Multimorbidity and breastfeeding practices: findings from a population-based survey in Peru during 2024

BackgroundOptimal breastfeeding practices including early initiation of breastfeeding and exclusive breastfeeding (EBF) are associated with positive health outcomes. Socioeconomic inequalities in key breastfeeding indicators may play a role in the prevalence of breastfeeding practices. The objective of this study was to examine the socioeconomic inequalities in early initiation of breastfeeding and EBF practices in Bangladesh based on the 2018 Bangladesh Demographic and Health Survey (BDHS).MethodsThis was a secondary data analysis of the nationally representative 2018 BDHS. Data on 4950 women of reproductive age who had ever given birth and 924 children aged 0–5 months were extracted, for early initiation of breastfeeding and EBF. Early initiation of breastfeeding was determined from children who were put to the breast within the first hour of birth. Exclusive breastfeeding was estimated from children aged 0–5 months who were exclusively breastfed.ResultsThe weighted prevalence of early initiation of breastfeeding and EBF were 60.8% (95% CI; 59.0, 62.6%) and 66.8% (95% CI; 63.1, 70.3%), respectively. The estimated prevalence of early initiation among the poorest, poorer, middle, richer and richest households were 67.8, 66.3, 58.4, 56.3 and 54.4%, respectively. Similarly, early initiation prevalence of 64.4, 65.0, 61.1 and 52.3% were estimated among women with no formal education, primary, secondary and higher education, respectively. The estimated prevalence of EBF among the poorest, poorer, middle, richer and richest households were 63.0, 65.2, 67.7, 66.7 and 69.9%, respectively. Similarly, the estimated EBF prevalence were 62.5, 66.0, 66.3 and 68.9% among women with no formal education, primary, secondary and higher education, respectively. Early initiation of breastfeeding was higher among lower household wealth (Conc. Index = − 0.049; SE = 0.006) and lower educational attainment groups (Conc. Index = − 0.035; SE = 0.006).ConclusionsImproving optimal breastfeeding practices in Bangladesh should be given utmost priority. A need to address the socioeconomic inequalities in breastfeeding practices was also identified.

Background: It is estimated that, on an average about 35% of infants 0 - 6 months old are exclusively breastfed around the world. Optimal breastfeeding and complementary feeding practices can save the lives of 1.5 million children under five every year. The condition is further worse in slum areas where vulnerable group of people resides. So, this study aims to assess prevalence on initiation of breastfeeding, exclusive breastfeeding and complementary feeding practices. Methods: A cross sectional study was conducted from November 2017 - February 2018 among 400 married women having child between 6 - 24 months. A pre-tested structured questionnaire comprising of socio-demographic characteristics, exclusive breastfeeding and complementary feeding practice were used. Data was analyzed using Statistical Package for Social Sciences (SPSS) 18.0 version. Results: About 55% of the mothers had initiated breastfeeding within an hour (<1 hour). About half (50.5%) had practiced exclusive breastfeeding to their children. More than fifty percentages (51.5%)of the mothers introduced complementary foods at 6 months. Age at pregnancy, mode of delivery, family size and colostrum feeding is associated with early initiation of breastfeeding at 95% CI i.e. p value <0.05. Whereas, age of mother, ethnicity, mode of delivery and initiation of breastfeeding were significantly associated with exclusive breastfeeding at 95% CI i.e. p value <0.05. Conclusions: The breastfeeding and complementary feeding practice in slum area is not optimal. Health awareness program focusing on early initiation of breastfeeding, exclusive breastfeeding practices and timely introduction of complementary foods in these vulnerable groups of population is needed o prevent its untoward effects. Keywords: complementary feeding; exclusive breastfeeding; initiation; malnutrition.

This paper provides information on optimal breastfeeding practices in the People’s Democratic Republic of Lao from data collected in the2011 Lao Social Indicator Survey. Results: Early initiation of breastfeeding within the first hour of life occurred among 39.6% of Laotian infants. After controlling for the effects of wealth, early initiation of breastfeeding was found to be most prevalent among mothers with higher education, those who received antenatal services, and those who delivered in a health facility. Avoidance of prelacteal feeds within the first three days of life occurred among 65% of Laotian infants, and was highest among ethnic Hmong and Khmer infants, and among those born in public versus private health facilities. Avoidance of prelacteal feeds was lowest after deliveries in which a traditional birth attendant was present. Exclusive breastfeeding through the first 5 months of age was reported among 40.8% of infants nationally. Ethnicity again played a role with the highest levels of exclusive breastfeeding found to occur among ethnic Khmer infants (69.4%, OR 2.8, CI: 1.5 - 5.1). Discussion: These results highlight the role that health care workers can have on early breastfeeding practices at the point of both antenatal counseling and in the delivery setting. Strengthening the quality of counseling on infant feeding can have a significant impact on early initiation of breastfeeding. Ethnic difference significantly impact both early and exclusive breastfeeding practices. Conclusion: A complexity of factors at different levels of care impact breastfeeding practices. A synergy of strategic approaches are needed to target antenatal counseling as well as post-delivery practices, all which account for the unique social and cultural attitudes towards infant feeding. Stronger community-based interventions that account for cultural attitudes and practices are most likely to be successful in promoting exclusive and continued breastfeeding practices.

Background: The period of the first month of life is a critical moment for the sustainability of breastfeeding practices. Therefore optimal efforts are needed to maintain the breastfeeding practices. Early initiation of breastfeeding can help increase maternal confidence and support psychological condition of mothers in order to continue breastfeeding practices.Objective: To evaluate the impact of the early initiation of breastfeeding on breastfeeding practices in the first month of infant life.Method: The study was observational with cohort prospective study design using quantitative and qualitative approaches. Samples were 106 pairs of mothers and babies. The group from Pahandut Public Health Center (PHC) consisted of 53 women with early initiation of breastfeeding (exposed group) and the group from Tangkiling PHC consisted of 53 women without early initiation of breastfeeding (non exposed group). In both groups, dissemination on early initiation of complete breastfeeding and exclusive breastfeeding practices followed with one month breastfeeding practices was given. The quantitative data analysis was done in three stages. In addition, qualitative data analysis used exploration of in depth interview.Results: The result of mutivariable analysis with modeling showed that there was a significant relationship between early initiation of breastfeeding and breastfeeding practices in the first month of life (by controlling the variables of the decision to breastfeed, nipple condition, residence and gestational age) that could give contribution as much as 49% for breastfeeding practices in the first month of life. The result of in depth interview showed that breastfeeding practices were highly infuenced by information obtained by the women when checking up their pregnancy so that the decision to breastfeed could be made in advance and the women perceived the beneft of breastfeeding practices for her and her infant’s health. There were some reasons why the mother did not give complete breastfeeding, among others were the abnormal nipple condition and the mother’s fear on her child’s health for preterm baby.Conclusion: Breastfeeding practices in the first month of life occured more in mothers who practiced early initiation of breastfeeding than in those who did not. Mothers with at term delivery, nipple normal condition, breastfeeding decision prior to delivery, and residence in rural areas had greater chance of practicing breastfeeding in the first month of life.

Introduction: Exclusive breastfeeding plays an important role in preventing morbidity and mortality in infants and young children. However, exclusive breastfeeding coverage remains low, especially among working mothers. This study aimed to examine the relationship between early initiation of breastfeeding and prevalence of exclusive breastfeeding among working mothers in Bantul District, Yogyakarta Special Region, Indonesia. Methods: This study used a cross-sectional design. The population were all women in reproductive age who worked in middle and large companies. Samples included mothers whose infants were aged six to 12 months and were selected by probability proportional to size sampling technique. Main outcome was exclusive breastfeeding, while the independent variable was the early initiation of breastfeeding. Statistical analysis were descriptive statistics test, chi-square test, and multiple logistic regression at the level of significance of 0.05. Results: Exclusive breastfeeding coverage was around 22%, whilst the early initiation of breastfeeding coverage was 10%. Early initiation of breastfeeding was associated with exclusive breastfeeding practice (adjusted OR = 2.93; 95% CI: 1.04 - 8.28). Variables that were not significantly related to exclusive breastfeeding included being a first-time mother, maternal age, maternal educational level, breastfeeding counselling during antenatal visits, and delivery methods. Conclusions: Early initiation of breastfeeding is associated with higher prevalence of exclusive breastfeeding among working mothers. To increase exclusive breastfeeding coverage, particularly among employed women, it is highly recommended to enhance early initiation of breastfeeding program.

Improving infant and young child feeding (IYCF) practices in children 0–23 months of age is critical to improved nutrition and development of children. Despite strong recommendations for optimal breastfeeding during the first six months, the practice remains lower than the desired targets globally. Socio-cultural and psychosocial factors, and mothers’ breastfeeding knowledge and attitude, challenge optimal IYCF practices. The study was conducted to assess the impact of breastfeeding knowledge and attitude on the primiparous women’s early initiation and exclusive breastfeeding practices during the first six months after delivery. A prospective follow-up health facility-based study design with quantitative methods was used. Both structured and semi-structured questions were used for data collection. Statistical Package for Social Sciences (SPSS) version 21 was used for data management. Findings at the 95% confidence interval and P-value of 0.05 (5%) were reported as statistically significant. The majority of the respondents (86.5%) had no comprehensive breastfeeding knowledge. Meanwhile, over 60% of the respondents had a positive attitude to breastfeeding. Medium, positive and statistically significant correlation was observed between breastfeeding attitude and exclusive breastfeeding (EBF) practices (x2(1df) =2.082 (P<0.00)), as well as between early initiation of breastfeeding practices and EBF practices (x2(1df) =0.973 (p<0.05)). A positive breastfeeding attitude and early initiation of breastfeeding can predict EBF practices among primiparous women. Therefore, improving primiparous women’s breastfeeding attitude and early initiation of breastfeeding practices, as well as further qualitative research to document perceptions and cultural factors affecting the practices of EBF among primiparous women, are strongly recommended.

The achievement towards 100% exclusive breastfeeding still a challenge in many countries despite adverse impacts due to the absence of exclusive breastfeeding. One consequence from the low practice of exclusive breastfeeding is malnutrition, including stunting that can be prevented by providing optimal food to infants, starting with providing exclusive breastfeeding from birth to 6 months of age. However, the practice of exclusive breastfeeding still low and it is suspected that this practice also decreased during the COVID- 19 pandemic. This study aims to analyze the determinants of exclusive breastfeeding in sub-urban areas during the COVID-19 pandemic. This study using cross sectional design conducted from interviewing 206 mothers in 2022 who meet the inclusion criteria, consisted of breastfeeding their babies in the last 1 year and live in Sub-urban area in Depok City, West Java. Multiple binary logistic regression used to measure the association and strength between independent variables with the outcome variable. Independent variables with a p-value < 0.25 during the Chi-square test were included in the logistic regression model. Prevalence of exclusive breastfeeding and early initiation of breastfeeding (EIB) was 58.3% and 57.8% respectively. Factors associated with exclusive breastfeeding practices are education, employment status, knowledge and attitude about exclusive breastfeeding, self-efficacy in providing exclusive breastfeeding, EIB practice, and eating pattern. From multivariate analysis, it was found that the dominant factors to exclusive breastfeeding are EIB. The study highlights the importance of improving exclusive breastfeeding practice through early initiation of breastfeeding, mother's knowledge, education and self-efficacy. Therefore, health promotion and education should emphasize the importance of those factors, supported by the health policy and massive campaign as a key success in exclusive breastfeeding.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Considering the poor practices of optimal breastfeeding, a cross-sectional study with the objective to ascertain the disparity in knowledge, attitude and practice (KAP) pertaining to early initiation, exclusive and continued breastfeeding behaviours was conducted among the mothers of children below 3 years of age.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 400 mothers of children ≤6 months from 52 villages of Rajasthan were included in the analysis for EBF. The data collection was analysed using statistical software SPSS version 23.0. All characteristics were summarized descriptively. Chi-square (χ2) test was performed to study the association between two categorical variables. Three points liket scale was administered to assess the attitude of mothers. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 72.8 % mothers initiated early breastfeeding, 22.5% continued breastfeeding, and exclusively breastfeeding was practiced by none. 34.3% mothers had knowledge on early initiation of breastfeeding, 34.6% on exclusive breastfeeding and 65.5% had knowledge on continued breastfeeding. 73.8% mothers had positive attitude towards early initiation of breastfeeding, 13.5 % on exclusive breastfeeding and 79.5% had positive attitude towards continued breastfeeding up to 2 years.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Though the attitude and knowledge on breastfeeding is good yet exclusive breastfeeding practice was observed very poor. These findings indicate that despite of having good knowledge and a positive attitude towards breastfeeding, there are certain myths and social determinants which hinder optimal breastfeeding. Identification of such barriers will be extremely useful, since counselling and behaviour change strategies will focus and address them, resulting in the practice of good behaviours.&lt;/p&gt;

The main aim of this study was to compare breastfeeding knowledge, attitude, and practice and infants nutritional status between rural and urban areas. In this cross-sectional study, Desa Jayabakti, Kabupaten Sukabumi represents rural area, while Kelurahan Kedung Jaya, Kota Bogor represents urban area. Samples were 31 mothers-infants in each area who were selected by simple cluster sampling method. The differences between two areas were analyzed with the independent t-test, chi-square test, and Fisher's exact test. The correlation between variables was analyzed with rank Spearman. The result of this study showed that mother's knowledge and attitude of nutrition, especially about exclusive breastfeeding, was higher in urban than in rural area. There were differences in mothers' knowledge and attitude between rural and urban areas (p&amp;amp;lt;0.05). Exclusive breastfeeding in rural area practiced by 41.9%, which is higher than in urban area (25.8%). Nevertheless, there was no statistical difference in exclusive breastfeeding practice between rural and urban areas (p&amp;amp;gt;0.05). The aspects of breastfeeding practices which statistically difference in rural and urban areas were the introduction of colostrums status and breastfeeding time (p&amp;amp;lt;0.05). Early initiation of breastfeeding was associated with exclusive breastfeeding practice in urban area (p&amp;amp;lt;0.05), but none of the variables were associated with exclusive breastfeeding practice in rural area (p&amp;amp;gt;0.05). Furthermore, exclusive breastfeeding practice was not associated with 4-12 months infants nutritional status (p&amp;amp;gt;0.05). Mothers' family should be targeted as target of audience in breastfeeding promotion. Keywords: breastfeeding practice, exclusive breastfeeding, knowledge, attitude, infant nutritional status, rural and urban areas.

The Academy of Breastfeeding Medicine27 ^th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

Background: Breast feeding has been defines as the practice through which adequate nutrition and other nutritional requirements of the new born are being taken care of. Exclusively Breast feeding is a term used to define the process by which only breast milk is given to the new born till the first six months of life. But it has been enveloped in many layers of the factors like the Social and cultural attitudes which further affect the practice and rate of breast feeding worldwide and also in India which is considered to be one of the major reasons for the IMR and under-5 mortality rate. Methods: Cross-sectional study was conducted using a semi-structured interview schedule. A total of 256 mothers who were in their reproductive age and had delivered in the last 12 months were interviewed. Results: While studying the practice of exclusive breast-feeding among the participants it was seen that the practice of exclusive breast-feeding was were low among them, i.e., only 24.8% of the total women going for the practice of exclusive breast-feeding. On looking at the various reasons for the early cessation of exclusive breast feeding, multiple responses were seen like breast related factors included reasons like breast feeding were painful or the baby had difficulty in swallowing. Cultural belief was seen to be one of most dominant factor for the practice of giving prelacteal feed. It was seen that many factors associated with the practice of breastfeeding including psychosocial factors, maternal socio-demographic characteristics, hospital practices and environmental support, etc. Conclusion: Nutrition has been considered to be one of the basis of a healthy foundation of the future. Breast milk and breast feeding has been considered to be the best nutrition for the new born till the first six months of age. Under nutrition during first two years impairs not only the cognitive development, intelligence, strength, energy and productivity. Although breast feeding is almost universal in India the rate of early initiation of breast feeding and exclusive breast feeding are dismally low. Several f actors can be attributed to this which has a great influence on the breast feeding practices.

Breastfeeding plays a crucial role in promoting the health and wellbeing of both mothers and their infants, contributing to healthier populations and reducing long-term healthcare costs. Encouraging breastfeeding through education, support, and policies is essential for maximizing these benefits. The purpose of this study was to evaluate the impact of immediate postpartum counseling on early initiation of breastfeeding rates and exclusive breastfeeding in Bule Hora Teaching and Yabelo General Hospitals. A cluster randomized single-blinded trial was conducted on 224 postpartum women (112 in the intervention group and 112 in the control group) from January 1, 2023, to May 30, 2023. The effects of immediate postpartum counseling and its associated variables on early initiation and exclusive breastfeeding practices were evaluated using logistic regressions. A p-value of less than 0.05, a 95% confidence interval, and an adjusted odds ratio were used to determine statistical significance. The proportion of early initiation of breastfeeding was significantly greater in the intervention group than in the control group (54.1% vs. 45.9%, p = 0.001), and exclusive breastfeeding practice were also significantly greater among women who received immediate breastfeeding counseling than among those who did not receive it (61.9% vs. 38.1%, p = 0.015). Those mothers who had an ANC visit for their pregnancy were three times more likely (AOR = 3.01, 95% CI = 1.12-8.1) to initiate breastfeeding. Having good knowledge regarding breastfeeding made them six times more likely to initiate breast-feeding earlier (AOR = 6.18, 95% CI = 1.77-21.57). Women who received counseling (AOR = 3.36, 95% CI: 1.83-6.16) and women who had good knowledge about breastfeeding (AOR = 1.88, 95% CI: 1.01-3.49) were significantly associated with exclusive breastfeeding practices. This study revealed that immediate postpartum breastfeeding counseling can positively influence both early initiations of breastfeeding and exclusive breastfeeding practices. Providing sustained education to women regarding early initiation and exclusive breastfeeding practices should be strengthened.

BackgroundThe prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China.MethodsThe cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0–5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale–Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices.ResultsIn the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice.ConclusionsExclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged.

BackgroundExclusive breastfeeding is recommended in the first six months of life. Observing breastfeeding practices and further the introduction of complementary food using a birth cohort can provide a better understanding with reference to the child’s growth and nutrition. We aim to describe the exclusive breastfeeding practices in the Indian MAL-ED birth cohort.MethodsThe Indian MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort comprises of eight contiguous urban slums in Vellore. Of the 251 children enrolled in the cohort at birth, a 24 month follow-up was completed for 228 children and data collection was from March 2010 through February 2012. Trained field research assistants collected data on exclusive breastfeeding and complementary feeding practices from birth using a structured questionnaire through a biweekly surveillance. Survival and Cox proportional hazard regression analyses were used to estimate the duration of exclusive breastfeeding and factors influencing the same.ResultsBreastfeeding was initiated within the first hour of birth in 148 (59%) infants. Colostrum was given in 225 (89.6%) infants whilst 32 (12.7%) infants received prelacteal feeds. Exclusive breastfeeding up to four months was observed in 55 (22.1%, 95% Confidence Interval [CI] 17.1%, 27.5%) infants with only three (1.1%, 95% CI 0.2%, 3.5%) of the cohort mothers continuing to exclusively breastfeed up to six months. Cox proportional hazard regression analysis revealed no gender differences to being exclusive breastfed (Adjusted Hazard Ratio [AHR] 0.97; 95% CI 0.74, 1.27). Children from families of low socioeconomic status had a lower risk of early cessation of exclusive breastfeeding compared to children from middle or higher socioeconomic status (AHR 0.52; 95% CI 0.38, 0.71).ConclusionsEarly initiation of exclusive breastfeeding is important and improving rates suggest continuation of efforts in this direction energetically. Continuation of exclusive breastfeeding practice is significantly low in these urban slums with introduction of animal milk and complementary foods even before six months of age. This highlights the urgent need to evaluate pragmatic interventions to raise awareness on the importance of exclusive breastfeeding and its practice.

ObjectivesThe aim of this systematic review and meta-analysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding...