Continued Breastfeeding Research Articles

Role of proper postnatal care in continued exclusive breastfeeding among young Indonesian mothers.

Exclusive breastfeeding (EBF) provides numerous health benefits to children. However, the EBF rate is unsatisfactory among young mothers because they often experience difficulties. Thus, interventions during the postnatal period are imperative to encouraging EBF practices in these populations. Postnatal care (PNC) should be delivered appropriately to ensure a positive postnatal experience; however, there has been little discussion of evidence therein to date. This study investigated the association between proper PNC and EBF practices among young Indonesian mothers. This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. All mothers aged 15-24 years who delivered an infant within the 2 years preceding the survey were included. Mothers were considered to be receiving proper PNC if they started breastfeeding soon after delivery, attended a PNC appointment within 2 days after giving birth, and received breastfeeding counseling and observation during the PNC visit. Approximately 51.6% of infants under 6 months of age born to young mothers (those aged 15-24 years) were exclusively breastfed. Appropriate PNC was received by approximately 24.3% of the total population. The correlation between proper PNC and EBF practices was significant among adolescent mothers aged 15-19 years after an age stratification analysis (odds ratio, 8.22; 95% confidence interval, 1.957-34.524). Maternal age became a noticeable confounder after a risk stratification analysis. Our findings imply the importance of breastfeeding service delivery during the early postnatal period in continuing EBF. Ensuring high PNC quality helps ensure positive postnatal experiences, particularly for adolescent mothers.

Evolutive Study of Dietary Aspects and Intestinal Microbiota of Pediatric Cohort with Cow's Milk Protein Allergy.

One of the most common food allergies in the pediatric population is allergy to cow's milk protein (CMPA). Treatment consists of avoiding cow's milk proteins in lactating mothers and/or using therapeutic formulas based on hydrolysates or vegetable formulas. In infants with CMPA at diagnosis, a different gut microbial profile has been found compared to healthy children, with a reduction in beneficial bacteria. The aim of this study was to evaluate changes in the gut microbiota profile and its metabolites, dietary patterns and anthropometric variables in a pediatric cohort with CMPA after six months on a restrictive diet compared to healthy controls. In total, 21 patients diagnosed with CMPA and a control group of 24 healthy infants participated in this study. The fecal microbiota of all participants were investigated by metataxonomic analysis of 16S rDNA amplicons, and fecal short-chain fatty acids were measured by gas chromatography. Epidemiological assessment and dietary questionnaires were carried out for both groups. Regarding growth, no significant differences were found, but differences in dietary intake of some macro- and micronutrients were observed. Patients who were breastfed at six months had higher bifidobacteria and lipid intakes than patients fed with hydrolyzed formulas. Although the growth of CMPA infants fed with therapeutic formula is similar to breastfed CMPA infants, there are differences in microbiota composition and macronutrient intake that underline the importance of continued breastfeeding in CMPA cases.

Knowledge, Attitude, and Practice of Health Care Professionals Toward Breastfeeding

Successful initiation and continuation of breastfeeding is proportionate to the attitude and knowledge of health care professionals toward breastfeeding; therefore, we conducted a study in Alkhoms district hospital, aimed to evaluate knowledge, attitude and practices of health care professionals toward breastfeeding. A well-structured questionnaire was designed to test their knowledge on Breastfeeding process, and their ability to deal with different problems and questions that may face during their practice. A total of 155 health care providers participates in this study [72 nurses, 25 midwives, and 58 junior doctors], all of them filled the questionnaire completely and each separately. The study has shown clearly deficiencies of health care providers in some aspects of their knowledge on and their abilities to deal with practical problems that may facing the lactating mother.

Impact of Flood on Breastfeeding Practices at Flood Relief Camps of Pakistan.

To explore impact of flood on breastfeeding practices and identify barriers in continuation of breastfeeding among mothers residing in flood relief camps. This exploratory observational study was conducted during visit of medical team of The University of Child Health Sciences, Children's Hospital at flood relief camps of Sindh (7th September to 12th September, 2022) and south-west of Punjab province (18th November to 20th November, 2022). The data was collected on structured questionnaire from 40 lactating mothers residing in flood relief camps. Purposive sampling technique was used in this regard. The mean age of breastfed children was 16.1±7.811 months. There was negative impact on breastfeeding practices (n=21, 52.5%) as frequency decreased in 18(45%) mothers and 3(7.5%) totally stopped breastfeeding. There was significant relation between pre-flood breastfeeding status and impact of flood on breastfeeding practices (p=0.001). The major barriers to appropriate breastfeeding were mother's perception of insufficient breast milk due to inadequate diet (n=6, 15%) or depression and anxiety (n=4, 10%), mother's illness (n=3, 7.5%), constant displacement (n=2, 5%) and provision of breast milk substitutes (n=2, 5%). There has been significant negative impact of flood on breastfeeding practices among lactating mothers residing in flood relief camps. Perception of decreased milk production due to inadequate diet and stress are major barriers in continuation of breastfeeding. Breastfeeding supportive services need to be integral component of flood crisis management.

The Stunting Determinants in Toddlers from Landak Regency, West Kalimantan: A Cross-Sectional Study

Background: Stunting is a nutrition problem that can slow down the growth. With prevalence at 32.5%, Landak Regency in West Kalimantan has been designated as a stunting hotspot. The lack of a maximum penalty for the stunting case in Landak Regency is not based on factors causing the stunting itself, because there is no identifiable factor causing the stunting in certain area due to narrow roads and sharp curves. Objectives: The objective of this study was to identify causes and distribution of the stunting case in Landak Regency. Methods: A total of 330 households in Meranti, Sebangki, and Senakin were included in this cross-sectional study because they were at a risk of the stunting. Toddlers, mothers, health care, and environmental factors were among the found variables. The researchers employed a basic random sampling strategy for the sampling and used the secondary health center data to find out whether or not toddlers were stunted. Researchers in this study collected data on the independent variables by observing and interviewing participants. Using the chi-square test, the data was analyzed. Results: The results showed that determinants of the stunting in Landak Regency were the history of early breastfeeding initiation (p-value=0.032), exclusive breastfeeding (p-value=0.042), frequency of exclusive breastfeeding (p-value=0.040), the continued breastfeeding (p-value=0.024), complementary feeding (p-value=0.042), immunization history (p-value=0.007), infectious disease history (p-value=0.000), maternal height (p-value=0.046), delivery assistance (p-value=0.000), access to health services (p-value=0.004), the role of health workers (p-value=0.002), and family latrine ownership (p-value=0.000). Conclusions: Several factors were found to be associated with incidence of the stunting among toddlers in Landak Regency.

LATCHES – a memory aide for the principles of attachment for effective breastfeeding: findings of a regional pilot in the Northeast of England and North Cumbria

BackgroundThis paper outlines a pilot of a new memory aide for breastfeeding conducted in the Northeast of England and North Cumbria between April and August 2023. The United Kingdom has some of the lowest rates of breastfeeding, particularly in the Northeast of England, and as such more needs to be done to support mothers to breastfeed for as long as they would like to. Good support from health professionals can be effective in influencing decisions to breastfeed as well as helping to ensure initiation and continuation of breastfeeding but there is evidence to suggest that professionals and students do not always feel adequately trained and it is here, where memory aides may have value.MethodsKey breastfeeding practitioners and educators were brought together to select one of two memory aides for principles of attachment for effective breastfeeding. The selected memory aide, LATCHS, was piloted with 57 participants with a key role in promotion and support of breastfeeding in the Northeast of England and North Cumbria.ResultsParticipants conveyed mixed views about the proposed memory aide with more experienced staff reporting more favourable opinions than student midwives and early years practitioners. Experienced staff felt the new memory aide would complement an early memory aide, CHINS, which focused on principles of positioning.DiscussionFindings of the pilot indicate there is a role for a mnemonic to help practitioners understand, recall, and retain theory around attachment for effective breastfeeding and that memory aides can play an important role in complementing existing approaches to education and practice. The participants felt the proposed memory aide had some limitations and suggested important ways for it to be improved, particularly in adding an E to reflect the expecting wording. This produced the final memory aide: LATCHES.ConclusionUsing data from the pilot, the memory aide was refined, and the final version LATCHES agreed for wider dissemination. Future research is needed to understand the value of LATCHES on the wider breastfeeding workforce and whether any future improvements can be made to enhance its utility.

The interplay between maternal employment dynamics and trends in breastfeeding practices over the past decade

BackgroundWorking mothers are in a situation where they have to manage both their job and maternal roles simultaneously. We aim to show the relationship between mothers' breastfeeding behavior and working status, as well as the effect of their working conditions on the continuation of breastfeeding.MethodsThis study examined 3557 (weighted 3490) child-mother pairs from Turkey's Demographic Health Survey data in 2008, 2013, and 2018 with a complex sample multiple logistic regression analysis to explore the relationship between breastfeeding and maternal employment.ResultsIn our study, 35.5% of the mothers had never worked, 18.6% were still working, and 45.9% had worked in the past but were not currently working. When breastfeeding percentages were examined based on maternal working status, mothers who worked in 2008 had significantly lower breastfeeding percentages than those who had never worked or had worked previously but not currently. In both 2013 and 2018, after legal regulations, maternal employment didn't affect breastfeeding. After adjusting for confounding factors, maternal employment in the industry sector had lower breastfeeding percentages [AOR:0.06 (95% CI: 0.01–0.48)] than those working in agriculture.ConclusionIt seems that adhering to legal regulations such as paid maternity leave and lactation leave can promote breastfeeding. It is necessary to raise awareness of mothers working in the industry about the continuation of breastfeeding and to monitor their legal rights.

Investigating the Start time and duration of skin-to-skin contact in the delivery or operating room in the hospitals of Khorasan Razavi Province, Iran

Background. Skin-to-skin contact (SSC) plays a significant role in the initiation and continuation of breastfeeding and maintaining and improving the health of infants. The goal of this research was to study the start time and duration of SSC in the labor rooms or operating rooms of the hospitals in Khorasan Razavi province. Methods. This descriptive study has been done on 714 newborn babies in labor rooms and ORs of governmental hospitals in Khorasan Razavi province from 1399 to 1401 through convenience sampling method. A midwife who did not have any role in the delivery process kept a record of the time of the SSC and its duration after the delivery. In the next stage, probable reasons for not having SSC, the connection of the start time of SSC and its duration with the start time and duration of breastfeeding were studied. Results. Based on the results of the study, 65% of the cases had SSC after the delivery in labor rooms under study . The mean start time of the SSC was 5.06±12.30 minutes, and the mean duration of the SSC after the birth was 9.28±13.66 minutes. Non-cooperation of the mother (61.38%), the fear of non-sterile environment (8.62%) and hastening the delivery process by the professionals involved (3.79%) were the most common reasons for not having SSC. Conclusion. In 35% of cases, there was no SSC after birth. Starting the contact early after birth can increase the success rate of breastfeeding. Practical Implications. According to the results of our study, skin-to-skin contact in our maternity hospitals is not done in one-third of the cases, which is necessary after the birth of babies. Babies who received skin-to-skin contact started breastfeeding earlier and held the breast longer, indicating that skin-to-skin contact facilitates the initiation of breastfeeding and increases its duration. The non-cooperation of the mother is the most common reason for not having skin-to-skin contact. Therefore, providing the necessary information and training to mothers about the importance of skin-to-skin contact in maintaining the health of babies, facilitating the initiation of breastfeeding, and changing the attitudes and behaviors of mothers seems necessary.

A Qualitative Study of Breastfeeding Mothers' Perspectives Regarding Lactation Support Services.

Although breastfeeding is widely accepted as beneficial, only half of U.S. mothers are breastfeeding at 6 months. This study aimed to learn whether a quality improvement project to embed lactation support services into the newborn visit at a primary pediatric practice met families' needs. Mothers who were aged 18+ years, had an infant born in October 2021 with a well-child visit to the study practice (urban, 85% Medicaid, and 90% African American), and planned to breastfeed were invited to participate in a semi-structured telephone interview about their experience with breastfeeding and lactation support. We interviewed 18 mothers and, using a descriptive qualitative approach (thematic analysis), found that early support was helpful in addressing initial challenges such as latching pain but did not adequately anticipate later barriers to continued breastfeeding. This suggests lactation support offered by pediatric primary care practices should extend beyond the newborn period and be tailored to families' evolving needs.

Infant feeding practices and associated factors during the COVID-19 pandemic: Findings from an online crosssectional study in Indonesia

Introduction: COVID-19 pandemic presents a challenge to ensuring optimal infant feeding practices. This study aimed to assess infant feeding practices and investigate potential factors associated with exclusive and continued breastfeeding practices during the COVID-19 pandemic in Indonesia. Methods: An online survey was conducted during December 2020 – August 2021. A total of 817 Indonesian mothers aged ≥18 years old with infants aged <18 months were obtained through convenience sampling. Exclusive breastfeeding was the practice at the time of the survey among infants <6 months old; continued breastfeeding was considered when infants aged >6 months received any type of breastfeeding in the previous day. Results: Most subjects were aged 25-34 years old (81.3%), had a high education level (85.7%), with middle household income level (40.5%), and lived in Java Island (81.6%). Infants’ age and sex were comparable between younger vs. older infants and boys vs. girls, respectively. Exclusive breastfeeding was 81.3%. Continued breastfeeding was 93.4%, with 74.3% meeting the minimum acceptable diet. Breastfeeding intention (92.9%) and husband’s support for infant feeding (67.2%) were reported during the COVID-19 pandemic. Multivariate analyses showed that breastfeeding intention was one of the factors associated with exclusive breastfeeding [aOR=12.6; 95%CI (4.1-39.1)] and continued breastfeeding [10.9 (4.4-27.0)]. Conclusion: The study suggested that mothers’ intention to breastfeed during the COVID-19 pandemic provided affirmation of good breastfeeding experiences by allowing mothers to have more time for childcare activities and more opportunities to develop meaningful coparenting practices while staying at home.

Complex intertwined association between breastfeeding practices and household food insecurity: Systematic review and meta-analysis.

Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, literature searches using 'breastfeeding', 'food insecurity' and 'infant' terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross-sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta-analysis was performed for studies assessing EBF (n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49-0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55-0.94), moderate (OR = 0.59, 95% CI = 0.41-0.84) and severe HFI (OR = 0.49, 95% CI = 0.32-0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta-analysis was not performed due to the low number of studies (n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy-level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food-insecure families.

Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study.

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.

Perception and Practice of Sub-Himalayan Region Mothers for Breastfeeding: A Cross-Sectional Survey

Abstract Background: Breast milk is an ideal food for neonates, which is also beneficial for mothers. Nowadays, modern mothers choose not to breastfeed their babies. The World Health Organization also recommends continuous breastfeeding of babies for up to 2 years. The present study focuses on assessing the perception and practice of mothers for exclusive breastfeeding in the sub-Himalayan region of India. Materials and Methods: A cross-sectional study was conducted among postnatal mothers who were attending pediatric outpatient departments (OPDs) and immunization clinics at All India Institute of Medical Sciences, Rishikesh, India. Interview schedules were conducted to assess knowledge and skills, and data related to breastfeeding were collected from 210 mothers. Purposive sampling techniques were used to select each participant. Results: The mean age of mothers was 26.8 years, 56% had previous experience of breastfeeding, 76% had a cesarean delivery, and 70% had started breastfeeding within 1 h. More than half (53%) of the mothers had inadequate knowledge of breastfeeding. On the Iowa Scale, only 8% of mothers reported a very positive attitude toward breastfeeding. On the Bristol scale, 81% of mothers reported that they were following good breastfeeding practices. Conclusions: The study concludes that sub-Himalayan mothers have inadequate knowledge of breastfeeding, but their practices are still suboptimal. We recommend more public health awareness programs to promote breastfeeding in this region.

Infant and Young Child Feeding practices and risk factors of SAM among beneficiaries of Nutrition Rehabilitation Centre – a cohort study

Introduction: Mission Balam Sukham's Nutrition Rehabilitation Centre (NRC) combats malnutrition through prevention, treatment, and community engagement, ensuring children receive adequate nutrition for healthy growth. Objective: To document IYCF practices and risk factors of severe acute malnutrition (SAM) among NRC beneficiaries Methodology: A prospective cohort study was conducted comprising of 63 children aged 6 months to 5 years having SAM alongwith complications admitted at NRC of South Gujarat over the duration of 10 months. Observations: 90.5% poverty, 57.1% migrants, 7.9% single parent. 69.8% initiated breastmilk within 1hr, 15.9% weren’t fed with colostrum, 6.3% were given pre-lacteals. 93.7% were exclusively breastfed, 6.3% initiated breastmilk at the time of 6 months. 16%, 60% and 9.8% met the criteria of MDD, MMF and MAD respectively. Boys show significant association on admission and discharge both (t = 2.43, p= 0.026 on admission and t= 2.66, p= 0.015 on discharge). In 13-24 months, MDD group (t = 2.34, p=0.02), children not suffering from anaemia shows significant weight (t=-2.540, p=0.18). Conclusion & Recommendations: Children's weight improvement is linked to better IYCF practices, emphasizing its importance of caregiver attention and education, highlighting need to address cultural barriers and promote practices like exclusive breastfeeding and continuous breastfeeding, focusing on empowering mothers and caretakers.

Factors associated with exclusive breastfeeding by maternal HIV status: a population-based survey in Kenya

BackgroundExclusive breastfeeding (EBF) in the first six months remains low globally, despite known benefits of lower morbidity and mortality among breastfed infants. It is important to understand factors associated with breastfeeding to support optimal breastfeeding practices, particularly in settings with a high burden of HIV.MethodsWe analyzed data from a population-level survey of mother-infant pairs attending 6-week or 9-month immunizations at 141 clinics across Kenya. Primary outcomes included maternal report of (1) EBF at 6-week visit, defined as currently feeding the infant breast milk only, (2) EBF for the first 6-months of life, defined as breastfeeding or feeding the infant breast milk only with no introduction of other liquids or solid foods until 6 months, and (3) continued breastfeeding with complementary feeding at 9-months. Correlates of breastfeeding practices were assessed using generalized Poisson regression models accounting for facility-level clustering.ResultsAmong 1662 mothers at 6-weeks, nearly all self-reported breastfeeding of whom 93% were EBF. Among 1180 mothers at 9-months, 99% had ever breastfed, 94% were currently breastfeeding and 73% reported 6-month EBF. At 6-weeks, younger age (< 25 years) (adjusted Prevalence Ratio (aPR) 0.96; 95% CI 0.93, 0.99), lower education (aPR 0.96; 95% CI 0.93, 0.99) and recent infant illness (aPR 0.97; 95% CI 0.94, 1.00) were associated with lower EBF prevalence while women living with HIV (WLWH) had higher EBF prevalence (aPR 1.06; 95% CI 1.02, 1.10) than women without HIV. 6-month EBF prevalence was 26% higher in WLWH (aPR 1.26; 95% CI 1.15, 1.35) than women without HIV, 14% lower in women reporting mild or above depressive symptoms (aPR 0.86; 95% CI 0.76, 0.99) than those with none or minimal depressive symptoms, and 15% lower in women with versus without history of intimate partner violence (aPR 0.85; 95% CI 0.74, 0.98). At 9-months, WLWH had a lower prevalence of continued breastfeeding with complementary feeding (aPR 0.73; 95% CI 0.64, 0.84) than women without HIV.ConclusionWLWH had higher EBF prevalence in the first 6-months, but lower prevalence of continued breastfeeding at 9-months. Strategies to support EBF and continued breastfeeding beyond 6-months postpartum, particularly among WLWH, are needed.

A Correlation Study Of Breast Milk Production Among Indonesia Mother : The Role Of Baby Formula Milk Feeding History 0-6 Months Old

Background: Continuity of breastfeeding can be influenced by social support from other people who interact with the mother so that the mother can feel physical and psychological comfort. The purpose was correlation between history beginning giving formula milk with breast milk production in Soko Tuban and Kendawangan Ketapang. Method: Cross sectional approach, correlational analytical research method . The population was all mother who has baby aged 0-6 months a total of 9 1 respondents , the sample is 74 respondents , the author used a simple random sampling technique. Data analysis using the contingency coefficient test. Result: The results show that the majority or 66.2% of babies aged 0-6 months were given formula milk, and less than half or 33.8% of babies aged 0-6 months were not given formula milk, the majority or 60.8% of mothers' breast milk production was not smoothly, and less than part or 39.2% of the mother's breast milk production was smooth and of the 49 babies who were given formula milk, more than part of 44 people (59.5%) were in the category of non-smooth milk production, while of the 25 babies who were not given formula milk less than half in the smooth breast milk production category as many as 24 people (32.4%). Discussion: From these two variables, after being tested statistically using the Contingency Coefficient test, a significance value = 0.000 &lt; a(0.05) was obtained, which means that H 1 was accepted, so that there was a correlation between the initial history of giving formula milk and the mother's breast milk production with a strong level of correlation 0.639. Conlussion: Researchers advise the public, especially mothers who have babies aged 0-6 months, that families should take the time to search for information. and come to health workers in order to seek information about The importance of exclusive breastfeeding so that families can support breastfeeding mothers in providing exclusive breastfeeding .

The impact of continuous and intermittent supportive counseling on self-efficacy and continuation of breastfeeding in lactating women affected by COVID-19: a quasi-experimental trial

BackgroundPromoting exclusive breastfeeding can have a great effect in reducing the complications and mortality rate of mother and child.ObjectiveThe study aimed to compare the effects of continuous and intermittent supportive counselling on the self-efficacy and continuity of breastfeeding among Lactating mothers with COVID-19.MethodsThe study was a semi-experimental research method and was conducted on 73 mothers with COVID-19 who were hospitalized in Ayatollah Mousavi Hospital in Zanjan, Iran from May 2021 to April 2022. In the continuous counselling group, counselling was provided daily for 14 days, while in the intermittent counselling group, counselling was provided once a week for four weeks. Breastfeeding continuity was assessed based on the World Health Organization’s classification, and breastfeeding self-efficacy was measured using Dennis’ standard breastfeeding self-efficacy questionnaire (BSE) up to four months after delivery. The data were analyzed using chi-square tests, independent t-tests, paired t-tests, analysis of variance with repeated measures, and survival analysis (Kaplan-Meier) with a 95% confidence level.ResultsThe survival analysis revealed that the cessation of exclusive breastfeeding occurred in 17 cases within the continuous counselling group and in 22 cases within the intermittent counselling group. The rates of continuation for exclusive breastfeeding were 52.8% and 40.5% in the continuous and intermittent counselling group respectively. However, no statistically significant differences were observed in the continuation of breastfeeding and the trend of changes in the mean scores of breastfeeding self-efficacies between the continuous and intermittent counselling groups. Furthermore, comparing the change in breastfeeding self-efficacy scores between the one-month and four-month follow-ups within the continuous counselling group, a statistically significant increase was observed.ConclusionThe results indicated no difference in the effectiveness of continuous and intermittent counseling methods in improving breastfeeding continuity in women with COVID-19. Further research is needed to explore the long-term effects of different counseling approaches on breastfeeding outcomes during crises.Trial registrationThe study was registered on the Iranian Registry of Clinical Trials website on 29/06/2021 with the registration code IRCT20150731023423N19. It can be accessed via this link: https://irct.behdasht.gov.ir/user/trial/55391/view.

General practitioners’ management of mastitis in breastfeeding women: a mixed method study in Australia

BackgroundMastitis is a common reason new mothers visit their general practitioner (GP). In Australia, the Therapeutic Guidelines: Antibiotic provides practical advice to GPs managing a range of infections, including mastitis. It is not known if Australian GPs prescribe antibiotics and order investigations as recommended for the management of mastitis.MethodsA convergent mixed methods design integrated quantitative analysis of a general practice dataset with analysis of interviews with GPs. Using the large-scale primary care dataset, MedicineInsight, (2021–2022), antibiotics prescribed and investigations ordered for mastitis encounters were extracted. Mastitis encounters were identified by searching ‘Encounter reason’, ‘Test reason’ and ‘Prescription reason’ free text field for the term ‘mastitis’; ‘granulomatous mastitis’ was excluded. Clinical encounters for mastitis occurring within 14 days of a previous mastitis encounter were defined as belonging to the same treatment episode. Semi-structured interviews were conducted with 14 Australian GPs using Zoom or telephone in 2021–2022, and analysed thematically. The Pillar Integration Process was used to develop a joint display table; qualitative codes and themes were matched with the quantitative items to illustrate similarities/contrasts in findings.ResultsDuring an encounter for mastitis, 3122 (91.7%) women received a prescription for an oral antibiotic; most commonly di/flucloxacillin ([59.4%]) or cefalexin (937 [27.5%]). Investigations recorded ultrasound in 303 (8.9%), blood tests (full blood examination [FBE]: 170 [5.0%]; C-reactive protein [CRP]: 71 [2.1%]; erythrocyte sedimentation rate [ESR]: 34 [1.0%]) and breast milk or nipple swab cultures in approximately 1% of encounters. Analysis using pillar integration showed consistency between quantitative and qualitative data regarding mastitis management. The following themes were identified:- GPs support continued breastfeeding.- Antibiotics are central to GPs' management.- Antibiotics are mostly prescribed according to Therapeutic Guidelines.- Analgesia is a gap in the Therapeutic Guidelines.- Low use of breast milk culture.ConclusionsPrescribing antibiotics for mastitis remains central to Australian GPs’ management of mastitis. Interview data clarified that GPs were aware that antibiotics might not be needed in all cases of mastitis and that delayed prescribing was not uncommon. Overall, GPs followed principles of antibiotic stewardship, however there is a need to train GPs about when to consider ordering investigations.

Development of a workplace breastfeeding support practice model in South Africa

BackgroundGlobally, mothers have identified work as one of the main obstacles to exclusive and continued breastfeeding. The support a woman receives in her workplace in terms of workplace arrangements can be critical to enable women to continue breastfeeding. This study aimed to develop and assess the face validity of a practice model to support exclusive and continued breastfeeding in workplaces in the Western Cape, South Africa.MethodsAn explanatory, sequential, mixed-method research design, was conducted (June 2017 to March 2019) in three distinct phases. Phase one employed a quantitative, descriptive, cross-sectional study design. Phase 2 used a qualitative, multiple case study. Phase three involved the development and face validity of a practice model to support exclusive breastfeeding in workplaces. The face validity included two Delphi rounds for experts to provide input on the draft practice model. This paper will only report on phase 3 of the study. The practice model was developed, drawing on the analysis of data from phases one and two and using programme theory approaches and a logic model.ResultsThe practice model was positively perceived. Participants viewed it as informative, well designed and easy to follow, even for those not knowledgeable about the subject. It was viewed as an ideal tool, if accompanied by some training. Participants were positive that the model would be feasible and most commended the tiered approach to implementation. They felt that workplaces would be more open to a step-by-step approach to implementation and if only a few activities are implemented it would be a start to make the work environment more conducive for breastfeeding employees. There were mixed opinions regarding commitment; a few participants mentioned commitment as a challenge they anticipated in the male-dominant environments in which they worked. The provision of space for breastfeeding at the workplace was also highlighted as a potential challenge.ConclusionsAdvocacy around creating an enabling workplace environment for breastfeeding is needed. The practice model has the potential to be internationally relevant, locally applied and may be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support.

Impact of Socio-Demographic Variables on Maternal Breastfeeding Knowledge and Practices: A Cross-Sectional Investigation in The Gambia

Background: Despite substantial evidence emphasizing the importance of breastfeeding, there is room for improvement in its prevalence in The Gambia, which currently stands at approximately 80% - 90%. Globally recognized as the preferred approach to infant feeding, the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months, followed by continued breastfeeding alongside complementary foods until the age of two years. Objective: This study aimed to evaluate the knowledge and practice of breastfeeding among postnatal mothers attending antenatal care at Fajikunda Health Center (FkHC) in The Gambia. Methods: A descriptive cross-sectional study was conducted at FkHC, involving a randomly selected sample of 500 maternal mothers. Data was collected through face-to-face interviews using both structured and unstructured questionnaires. Results: The study findings indicated that both the knowledge and practice of breastfeeding among maternal mothers were 99%. Most respondents were between the ages of 21 and 25, with 58% being married. Regarding education, 18% had primary education, 46% had secondary education, 20% had no formal education, and 16% had a diploma or university education. Additionally, 34% of the infants included in the study were less than one month old. Conclusion: The study concludes that maternal knowledge and practice of breastfeeding were high. Socio-demographic factors such as age, education, and occupation were found to significantly influence the knowledge and practice of breastfeeding among