Breastfeeding Recommendations Research Articles

Parvovirus B19 in Pregnancy.

Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed. This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections. Original articles were obtained from literature search in PubMed, Medline, and OVID; pertinent articles were reviewed. Parvovirus B19 is a viral infection associated with negative pregnancy outcomes. Up to 50% of people of reproductive age are susceptible to the virus. The incidence of B19 in pregnancy is between 0.61% and 1.24%, and, overall, there is 30% risk of vertical transmission when infection is acquired during pregnancy. Although most pregnancies progress without negative outcomes, viral infection of the fetus may result in severe anemia, congestive heart failure, and hydrops fetalis. In addition, vertical transmission carries a 5% to 10% chance of fetal loss. In pregnancies affected by fetal B19 infection, Doppler examination of the middle cerebral artery peak systolic velocity should be initiated to surveil for fetal anemia. In the case of severe fetal anemia, standard fetal therapy involves an intrauterine transfusion of red blood cells with the goal of raising hematocrit levels to approximately 40% to 50% of total blood volume. One transfusion is usually sufficient, although continued surveillance may indicate the need for subsequent transfusions. There are fewer epidemiologic data concerning neonatal risks of congenital parvovirus, although case reports have shown that fetuses with severe anemia in utero may have persistent anemia, thrombocytopenia, and edema in the neonatal period. Parvovirus B19 is a common virus; seropositivity in the geriatric population reportedly reaches 85%. Within the pregnant population, up to 50% of patients have not previously been exposed to the virus and consequently lack protective immunity. Concern for parvovirus B19 infection in pregnancy largely surrounds the consequences of vertical transmission of the virus to the fetus. Should vertical transmission occur, the overall risk of fetal loss is between 5% and 10%. Thus, understanding the incidence, risks, and management strategies of pregnancies complicated by parvovirus B19 is essential to optimizing care and outcomes. Further, there is currently a gap in evidence regarding delivery management, breastfeeding recommendations, and the risks of congenital abnormalities in pregnancies complicated by parvovirus B19. Additional investigations into optimal delivery management, feeding plans, and recommended neonatal surveillance are needed in this cohort of patients.

Multilevel modeling analysis of bottle feeding and its determinants among children 0-23 months in East Africa: evidence from recent DHS data (2015-2022).

Despite breastfeeding recommendations, the prevalence and length of breast milk feeding in developing nations is rapidly decreasing, with bottle feeding taking its place. This reduces the effectiveness of breastfeeding and is associated with diarrheal disease mortality and morbidity. The purpose of this study was to determine the prevalence, distribution, and determinants of bottle feeding among under-two-year-old children in the region. The ten East African countries' Demographic and Health Surveys (DHS) recent data from 2015 to 2022 was used. The data were weighted using sample weights for probability sampling and nonresponse. The study used 43,150 weighted children. A multi-level logistic regression model was used, and P - values of ≤ 0.2 and < 0.05 were used to declare candidate variables in the binary, and multivariable to declare significant variables, respectively. The prevalence of bottle feeding among children under-two-years-old in East Africa was 10.08% (95% CI 9.79, 10.36), ranging from 4.04% (95% CI 3.56, 4.53) in Tanzania to 33.40% (95% CI 32.72, 34.08) in Kenya. High antenatal care communities (AOR 1.22; 95% CI 1.11, 1.35), mothers aged 25-34 years (AOR 1.17; 95% CI 1.06, 1.28), high wealth index communities (AOR 1.12; 95% CI 1.02,1.25), women who had at least one types mass media exposure (AOR 1.64; 95% CI 1.53, 1.77), women from communities with high level mass media exposure (AOR 1.36; 95% CI 1.23, 1.52), given first birth after teenage years (AOR 1.17; 95% CI 1.09, 1.26), having more than one health visit in the year (AOR 1.37; 95% CI 1.27,1.47), multiple children (AOR 1.46; 95% CI 1.22, 1.75) were associated with higher rates of bottle feeding. Whereas a primary education (AOR 0.51; 95% CI 0.47, 0.54), having 3-5 living children (AOR 0.86; 95% CI 0.79, 0.95), a rural setting (AOR 0.53; 95% CI 0.49, 0.58), and a long distance from health facilities (AOR 0.84; 95% CI, 0.78, 0.91) were associated with lower rates of bottle feeding. The overall prevalence of bottle feeding was moderate in East African countries. Improving the availability and accessibility of health facilities to mothers, utilizing maternal healthcare, and media exposure will contribute to a significant decrease in the inappropriate bottle feeding of children in East Africa.

What to Expect With Pregnant or Postpartum Prescribing of Extended-Release Buprenorphine (CAM2038).

Weekly and monthly CAM2038 (Brixadi®) extended-release subcutaneous buprenorphine (XR bup) has been available in Europe and Australia for several years and was approved by the Food and Drug Administration in May 2023. Little is known about the clinical experience of patients and providers using this new medication during prenatal care. Two cases of pregnant persons with opioid use disorder receiving weekly XR bup in an ongoing randomized multi-site outpatient clinical trial are presented along with a brief review of the pharmacology and literature on XR bup formulations. The cases in pregnancy illustrate how treatment with the weekly formulation is initiated including how to make dose adjustments, which may be necessary given the longer half-life; it takes 1 month to achieve steady state. Injection site pain with medication administration was time limited and managed readily. Other injection site reactions experienced included subcutaneous erythema and induration that was delayed in onset and typically mild, resolving with minimal intervention. Delivery management and breastfeeding recommendations while on weekly XR bup were not different compared to sublingual buprenorphine (SL bup). Weekly XR bup is a new treatment for opioid use disorder that may be used in the obstetric population. Obstetric and addiction medicine clinicians should be aware of this new formulation as its use is expected to increase.

Health literacy: A missing link to breastfeeding protection, promotion and support?

Breastfeeding is a public health priority, recommended by all leading health authorities. Although numerous interventions and global initiatives have demonstrated some effect on improving breastfeeding outcomes, breastfeeding rates remain suboptimal. Educational support is a component of these interventions that assists families to establish and maintain breastfeeding. Although parents are being provided with education, information that is received appears to be inconsistent resulting in breastfeeding recommendations not being met. The objectives of this paper are to discuss health literacy, the evidence in support of health literacy, and potential strategies to guide the implementation of breastfeeding interventions and program development.

Determinants of Early Initiation of Breastfeeding after Cesarean Section in aTertiary Care Hospital

Objectives: To assessthe determinants of early initiation of breastfeeding (EIBF≤1 hr.) after cesarean section in a tertiary care hospital and to determine the perception of WHO breastfeeding recommendations among mothers. Material and Methods: An analytical cross-sectional study was conducted in Post-operative ward of obstetrics department of Services Hospital Lahore. Duration of Study was (9 October 2022 to 9 January, 2023). Sample size of 246 was calculated. Sampling technique was used purposive sampling. All mothers who had cesarean section deliveries were included except terminally ill. Data was analyzed by SPSS 26 using Binary logistic Regression . Results: Only 13.4% of mothers started breastfeeding within 1 hour after caesarean section. Adverse effects of analgesics (opioids) on milk production and delayed skin-to-skin contact immediately after delivery contributed for delay in EIBF. Conclusion: Delay in EIBF is attributed to decreased production of milk due to analgesics(opioids used for labour pain ) and non-practicing of immediate skin-to-skin contact. Perception regarding breastfeeding among mothers was good.

Applying Legitimation Code Theory to teach breastfeeding in nurse education: A case study

AimTo use Legitimation Code Theory as a framework to inform the design of nursing education and gain insights into student perspectives of this design. BackgroundInternationally, the World Health Organization’s breastfeeding recommendations are not being met. One contributing factor is that healthcare providers including registered nurses lack the knowledge to support breastfeeding women on an ongoing basis and rely on their personal experiences to inform the care they provide. Undergraduate nursing students should receive education to assist breastfeeding women in practice. DesignThe study is underpinned by case-study methodology. The Legitimation Code Theory (LCT) dimension of Semantics and the concepts of semantic gravity and semantic density were used to theoretically frame and develop an intervention module to teach undergraduate nurses about breastfeeding. MethodsThis module was part of an elective seven-week paediatric nursing course. University Human Research Ethics Committee (HREC201/203) reviewed the study. Participants (n = 9) completed semi-structured interviews and thematic analysis helped us to understand their experiences of the module. The Template for Intervention and Description and Replication (TIDeR) framework was used to report the intervention. ResultsThe breastfeeding module was positively received by participants who noted the module’s structure differed from previous courses. Three main themes were identified in the student experience. These are: a) threads and links; b) engaging structure; and c) seedlings. ConclusionLegitimation Code Theory is an effective course development framework to harness the learners’ prior informal knowledge and weave learning activities between theory and contextual practice to develop cumulative knowledge. ImpactWith an increased understanding of how undergraduate nursing students develop knowledge, the LCT dimension of Semantics can be ussed to structure content knowledge in instructional design. This approach builds explicit bridges between knowledge development in the nursing curriculum and learners' informal knowledge and contextual practice in clinical settings.

Breastfeeding in primiparous women – expectations and reality: a prospective questionnaire survey

BackgroundBreastfeeding provides the optimal nutrition for infants and offers numerous benefits for both mother and child. The World Health Organisation recommends exclusive breastfeeding during the first 6 months of life and the introduction of complementary feeding between the fifth and seventh months of life. There is a discrepancy between breastfeeding recommendations and the actual duration of breastfeeding. The aim of this study was to analyse breastfeeding behaviour in primiparous women in order to be able to provide support for mothers.MethodsIn this prospective, questionnaire-based study conducted between 2020 and 2022, primiparous women were asked to complete three questionnaires at three defined survey time points (routine prepartum presentation, postpartum hospitalization, completed sixth month of life).ResultsA total of 140 women were included and returned all three questionnaires. Fifty-eight percent performed breastfeeding exclusively at least until their baby had reached the age of 6 months, whereas 20% already stopped within the first 6 months. The main reasons given for early cessation were insufficient milk supply and inadequate infant weight gain. A comprehensive level of prepartum knowledge had a significant positive effect on participants’ sense of confidence with breastfeeding. Sociodemographic factors such as age and educational level were also associated with breastfeeding behaviour, but significant corresponding differences in the duration of breastfeeding were not observed. Women with postpartum midwifery care breastfed significantly longer (p < 0.05).ConclusionsBreastfeeding behaviour and duration are influenced by multiple factors. Although certain sociodemographic factors are unalterable, comprehensive prepartum knowledge transfer and postpartum midwifery care have a positive impact on breastfeeding behaviour.Trial registrationThe study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) on 6 December 2022 (DRKS00030763).

Exclusive breastfeeding for the first six months after birth: A cross-sectional study in health care centers in Khartoum, Sudan

Background: Encouraging exclusive breastfeeding (EBF) practices for the first 6 months of life is the most effective intervention for lowering childhood morbidity and death. However, compliance with breastfeeding recommendations is lacking in many developing countries. Thus, this study aimed to analyze mothers’ breastfeeding knowledge, attitudes, and practices, as well as factors that impact EBF at 6 months. Methods: This cross-sectional survey was conducted on 128 mothers who came for children’s vaccination at primary health care centers using a structured questionnaire in form of dichotomous, multiple choice, and open and scaling questions. Results: Of all mothers, 80.5% previously received information about breastfeeding. Of them, 38 (29.7%) initiated breastfeeding within 1 hour of delivery. Of the participants, &lt;50% knew (46.1% and 44.5%, respectively) about breastfeeding, and 92.2% of mothers (118) had a negative view of EBF. The length of EBF for 1–2 months, 3–4 months, and 5–6 months were 3.9%, 82.8%, and 13.3%, respectively. Other foods are introduced before 6 months of age because of insufficient breast milk (15.6%) and the mother has work (11.7%). Conclusion: EBF for up to 6 months was not recommended despite the high percentage of mothers who initiated breastfeeding right after birth or within a few hours. Sustained health and community-based nutritional education are recommended for pregnant and lactating mothers to promote optimal breastfeeding for the initiation and continuation of breastfeeding practices. More counseling and support are needed for working mothers. Key words: exclusive breastfeeding, first six months, Khartoum, Sudan

Prenatal Perception of WIC Breastfeeding Recommendations Predicts Breastfeeding Exclusivity and Duration in the Infants’ First Year

Pregnant participants who perceived that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) recommends breastfeeding only were more likely to have better early breastfeeding outcomes. Our objective was to examine the association between prenatal perception of WIC's breastfeeding recommendations and breastfeeding duration through the first year of infant life. This observational study used a national longitudinal sample of 1594 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 in 2013. Four measures of breastfeeding duration were used: 1) a discrete measure of exclusive breastfeeding through 5 mo; 2) a continuous measure of exclusive breastfeeding (in days up to 7 mo); 3) a discrete measure of any breastfeeding through 11 mo; and 4) a continuous measure of any breastfeeding (in days up to 13 mo). The primary explanatory variable was the participant's prenatal perception of whether WIC recommended breastfeeding only. The univariate analyses of time to breastfeeding cessation were performed using Kaplan-Meier curves. The Cox regression model was adopted to estimate the likelihood of breastfeeding outcomes over time. All analyses accounted for complex survey design effects. Compared with their peers who perceived WIC to recommend formula only or both breastfeeding and formula equally, participants who perceived WIC as recommending breastfeeding only were less likely to stop exclusive breastfeeding through 5 mo (HR = 0.83; 95% CI: 0.69, 0.99) or to stop any breastfeeding through 11 mo (HR = 0.80; 95% CI: 0.69, 0.92), without controlling for prenatal infant feeding intentions. Similar patterns were observed in the 2 continuous measures, as they were also less likely to stop exclusive breastfeeding by 7 mo (HR = 0.78; 95% CI: 0.69, 0.90) or to stop any breastfeeding by 13 mo (HR = 0.82; 95% CI: 0.71, 0.95). Prenatal perception of WIC's breastfeeding recommendation can be a useful predictor of breastfeeding duration in WIC participants.

The Impact of Breastfeeding and Safe Sleep Mobile Health Messaging on Breastfeeding and Bedsharing.

Mobile health (mHealth) safe sleep messaging increases rates of safe sleep. Bedsharing is more common among breastfeeders. Advice to not bedshare may negatively impact breastfeeding. We compared the impact of safe sleep or breastfeeding mHealth messaging on bedsharing and breastfeeding at 2 to 5 months. This is a secondary analysis of mothers who initiated breastfeeding from a cluster randomized clinical trial of mHealth messaging for safe sleep or breastfeeding. A multi-ethnic sample of 1600 mothers was recruited from 16 US birth hospitals and surveyed at 2 to 5 months regarding the previous 2 weeks' breastfeeding and bedsharing practices. Data on 997 mothers who initiated breastfeeding were analyzed with multivariable generalized estimating logistic regression models to examine the association of mHealth messaging with infant care practices. Overall, exposure to breastfeeding versus safe sleep messaging was not associated with a difference in any breastfeeding at 2 to 5 months (69.3% vs 65.5%, respectively; adjusted odds ratio [aOR]=1.33 [95% confidence interval, 0.91, 1.94]). Women with shorter planned duration of breastfeeding who received breastfeeding messaging had increased odds of breastfeeding at 2 to 5 months (50% vs 31%; aOR 3.13 [95% CI, 1.47, 6.65]). Mothers who received safe sleep messaging had lower rates of bedsharing overall when compared to breastfeeding messaging (24.8% vs 35.2%; aOR=0.58 [95% CI, 0.44, 0.78]). In this large multi-ethnic US sample, receipt of safe sleep mHealth messaging was associated with lower rates of bedsharing without negatively impacting breastfeeding rates. Future research should focus on continued development of interventions to improve adherence to both safe sleep and breastfeeding recommendations.

Proteomic Analysis of Human Milk Reveals Nutritional and Immune Benefits in the Colostrum from Mothers with COVID-19.

Despite the well-known benefits of breastfeeding and the World Health Organization’s breastfeeding recommendations for COVID-19 infected mothers, whether these mothers should be encouraged to breastfeed is under debate due to concern about the risk of virus transmission and lack of evidence of breastmilk’s protective effects against the virus. Here, we provide a molecular basis for the breastfeeding recommendation through mass spectrometry (MS)-based proteomics and glycosylation analysis of immune-related proteins in both colostrum and mature breastmilk collected from COVID-19 patients and healthy donors. The total protein amounts in the COVID-19 colostrum group were significantly higher than in the control group. While casein proteins in COVID-19 colostrum exhibited significantly lower abundances, immune-related proteins, especially whey proteins with antiviral properties against SARS-CoV-2, were upregulated. These proteins were detected with unique site-specific glycan structures and improved glycosylation diversity that are beneficial for recognizing epitopes and blocking viral entry. Such adaptive differences in milk from COVID-19 mothers tended to fade in mature milk from the same mothers one month postpartum. These results suggest that feeding infants colostrum from COVID-19 mothers confers both nutritional and immune benefits, and provide molecular-level insights that aid breastmilk feeding decisions in cases of active infection.

Intimate Partner Violence and Breastfeeding Behaviors: Does the Source of Breastfeeding Information Affect the Associations Between Prepregnancy or Prenatal IPV and Breastfeeding Behaviors of Women in the United States? A PRAMS 2018 Study.

Background: Most countries do not meet World Health Organization's breastfeeding recommendations, and exposure to intimate partner violence (IPV) hinders positive breastfeeding behaviors. One in four U.S. women (43.6 million women) experiences IPV. This study aims to assess relationships between IPV, and breastfeeding initiation, duration, and early cessation among women in 42 U.S. states; and to evaluate possible modifying effect(s) of different breastfeeding information sources. Methods: Centers for Disease Control and Prevention's 2016-2018 Pregnancy Risk Assessment Monitoring System data (n = 105,230) were used to assess relationships between prepregnancy/prenatal IPV and breastfeeding initiation, duration, and early cessation; and modify effects of various breastfeeding information sources on study associations using multilogistic regression models. Results: About 1.4% of women experienced prenatal IPV with reduced odds of breastfeeding for 6 months or more (odds ratio [OR] = 0.74; 95% confidence interval = 0.58-0.94). Receiving breastfeeding information from baby's doctor modified early cessation (0.37 [0.18-0.78]) (p for interaction = 0.009) with prenatal IPV exposure. Among women exposed to prenatal IPV, breastfeeding initiation was stronger in women who received breastfeeding information from family/friends (2.46, [1.24-4.88]) (p for interaction = 0.010) or from breastfeeding support groups (3.03 [1.17-7.88]) (p for interaction = 0.023) compared to those who did not. Breastfeeding information from family/friends modified association between prepregnancy IPV and breastfeeding duration (0.67 [0.45-0.99]) (p for interaction = 0.042). Conclusions: Prenatal IPV is a risk factor for short-duration breastfeeding. Receiving information from doctors, nurses, support groups, and family/friends may improve breastfeeding behavior among IPV-exposed women. Interventions promoting breastfeeding information dissemination by family/friends, support groups, and doctors/nurses during hospital visits are encouraged.

World Health Organization’s recommendation on breastfeeding: Knowledge and practices of nursing mothers in Enugu, Nigeria

Background: The World Health Organization (WHO) has made recommendations for breastfeeding. These recommendations are to promote proper breastfeeding practices, which are essential for improved child health and survival. Objectives: The study intended to determine the level of awareness of WHO breastfeeding recommendations among nursing mothers in Enugu and how awareness translates into practice. Materials and Methods: A questionnaire was used to assess the awareness of WHO recommendations on breastfeeding and breastfeeding practices of mothers in Enugu, Nigeria. Results: Most (254; 64.1%) mothers have not heard about the WHO recommendation on breastfeeding; majority (81.1%) were aware of exclusive breastfeeding. Antenatal clinics are the commonest source of information on breastfeeding. Only 2.5% mothers intend to breastfeed for the duration recommended. Awareness of WHO recommendations was not associated with decision to breastfeed or frequency of breastfeeding. Younger mothers were less likely to be aware of the recommendation (P = 0.007, OR = 0.559, 95% CI = 0.366–0.851), while antenatal care attendance was associated with increased awareness (P = 0.002, OR = 10.389, 95% CI = 2.439–44.262). Maternal education affected breastfeeding frequency only. Conclusion: Significant gaps exist in awareness of the WHO recommendations on breastfeeding among mothers in Enugu, Nigeria.

Prenatal perception of breastfeeding recommendations predicts early breastfeeding outcomes of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Prenatal psychosocial factors predict breastfeeding practices but are not assessed in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study examined how prenatal perceptions of WIC's breastfeeding recommendations were associated with early breastfeeding outcomes. This study used longitudinal data from a national sample of 2053 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) in 2013, the only national data assessing prenatal perceptions of WIC's breastfeeding recommendations. Early breastfeeding outcomes included breastfeeding initiation, breast milk first fed after birth, breastfeeding in the first hour, breast milk first fed after leaving the hospital, and breastfeeding status at the first and third months. The primary predictor was the participant's prenatal perception of whether WIC recommended breastfeeding only or not. Log-binomial regression was used with adjustment for socio-demographics, previous breastfeeding, WIC participation, breastfeeding support, and infant feeding intentions (IFI). Without controlling for IFI, the perception of WIC recommending breastfeeding only predicted breastfeeding outcomes positively. The risk ratio (RR) associated with prenatal perceptions varied from 1.14 (95% CI: 1.03, 1.25; P=0.008) for breastfeeding in the first hour, to 1.27 (95% CI: 1.12, 1.43; P<0.001) for breast milk first fed after leaving hospital, to 1.66 (95% CI: 1.35, 2.04; P<0.001) for 3-mo breastfeeding only. After controlling for IFI, the RRs were 1.13 (95% CI: 1.02, 1.24; P=0.017) for breastfeeding in the first hour, 1.20 (95% CI: 1.06, 1.35; P=0.004) for breast milk first fed after leaving hospital, and 1.49 (95% CI: 1.21, 1.84; P<0.001) for 3-mo breastfeeding only, suggesting that prenatal perception was independently associated with breastfeeding outcomes. Prenatal perception of WIC's breastfeeding recommendations can be regarded as a new psychosocial predictor of breastfeeding and a possible target for future intervention.

Breastfeeding Intention, Knowledge, and Attitude of Pregnant Women in Treatment for Opioid Use Disorder.

The objective of this study was to describe breastfeeding intention, knowledge, and attitude, and sources of infant feeding information during the prenatal period among a cohort of pregnant women in treatment for opioid use disorder (OUD). Pregnant women who were receiving treatment for OUD and in the third trimester completed a questionnaire that measured demographic characteristics, infant feeding intentions, breastfeeding beliefs and attitudes, and sources of breastfeeding information. Frequency counts and percentages and means and standard deviations were used to describe data. Sixty-five women completed the survey. Three-fourths reported some intention to breastfeeding. While attitudes around breastfeeding were generally positive, less than half of respondents knew the recommendations and infant health benefits of breastfeeding. Prenatal programs for women in treatment for OUD should consider addressing patient-reported concerns and gaps in knowledge regarding the benefits of and recommendation for breastfeeding. · Breastfeeding has unique benefits for mother-infant dyads affected by maternal OUD.. · Breastfeeding decisions are influenced by maternal psychosocial factors (e.g., knowledge and attitudes), however, such factors have not been previously assessed in women in treatment for OUD.. · Results indicate that attitudes around breastfeeding are positive but knowledge gaps exist..

Knowledge of Future Doctors (Senior Students, Interns, Residents) on Breastfeeding: Cross-Sectional Study

Background. The ratio of breasted children for more than six months increased from 33 to 40% in the period from 1991 to 2019 according to the Russian Federal State Statistics Service. This number has not changed in recent 12 years and remained on the level of 39-41%. Relatively low adherence to breastfeeding may be the consequence of the lack of training of future doctors in these issues.Objective. The aim of the study was to analyse the knowledge (and its dynamics over the past decade) of medical students, interns and residents on breastfeeding support and promotion in Russian Federation.Methods. We have conducted the survey among senior students, interns, and residents in 2009-2011 and 2018-2019. 8 medical universities participated in the study in 2009-2011, and 24 medical universities and one continuing education institute — in 2018-2019. Knowledge on breastfeeding support issues was estimated according to the results of future doctors’ responses to the proposed questionnaires.Results. Sample of 2009-2011 has included 1088 students, interns, and residents, sample of 2018-2019 — 3694. There is still high level of mistakes in the breastfeedng issues due to the decline in knowledge of the WHO breastfeeding recommendations. The level of understanding of practical aspects has not changed significantly over the 10 years, and there is still a gap between theoretical knowledge and practice.Conclusion. The necessity to improve quality of future doctors training in breastfeeding issues is shown.

Factors associated with non-compliance with breastfeeding recommendation: a retrospective survey in hepatitis B virus-infected mothers who had taken Nucleos(t)ide analogs during pregnancy

BackgroundWe encourage Hepatitis B virus-infected mothers to breastfeed postpartum, even when continuing pregnancy category B nucleos(t)ide analogs (NAs) treatment. However, a large proportion of the Hepatitis B virus-infected mothers were noncompliant with this breastfeeding recommendation. This study aimed to investigate the factors associated with noncompliance with breastfeeding recommendation in Hepatitis B virus-infected mothers who had received NAs treatment during pregnancy.MethodsA total of 155 mothers with chronic hepatitis B receiving NAs treatment for preventing mother-to-child transmission during the late gestation period were included and divided into exclusive breastfeeding (n = 63), mixed feeding (n = 34), and artificial feeding (n = 58) groups according to the postpartum feeding methods. Independent variables associated with feeding methods were analyzed using logistic regression analysis.ResultsCompared to the breastfeeding and mixed feeding groups, the artificial feeding group had significantly more multiparity, later postpartum timing of stopping NAs treatment, and a lower proportion of having knowledge of NAs medications (all P < 0.05). In addition, multivariable logistic regression analysis confirmed that multiparity, later postpartum timing of stopping NAs treatment, and lacking knowledge of medication were independent factors associated with noncompliance with breastfeeding recommendation.ConclusionsHepatitis B virus-infected mothers who stopped NAs treatment at late postpartum period or had less knowledge of medication were more likely to be noncompliant with breastfeeding recommendation. Strengthening health education for participants taking NAs may be an important method to improve compliance with breastfeeding recommendation.

Risk factors for and protective factors against breastfeeding interruption before 2\u2009years: a birth cohort study

BackgroundLittle is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. The objective of this study was to identify risk factors for and protective factors against breastfeeding interruption before 2 years of age.MethodsIn this live birth cohort, mother and infant dyads were followed for 2 years. Data collection was performed at the maternity ward and subsequently at the children’s homes, monthly during the first 6 months of life and then at 9, 12, 18, and 24 months. The outcome of interest was breastfeeding interruption before 2 years of age. Median duration of breastfeeding was estimated using Kaplan-Meier’s survival analysis, and the associations were tested using Cox’s hierarchical multivariate model. Significance was set at 5%.ResultsData from a total of 1344 dyads were assessed. Median breastfeeding duration was 385 days. The following risk factors for breastfeeding interruption were identified: white skin color (adjusted hazard ratio [HRa]: 1.31; 95% confidence interval [95%CI]: 1.10–1.56), primiparity (HRa: 1.21; 95%CI: 1.05–1.40), working outside the home (HRa: 1.52; 95%CI: 1.30–1.77), child sex male (HRa: 1.18; 95%CI: 1.03–1.35) and use of a pacifier (HRa: 3.46; 95%CI: 2.98–4.01). Conversely, the following protective factors were identified: lower family income (HRa: 0.81; 95%CI: 0.71–0.94), mother-infant bed-sharing (HRa:0.61, 95%CI: 0.52–0.73), on-demand breastfeeding in the first month (HRa: 0.64; 95%CI: 0.47–0.89) and exclusive breastfeeding at 4 months (HRa: 0.58, 95%CI: 0.48–0.70).ConclusionsThe findings allowed to identify both risk factors for and protective factors against breastfeeding interruption before 2 years of age. Knowledge of these factors may help prevent this event and aid in the development of programs that help women maintain breastfeeding for at least 2 years, as recommended by the WHO.

‘It’s quite a taboo subject’: an investigation of mother’s experiences of breastfeeding beyond infancy and the challenges they face

ABSTRACT Current recommendations state that women should breastfeed their child up to 2 years and beyond. However, the UK has one of the lowest breastfeeding rates in the world. This could in part be explained by the stigma mothers face when breastfeeding an older child. This research aims to provide a detailed understanding of what motivates women to continue breastfeeding beyond infancy and the barriers they face to (i) add to existing research literature which has examined this area and (ii) support and normalize this practice. Semi-structured interviews were conducted between April and June 2018 with 24 women who had breastfed at least one child past 12 months. A theory-driven thematic analysis identified themes that ran through the interviews centering on the benefits of continued breastfeeding, the stigma mothers faced when breastfeeding past infancy and the challenges of returning to work. The women felt that continued breastfeeding enabled them to play a central role in their child’s health and develop an attachment led parental style but faced social and cultural stigma due to a lack of public awareness of current breastfeeding recommendations. Interventions which raise awareness of breastfeeding beyond infancy are needed to normalize this practice in the UK.

Do Women Enrolled in PMTCT Understand the Recommendations: A Case Study from Kilimanjaro.

IntroductionPrevention of mother-to-child transmission (PMTCT) remains a cornerstone of HIV prevention and control efforts. It is vital that the beneficiaries of PMTCT programs understand PMTCT recommendations, especially since their adherence to recommendations is key to successful PMTCT. There have been several major changes in PMTCT recommendations, and many women have encountered different recommendations. It is plausible that confusion has arisen as to what is currently recommended for successful PMTCT. This confusion can affect adherence to recommendations and hinder PMTCT efforts. However, little is known about how women enrolled in PMTCT understand the recommendations in the context of these frequent changes.AimIn this paper, we present our findings regarding how HIV-positive women enrolled in PMTCT in Kilimanjaro understand PMTCT recommendations pertinent to them.MethodsFrom August 2019 to April 2020, we surveyed 521 mothers enrolled in PMTCT in seven districts in the Kilimanjaro region, Northern Tanzania. A pretested questionnaire was administered to consenting mothers. The questionnaire collected information on mothers’ demographic characteristics, previous encounters with PMTCT, and knowledge of various PMTCT program elements, including medication duration, breastfeeding recommendations and infant HIV testing schedule. A logistic regression model was used to determine factors associated with good PMTCT knowledge among mothers.ResultsA total of 521 women were enrolled, the median score for the 19 items used to assess knowledge was 57.9%, and 64.9% scored above the median. Counselling on ART (OR=2.17, 95% CI 1.08–4.36) and counselling on breastfeeding during the ANC visits (OR=2.38, 95% CI 1.38–4.11) were the only factors that we found to be significantly associated with higher odds of good knowledge of PMTCT.ConclusionEven amongst mothers enrolled in PMTCT, poor understanding regarding key PMTCT recommendations prevails. There is a need to reassess the training modalities and look at ways to reinforce PMTCT messages to mothers.