutes are thought to play a role in increasing rates of breastfeeding duration, which remain below Healthy People 2010 goals. As of 2010 24 states including the District of Columbia had such worksite statutes. Of these only 18 required both break time and a site. This preliminary analysis assessed if infants born in states with worksite breastfeeding statutes had longer breastfeeding duration.
Using the 2009 National Immunization Survey we analyzed infants comparing breastfeeding duration at 6 months with type of worksite breastfeeding statute in place, while adjusting for year enacted and other state characteristics (years since founding of state breastfeeding coalition, breastfeeding supportive hospital practices). Other covariates included maternal and infant characteristics. Only those infants whose mothers were at least 18 years old and who had not changed state of residence since birth were included (n=16,145).
Although requiring a site and/or break time for breastfeeding increased the likelihood of breastfeeding at 6 months (odds ratio, 1.20; 95% confidence interval, 1.07–1.35; p=0.002), after accounting for other factors this relationship remained positive but was not significant (adjusted odd ratio, 1.07; 95% confidence interval, 0.92–1.24). Because all mothers, not just those in or returning to the workforce, were included in the analysis this relationship could be underestimated. Breastfeeding at 6 months was associated with being from a state that had had a breastfeeding coalition for a longer period of time (adjusted odds ratio, 1.25; 95% confidence interval, 1.04–1.49; p<0001).
State worksite breastfeeding statutes alone may not directly affect breastfeeding duration. Analysis of breastfeeding duration using the multiple levels of the social-ecological model is a potentially useful approach to understanding the impact of state breastfeeding statutes. The impact of state breastfeeding coalitions warrants further study.