Background Breastfeeding Research Articles

Breastfeeding knowledge, attitudes and practices of HIV-positive women in Africa, a systematic review

Abstract Background Breastfeeding (BF) is essential to ensure the health and survival of children, especially in regions where diarrhoea, pneumonia and malnutrition are common causes of child mortality. The WHO currently recommends, along with antiretroviral treatment, exclusive BF (EBF) for the first six months and mixed BF for the next six months and extending it to 24 months. In sub-Saharan Africa, more than one million HIV-positive women face the challenge of infant feeding due to limited access to treatment and safe water. The aim of this study was to understand the knowledge, attitudes, and practices of HIV-positive mothers in Africa to provide evidence for public health strategies. Methods We conducted a systematic review of studies on Knowledge, Attitudes and Practices of BF among HIV-exposed children in African countries, following the principles of the PRISMA statement and identified by searching major databases of records published between 2013 and 2023. Results Of the 498 articles identified, 21 met the inclusion criteria. 70% of the studies were conducted in Ethiopia, South Africa, and Kenya. 95% of the studies were conducted in health care facilities. Mothers showed good knowledge, attitudes and practices regarding EBF of HIV-exposed children, but low knowledge and fear of continuing to practice BF later on. The HIV-positive mothers mentions a range of recommendations received from health workers, identified as their main source of information. Stigma against mothers who practice EBF was found. The primary reason for early cessation of BF was due to work. Conclusions Knowledge, attitudes, and practices of the infant feeding currently recommended by WHO for HIV-positive mothers was weak. There is little evidence of what happens in other African countries and in women with limited access to the health system. Public health policies need to be strengthened to ensure that health workers are trained in the current guidelines to improve HIV-positive women’s BF. Key messages • HIV-positive mothers are afraid to continue breastfeeding their babies after 6 months. • More studies about the breastfeeding practices of children of HIV-positive mothers with limited access to health services are needed.

Disparities in Breastfeeding Patterns Persist Despite Improved Rates: Findings from Irish COSI R6

Abstract Background Breastfeeding is crucial for reducing childhood obesity, recommended exclusively for 6 months by World Health Organisation (WHO). Previous reports have highlighted disparities in breastfeeding patterns between Irish and non-Irish mothers. The Irish Childhood Obesity Surveillance Initiative (COSI) family survey offers insights into breastfeeding rates and patterns in Ireland and their differences between Irish and non-Irish mothers. Aims This study aims to compare the breastfeeding rates in Ireland between COSI Round 6 (R6) and COSI R5, elucidating the differences between Irish and non-Irish mothers. Additionally, it aims to establish the association between breastfeeding pattern and socio-economic factors involved in the Irish households. Methods Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on breastfeeding rates and pattern were collected, anonymised, and analysed using SPSS version 29. Results Around 88% of respondents were mothers. The number of children breastfed for at least a month increased in R6 (55.7%) compared to R5 (45.6%). The mean duration of exclusive breastfeeding increased to 5.86 months in R6 from 4.91 months in R5, in line with WHO recommendations. Significant disparities were found in breastfeeding patterns, with higher rates among non-Irish mothers (67.8%) compared to Irish mothers (52.6%) (p < 0.001). Linear regression showed a significant association between breastfeeding duration and maternal birth country. Irish mothers exhibited a negative coefficient (b1=-2.442; 95% CI -4.1 to -0.8; p = 0.004), suggesting shorter breastfeeding durations compared to non-Irish mothers. Conclusions Breastfeeding rates improved in COSI R6 compared to R5. There are significant disparities in breastfeeding pattern between Irish and non-Irish mothers. Key messages • Improved breastfeeding rates indicate good feeding practices in Ireland. • Targeted interventions and policies are necessary to address the disparities between Irish and non-Irish mothers in breastfeeding patterns.

Comprehensive Analysis of Breastfeeding's Influence on Child Health Outcomes: A Cross-Sectional Study.

Background Breastfeeding is recognized as a crucial determinant of child health and development, yet its multifaceted effects remain underexplored in many contexts. This cross-sectional study investigates the association between breastfeeding practices and various health and developmental outcomes in infants and young children, focusing on exclusive breastfeeding, partial breastfeeding, and formula feeding. Done at Khyber Teaching Hospital, Pakistan, the research aims to provide comprehensive insights into the nuanced impacts of breastfeeding on child well-being. Objectives This study aims to assess the association between breastfeeding duration and practices with the incidence of infectious diseases in infants and young children. It investigates the relationship between different breastfeeding practices: exclusive breastfeeding, partial breastfeeding, and formula feeding and cognitive development outcomes in early childhood. Additionally, the study evaluates the role of breastfeeding in the development of motor skills in infants and young children. Methodology A cohort of 390 participants, aged one month to three years, participated in the study. Data collection encompassed parental interviews, clinical assessments using standardized tools such as the Bayley Scales of Infant Development, and reviews of medical records. Statistical analyses, including frequency analysis and chi-square tests, were conducted to elucidate the relationships between breastfeeding practices and health outcomes. Results Exclusive breastfeeding exhibited a significantly lower incidence of infectious diseases compared to partial breastfeeding and formula feeding. Specifically, among exclusively breastfed children, incidences of colds, pneumonia, and diarrhea were 32%, 39.7%, and 40%, respectively. These rates were notably higher in partially breastfed and formula-fed children. Cognitive development outcomes also varied significantly across feeding groups. Exclusively breastfed children demonstrated superior cognitive performance, with 34.2% rated above average, compared to only 6.5% in the formula-fed group. Additionally, the prevalence of developmental delays was lowest among exclusively breastfed children (14.1%), contrasting with 62.8% in the partial breastfeeding group and 77.0% in the formula-feeding group. Conclusions The study underscores the pivotal role of exclusive breastfeeding in promoting optimal child health and development. Exclusive breastfeeding is associated with significantly reduced incidences of infectious diseases, superior cognitive development outcomes, and a lower prevalence of developmental delays. These findings highlight the importance of supportive interventions and policies aimed at encouraging exclusive breastfeeding practices, ultimately enhancing child well-being and developmental trajectories.

Maternal depression, psychosocial stress and race/ethnicity: examining barriers to breastfeeding for young mothers

ABSTRACT Background Breastfeeding has a positive impact on child and maternal health outcomes. Black and Latina women and adolescent mothers have lower rates of breastfeeding initiation and continuance in the U.S. Maternal depression and psychosocial stressors may contribute to reduced rates of breastfeeding. The current study aims to better understand behaviours and associated factors related to breastfeeding in a diverse group of adolescent mothers attending a teen-tot clinic for postpartum and infant well care. Methods Participants were 191 mother-infant dyads. Mother’s age ranged from 13 to 25, and 54% of mothers identified as Latina, 22% Black, 11% more than one race and 5% white. Demographic information and breastfeeding behaviour were abstracted from the medical record. Rates of postpartum mood/anxiety symptoms and psychosocial stressors were obtained from screening measures completed at medical visits. Results Analyses revealed that 87% of adolescent mothers in the sample initiated breastfeeding at birth and the racial/ethnic breakdown of those mothers closely mirrored the overall population (58% Hispanic or Latina, 17% Black, 10% more than one race, 5% white). At 2 months postpartum, only 41% of the population was still breastfeeding. Mothers with significant mood/anxiety symptoms at the newborn visit were more likely to be breastfeeding at the 1- and 2-month visits. Mothers with psychosocial stressors at the newborn visit were less likely to be breastfeeding at the 1- and 2-month visits. Conclusion Efforts to promote health equity through breastfeeding for at-risk mothers must occur within the first few weeks postpartum and must consider associated factors including postpartum mood/anxiety symptoms and psychosocial stressors.

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

ABSTRACT Background Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. Objective This study investigated the association between breastfeeding duration and children’s educational attainment in rural Southwest Uganda. Methods We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. Results Most mothers breastfed for more than a year. Just over one-third breastfed for 18–23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7–12, 13–17, 18–23, and > 23 months compared to those breastfed for 0–6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. Conclusion Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children’s health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.

Perinatal Hospital Practices Are Associated with Breastfeeding through 5 Months Postpartum among Women and Infants from Low-Income Households

BackgroundBreastfeeding (BF) provides optimal nutrition during the first 6 mo of life and is associated with reduced infant mortality and several health benefits for children and mothers. However, not all infants in the United States are breastfed, and sociodemographic disparities exist in BF rates. Experiencing more BF-friendly maternity care practices at the hospital is associated with better BF outcomes, but limited research has examined this association among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk of low BF rates. ObjectivesWe assessed the association between BF-related hospital practices (rooming-in, support from hospital staff, and provision of a pro-formula gift pack) and the odds of any or exclusive BF through 5 mo among infants and mothers enrolled in WIC. MethodsWe analyzed data from the WIC Infant and Toddler Feeding Practices Study II, a nationally representative cohort of children and caregivers enrolled in WIC. Exposures included maternal experience of hospital practices reported at 1 mo postpartum, and BF outcomes were surveyed at 1, 3, and 5 mo. ORs and 95% CIs were obtained using survey-weighted logistic regression, adjusting for covariates. ResultsRooming-in and strong hospital staff support were associated with higher odds of any BF at 1, 3, and 5 mo postpartum. Provision of a pro-formula gift pack was negatively associated with any BF at all time points and with exclusive BF at 1 mo. Each additional BF-friendly hospital practice experienced was associated with 47% to 85% higher odds of any BF over the first 5 mo and 31% to 36% higher odds of exclusive BF over the first 3 mo. ConclusionsExposure to BF-friendly hospital practices was associated with BF beyond the hospital stay. Expanding BF-friendly policies at the hospital could increase BF rates in the United States WIC-served population.

Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates.

BackgroundBreastfeeding (BF) is considered the ultimate method of infant feeding for at least the first 6 months of life. Exclusive breastfeeding (EBF) is one of the most effective interventions to improve child survival. The main objective of this study was to assess the prevalence and duration of exclusive breastfeeding and the associated factors among women in Dubai and Sharjah, UAE.MethodsA cross-sectional study was conducted in four hospitals and four healthcare centers in Dubai and Sharjah between September 2017 and December 2017. Hospitals and centers are governmental and provide maternal and child health services. A convenience sample of 858 Arab and Emirati mothers with children under the age of 2 years participated in the study. Face-to-face interviews were conducted by using structured questionnaires. The study was approved by the University Ethical Committee and the UAE Ministry of Health before data collection. Descriptive statistics were computed to describe all the questionnaire items. The chi-square test was used to compare the study's categorical variables. A binary logistic regression analysis was used to predict the relationship between BF and its associated factors. Statistical tests with P-values < 0.05 were considered statistically significant.ResultsThe mean age of the participating mothers was 30.6 (SD 5.5) years. Results showed that the prevalence of exclusive breastfeeding among the study participants was 24.4% (31.1% in Sharjah and 22% in Dubai; P = 0.003). The binary logistic regression reported that mother's and father's education, skin-to-skin period, number of children, mothers' health, and place of living were significantly associated with exclusive breastfeeding (P < 0.05). The results reported a significant association between EB and duration of breastfeeding (OR = 6.9, P = 0.002), husband education (OR = 2.1, P = 0.015), mother education (OR = 1.3, P = 0.027), number of children (OR = 7.9, P = 0.045), having any health problem (OR = 1.2, P = 0.045), and living place (OR = 1.4, P = 0.033), and a non-significant positive effect of family size and family income. Furthermore, the result reported a significant association between mixed breastfeeding and duration of breastfeeding (OR = 0.1, P = 0.000), skin-to-skin period (OR = 0.3, P = 0.002), underweight (OR = 4.7, P = 0.034), last infant's sex (OR = 1.6, P = 0.010), having maid at home (OR = 2.1, P = 0.000), number of children (OR = 0.2, P = 0.013), and living place (OR =1.1, P = 0.014), and a non-significant association with family size and family income.ConclusionsTherefore, a health promotion program for exclusive breastfeeding during antenatal health visits, together with initiating health policies in maternal hospitals to encourage the initiation of breastfeeding during the first hour of birth and the introduction of skin-to-skin contact during the first 5 min of birth are highly recommended.

Breastfeeding and autism spectrum disorder

Background Breastfeeding (BF) was suggested as an environmental factor that may confer a protective role against autism. Aim The primary aim was to compare the patterns of BF in children with autism spectrum disorder (ASD) with their typically developing siblings. The secondary objective was to conduct a pilot study to investigate the effect of BF on the severity of the core ASD symptoms and the intellectual functions among children with ASD. Patients and methods A comparative cross-sectional study was conducted at the Outpatient Clinic of Alexandria University Children’s Hospital on 100 children; 50 children with ASD (group A, n=50) and 50 typically developing children; siblings of children of group A (group B, n=50) using a designed semistructured questionnaire. Results The comparison between both groups revealed that neither BF ever, early initiation, prolonged duration, nor exclusive BF were statistically different in children with autism and their siblings. Among children with ASD, there was a significant positive relationship between early BF initiation and less severe core symptoms of autism on Childhood Autism Rating Scale scores (U=405, P=0.017) and better intellectual functions on intelligence quotient score (U=18, P=0.03). Exclusive BF had a weak significant positive correlation (r=0.31, P=0.03) with higher intellectual functions on the intelligence quotient score. Conclusion In conclusion, BF practices are not linked to autism in children at risk. However, because early BF initiation is connected to less severe ASD core symptoms, our study implies that BF can be regarded a predictive factor of optimal outcomes for children with ASD. Future research with a prospective design and a large sample size could aid in establishing a cause-and-effect relationship.

Attitudes and Barriers to Breastfeeding among Mothers in Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia.

Background Breastfeeding provides unsurpassed natural nutrition to the newborn and infant. It has a nearly perfect mix of food elements and vitamins that infants need to grow up. Nonetheless, the tendency for breastfeeding remains below the expected levels. Objectives To explore the attitudes and barriers to breastfeeding among mothers in Princess Nourah Abdulrahman University (PNU), Riyadh, Saudi Arabia. Methods A cross-sectional study was conducted, from January to April 2019; 399 PNU students, employees, and faculty mothers aged 18 years and above with experience of childbirth and breastfeeding were included in the study using a predesigned validated questionnaire. The questionnaire consisted of four scales: sociodemographic, attitude toward breastfeeding, barriers to breastfeeding, and induced lactation knowledge. Results The participants' mean age was 34.1 ± 10.4 years; most (87.8%) were Saudi; 92.8% were married; 62% had a bachelor's degree; and 43% had “enough income.” While 40% of the mothers reported >6 months “exclusive breastfeeding” for the first baby, only 34.8% did so for the last baby, and 54.5% did so for most of all babies altogether. The mothers' parity ranged between 1 birth and 4 births in 23.5% and 17.5% of the participants, respectively. An overall score of breastfeeding attitude averaged 59.6 ± 7.3. The tendency for scoring a negative attitude to breastfeeding was significantly reported (p < 0.5) among 127 (31.8%) 31- to 40-year-old mothers; 153 (38.3%) bachelor's degree holders; and 157 (39.3%) employees (χ2 (4) 14.6, p = 0.006; χ2 (4) 10.4, p = 0.034; and χ2 (4) 20.4, p < 0.001, respectively). “Mother's illness” was the most commonly (63%) reported barrier to “not to breastfeed,” followed by “work” (45.5%) and “father not supporting breastfeeding” (14.8%). Conclusions An overall negative attitude toward breastfeeding among PNU mothers was noted. Barriers included mother's sickness and work. Efforts to minimize such negative attitudes and barriers among susceptible mothers are warranted.

Excretion of SARS-CoV-2 in breast milk: a single-centre observational study

BackgroundBreast feeding by SARS-CoV-2-infected mothers has been a concern because of the possibility of excretion of virus in breast milk.ObjectiveTo detect SARS-CoV-2 in expressed breast milk (EBM) of mothers infected...

Effect of the theory of planned behavior on primipara breastfeeding.

Breastfeeding is the most effective way to provide food for the healthy growth and development of babies. It has been reported in the literature that interventions on parturients, with the theory of planned behavior (TPB) as the guiding framework, can achieve good results. The purpose of the present study was to explore the effect of the TPB on primipara breastfeeding. A total of 70 primiparas, who were given regular intervention mode at Haian People's Hospital from May 2017 to May 2018, were selected as the control group, and a total of 70 primiparas, who were given the TPB model from June 2018 to June 2019, were selected as the observation group. Exclusive breastfeeding rates, continuous breastfeeding rates, and breastfeeding confidence and breastfeeding impact factors were compared between the two groups. After the intervention, the pure breastfeeding rates of the observation group at discharge, 1 month after delivery, and 4 months after delivery were higher than those of the control group (P<0.05). After intervention, the continuous breastfeeding rates of the observation group was higher than that of the control group at 4 months after delivery (P<0.05). After intervention, the skill dimension, inner activity dimension, and total score of the observation group were higher than those of the control group (P<0.05). After intervention, scores of attitude, perceptual behavior control, and knowledge in the observation group were higher than those of the control group (P<0.05). The application of the TPB to primipara breastfeeding can significantly increase the rate of exclusive breastfeeding and continuous breastfeeding, and effectively improve the impact factors of breastfeeding.

Breastfeeding promotes early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens.

Breastfeeding is associated with long-term health benefits, such as a lower incidence of childhood infections, asthma, obesity and autoimmune disorders. However, little is known regarding how the maternal and neonatal immune systems interact after parturition when the neonate receives nutrition from maternal breast milk. We undertook a comparative analysis of immune repertoire and function at birth and 3weeks of age in a cohort of 38 term neonates born by caesarean section grouped according to feeding method (breast milk versus formula). We used flow cytometry to study the immune phenotype in neonatal and maternal blood samples and mixed lymphocyte reactions to establish the proliferation response of neonatal versus maternal lymphocytes and vice versa. The microbiome of neonatal stool samples was also investigated using 16S rRNA sequencing. We show that the proportion of regulatory T cells (Tregs) increases in this period and is nearly twofold higher in exclusively breastfed neonates compared with those who received formula milk only. Moreover, breastfed neonates show a specific and Treg-dependent reduction in proliferative T-cell responses to non-inherited maternal antigens (NIMA), associated with a reduction in inflammatory cytokine production. We also observed the enrichment of short chain fatty acid producing taxa (Veillonella and Gemella) in stool samples of exclusively breastfed neonates. These data indicate that exposure of the neonate to maternal cells through breastfeeding acts to drive the maturation of Tregs and 'tolerizes' the neonate towards NIMA.

Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review.

BackgroundBreastfeeding is a fundamental component of health care, and health professionals need to be adequately prepared. As part of the system, health care professionals have the ability to influence the establishment and maintenance of breastfeeding. The global literature regarding the curricular approach or established best practices for health professional education in lactation is inconclusive and lacking in rigor.Research aimTo explore the literature for the educational resources, methods, and curriculum used in the education of undergraduate health students related to lactation.MethodsA scoping review examining the curricular programs of health professional students in lactation was undertaken exploring and summarizing evidence from peer reviewed and grey literature. A scoping review with a five-stage review process was followed. The database search between 1982–2018 generated 625 results, 79 full-text articles were reviewed, and 29 articles published in English met the inclusion criteria.ResultsIn general, educational resources, methods, curricular approaches, and foundational topics were based on best practice standards. Some authors incorporated a variety of learning methods and provided experiential learning, with evidence of translation of knowledge into clinical practice. In the studies examined, researchers reported that students had improved their: knowledge and attitudes (59%); breastfeeding support skills (45%); and confidence (10%). However, even in programs that focused on developing students’ breastfeeding support skills, authors reported a lack of change in students’ confidence.ConclusionsAlthough only English articles met the inclusion criteria, this review was unique in its search of multidisciplinary, multilingual, and international studies. Consistency in teaching across disciplines is key and not evident in the studies reviewed.

A service evaluation of a hospital-based specialist postnatal breastfeeding clinic

Background Breastfeeding is described as the gold standard of infant feeding and is beneficial to both infant and maternal health, reducing healthcare costs. Breastfeeding rates are low in Ireland. Interventions that support and protect breastfeeding are required. Aim To conduct a service evaluation of a hospital-based specialist postnatal breastfeeding clinic. Methods A telephone questionnaire was administered to 99 participants who attended a breastfeeding specialist clinic. Descriptive analysis was conducted on the quantitative data. The qualitative data was anonymised and subjected to thematic analysis. Results Of the 99 women, 99% were breastfeeding at 6 weeks, 92% at 3 months and 77% at 6 months, respectively. The majority of women attended with one breastfeeding challenge (63%) while 24% of women attended with two breastfeeding challenges. Conclusions Skilled professional breastfeeding support, in addition to peer support, is an effective and acceptable way to increase breastfeeding among women who present with common breastfeeding challenges.

Exclusive breastfeeding among HIV exposed infants from birth to 14 weeks of life in Lira, Northern Uganda: a prospective cohort study

ABSTRACT Background Breastfeeding is important for growth, development and survival of HIV exposed infants. Exclusive breastfeeding reduces the risk of morbidity, mortality and increases HIV free survival of infants. Evidence on risk factors for inappropriate breastfeeding in Northern Uganda is limited. Objective This study determined the risk factors for non-exclusivity of breastfeeding in the first 14 weeks of life. Methods This prospective cohort study was conducted among 466 mother-infant pairs between August 2018 and February 2020 in Lira district, Northern Uganda. HIV infected pregnant women were enrolled and followed up at delivery, 6- and 14- weeks postpartum. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related, HIV-related characteristics and exclusive breastfeeding. Data were analysed using Stata version 14.0 (StataCorp, College Station, Texas, USA.). We estimated adjusted risk ratios using modified Poisson regression models. Results The proportion of HIV exposed infants that were exclusively breastfed reduced with increasing age. Risk factors for non-exclusive breastfeeding included infants being born to HIV infected women who: were in the highest socioeconomic strata (adjusted risk ratio = 1.5, 95%CI: 1.01– 2.1), whose delivery was supervised by a non-health worker (adjusted risk ratio = 1.6, 95%CI: 1.01– 2.7) and who had not adhered to their ART during pregnancy (adjusted risk ratio = 1.3, 95%CI: 1.01– 1.7). Conclusions HIV infected women: with highest socioeconomic status, whose delivery was not supervised by a health worker and who did not adhere to ART were less likely to practice exclusive breastfeeding. We recommend ART adherence and infant feeding counselling to be emphasised among HIV infected women who are at risk of having a home delivery, those with poor ART adherence and those of higher socioeconomic status. We also recommend integration of these services into other settings like homes, community and work places instead of limiting them to hospital settings. Abbreviations HIV: Human Immunodeficiency Virus; ART: Antiretroviral therapy; HEI: HIV exposed infant; PMTCT: Prevention of mother-to-child transmission of HIV; MTCT: Mother-to-child transmission of HIV; AFASS: Acceptable, Feasible, Affordable, Sustainable and Safe; LRRH: Lira regional referral hospital; CI: confidence interval; ARR: Adjusted risk ratio; SD: Standard deviation; PCA: Principal component analysis

Systematic review of infant and young child feeding practices in conflict areas: what the evidence advocates

BackgroundBreast feeding in conflict settings is known to be the safest way to protect infant and young children from malnourishment and increased risk of infections. This systematic review assesses the...

Estimating the population impact of hypothetical breastfeeding interventions in a low-income population in Los Angeles County: An agent-based model.

BackgroundBreastfeeding has clear benefits. Yet, breastfeeding practices fall short of recommendations in low-income populations including participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). To promote breastfeeding, it is important to understand breastfeeding-related behaviors such as initiation and maintenance within the context of a complex societal system. For individual women, making choices about infant feeding (whether to breastfeed or formula-feed a newborn, or when to stop breastfeeding) is a dynamic process involving interactions with health professionals, family, peers and workplaces. Integrating behavioral change theories with systems science tools such as agent-based modeling can help illuminate patterns of breastfeeding behaviors, identify key factors affecting breastfeeding behaviors within this complex dynamic system, and estimate the population impact of hypothetical interventions.MethodsAn agent-based model (ABM) was developed to investigate the influences of multiple levels of factors affecting breastfeeding behaviors among WIC participants. Health behavioral change theories were applied and stakeholder input obtained to improve the model, particularly during the conceptual design and model specification steps. The model was then used to identify critical points for intervention and assess the effects of five common interventions (improving knowledge through education, implementing Baby-Friendly Hospital Initiative practices, providing postpartum breastfeeding counselling, strengthening partner support, and fostering supportive workplace environments.)ResultsThe ABM developed in this study produced outcomes (i.e., breastfeeding rates) that were concordant with empirical data. Increasing the coverage of the five selected interventions produced various levels of improvement in breastfeeding practices in the target population. Specifically, improving breastfeeding knowledge had a positive impact on women’s intent to breastfeed, while increasing the availability of the Baby-Friendly Hospital Initiative improved breastfeeding initiation rates. However, neither of these two interventions showed a significant impact on breastfeeding maintenance, which was supported by postpartum breastfeeding counseling, partner support and a supportive workplace environment. These three intervention strategies each improved breastfeeding rates at 6 months from 55.6% to 57.1%, 59.5% and 59.3%, respectively. Increasing the coverage of multiple interventions simultaneously had a synergistic effect on breastfeeding maintenance with their effects being greater than the cumulative effects of increasing the coverage of these interventions individually.ConclusionThe ABM we developed was helpful for understanding the dynamic process of decision-making regarding infant feeding modalities in a low-income population, and for evaluating the aggregated population-level impact of breastfeeding promotion interventions.

Breastfeeding is associated with reduced risk of multiple sclerosis in males, predominantly among HLA-DRB1*15:01 carriers.

BackgroundBreastfeeding as an infant appears protective against later development of some autoimmune diseases, but research into its influence on multiple sclerosis (MS) risk has yielded inconclusive results.ObjectiveWe investigated the possible impact of breastfeeding on MS risk.MethodsWe used two population-based case–control studies comprising 3670 cases and 6737 matched controls. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for association between MS and exposure to prolonged breastfeeding (4 months or longer) versus reduced breastfeeding (less than 4 months). A meta-analysis of case–control studies that assessed the impact of breastfeeding on MS risk among women and men was conducted.ResultsProlonged breastfeeding was associated with reduced MS risk among men (OR 0.7, 95% CI 0.5–0.9) but not among women (OR 0.9, 95% CI 0.8–1.1). Among men, a synergistic effect was observed between HLA-DRB1*15:01 carrier status and reduced breastfeeding.ConclusionsFindings from the current study add to accumulating evidence that breastfeeding may be a modifiable protective factor for reducing the risk of MS in offspring. When possible, mothers should be supported to breastfeed their infants; however, the mechanism of a sex-specific biologic effect of breastfeeding on MS risk is unclear.

Do Expectant Mothers' Breastfeeding Plans Influence Provider Prenatal Contraceptive Counseling?

Breastfeeding and optimal birth spacing are associated with improved maternal and infant health outcomes worldwide. Provision of contraceptive advice that is aligned with recommendations for breastfeeding has potential to maximize maternal and infant health. Although there is broad agreement regarding the breastfeeding compatibility of specific postpartum contraceptive methods, it is not known whether maternal breastfeeding intention influences prenatal provider contraceptive counseling. We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling. This was a cross-sectional online author-created survey including all prenatal providers (N = 40) at two academic safety-net institutions in Cleveland, Ohio. Of 100 obstetrics/gynecology faculty members, 40 (40%) completed the survey, which included multiple-choice questions. Nominal and ordinal survey results were reported with percentages and frequencies, and categorical variables were compared using the Fisher exact test. Participants appropriately promoted breastfeeding-compatible postplacental intrauterine device placement, even though maternal feeding intention was specifically considered by just 12 (30%). Endorsed barriers to contraception for breastfeeding mothers included provider medical worries, patient concerns, and colleague resistance. Postplacental levonorgestrel intrauterine devices were recommended for all mothers by 92.5% of participants (n = 37). Recommendations regarding progestin-only and combined oral contraceptive pills were influenced by maternal breastfeeding versus formula-feeding intention. Asking expectant women about their feeding intentions within each contraceptive discussion may create opportunities for shared decision making that can optimize perinatal outcomes for both mother and infant worldwide.

Breast Feeding Practice: Positioning and Attachment during Breast Feeding among Lactating Mothers Visiting Health Facility in Areka Town, Southern Ethiopia.

Background Breastfeeding is the act of milk conveyance from the mother to the infant. Adequate nutrition during infancy and early childhood are mandatory to ensure growth, health, and development of children to their maximum potential. The positioning of the baby's body is important for maintaining good attachment and successful breastfeeding. Most difficulties of breastfeeding can be avoided altogether if good attachment and positioning can be achieved at the first and early feeds. Plenty of studies have been conducted to explore factors affecting breastfeeding practice in general; however, there is a meagerness of evidence that assesses factors affecting attachment and positioning during breastfeeding specifically. Therefore, the current study was aimed to assess positioning and attachment during breastfeeding among lactating mothers visiting health facilities of Areka town. Methods an institution-based cross-sectional study was conducted by using observational checklist adopted from the World Health Organization breastfeeding observation form. Maternal-related characteristics were collected by using a structured and pretested questionnaire. The study was conducted from April to June 2017. Respondents were selected by using a systematic random sampling technique. Descriptive summaries were done to present pertinent findings and a chi-square test was used to check association between variables. Result There was poorer positioning among primipara mothers (47.1%) than multipara mothers (28.7%). A poor attachment was also more apparent among primipara mothers which were more (31.1%) than the multipara (27.1%) mothers. Conclusion Younger mothers (<20 years old), the primipara, and those who have no formal education deserve more attention, support, and direction to make sure that they can achieve proper positioning and attachment during breastfeeding at the first and early feeds.