Current Breastfeeding Status Research Articles

Spatial distribution of inadequate meal frequency and its associated factors among children aged 6-23 months in Ethiopia: Multilevel and spatial analysis.

More than two-third of global child death is occurred due to inappropriate feeding practice that happened during early childhood period. Evidence on meal frequency status among infant and young children at national level can be used to design appropriate interventions to improve the recommended feeding frequency. Therefore, this study was aimed to explore the spatial distribution and identify associated factors of inadequate meal frequency among children aged 6-23 months in Ethiopia. Secondary data analysis was conducted using the 2019 mini Ethiopian Demographic and Health Survey data. A total weighted sample of 1,532 children aged 6-23 months were included. To identify significant factors associated with of inadequate meal frequency, multilevel binary logistic regression model was fitted. Variables with p-value < 0.25 from the bi-variable model were exported to multivariable analysis. In the multivariable model, variables with p-value < 0.05 were declared as significantly associated factors and adjusted odds ratio (AOR) with its 95% confidence interval were reported. Multilevel models were compared using deviance and log-likelihood. Spatial analysis tools were utilized to visualize the distribution of inadequate meal frequency. Bernoulli model was fitted using SaTScan V.9.6 to identify most likely clusters and ArcGIS V.10.8 was used to map the hotspot areas. Ordinary least square and geographic weighted regression models were used and compared using information criteria and adjusted-R2. Local coefficients of factors associated with hotspots of inadequate meal frequency were mapped. The prevalence of inadequate meal frequency was 47.03% (95% CI: 44.54%, 49.53%) in Ethiopia. Age of the child, sex of the household head, timely initiation of breastfeeding, current breastfeeding status, number of antenatal care visit, maternal education, and region were significantly associated with inadequate meal frequency. The spatial distribution of inadequate meal frequency was showed significant variation across Ethiopia (Global Moran's I = 0.164, p-value <0.001). A total of 38 significant clusters were detected through SaTScan analysis, from these the 22 primary clusters were located in Somali and Harari. The prevalence of inadequate meal frequency was high in Ethiopia and had significant clustering patter. Significant hotspot clusters were located in Somali, northern Afar, Harari, Amhara, Gambela, and eastern South nation nationalities and peoples' region. Therefore, public health interventions which enhance breastfeeding practice, optimal number of antenatal care visits, educational empowerments should target hotspot areas to decrease inadequate meal frequency practice.

Maternal socioeconomic status and infant feeding practices underlying pathways to child stunting in Cambodia: structural path analysis using cross-sectional population data

ObjectivesTo identify and investigate complex pathways to stunting among children aged 6–24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic...

Potential determinant factors of under-five mortality in the Amhara region of Ethiopia

BackgroundEven though child mortality decreased greatly (44%, since 1990), children in developing countries are eight times more likely to die before they attain their five years birthday. When comparing under-five mortality around the world, the African including Ethiopia and Southeast Asian regions showed an uneven child death rate. Therefore, this study was aimed to identify the potential determinant factors of under-five mortality in the Amhara regional state of Ethiopia.MethodsStatistics from a national representative cross-sectional survey of the Ethiopian Demographic and Health Survey (EDHS) of the year 2016 were used. Data was collected from the population of all under-five children in randomly selected enumeration areas of the Amhara region of Ethiopia. To investigate the relationship between the dependent variable (under-five mortality) and various independent factors, inferential statistics such as binary logistic regression and multiple logistic regressions were used. In multivariable analysis, statistically significant variables in binary logistic regression analysis, i.e. (p-value 0.250), were entered, and P-value 0.050 was considered significant at 95% CI.ResultsThe survey was included 977 children under the age of five and more than half of children in the family (68%) were ≤ 4. The findings showed that children whose mothers had no formal education were 2.59 times more likely to die than children whose mothers had formal education [AOR: 2.59(1.12–5.99)]. Similarly, children who did not receive breastfeeding from their mothers were 3.61 times more likely to die than children who received breastfeeding from their mothers [AOR: 3.61(1.83–6.19)].Conclusion and RecommendationThe number of children in the family, as well as the mother’s educational status and current breastfeeding status, were all found to be important factors in under-five mortality in the study area. As a result, the potential determinants of under-five mortality should be addressed as part of a program targeted at lowering childhood mortality.

Determinants of Under-Five Child Mortality in Ethiopia: Analysis Using Ethiopian Demographic Health Survey, 2016.

Background Under-five mortality rate is a leading indicator of the level of child health and the overall development in countries which indicate the quality of life of a given population, as measured by life expectancy. Objectives To identify and analyze factors that may have a significant influence on under-five mortality in Ethiopia. Methods A national representative cross-sectional study and a quantitative study were conducted among 18,008 households selected based on 2016 EDHS data. The analysis was done using SPSS version 20 statistical software. Both bivariate and multivariable analyses were employed. In multivariable analysis, p value less than 0.05 was considered statistically significant and odds ratio with 95% CI (confidence interval) was used to assess the determinants of under-five child mortality. Results A total of 10,641 children were included in the study with a 99.0% response rate. The U5CM for being a rural resident (AOR = 1.802, 95% CI: 1.251, 2.595), not breastfeeding (AOR = 2.956, 95% CI: 2.490, 3.511), having multiple birth (AOR = 4.755, 95% CI: 3.440, 6.572), male gender (AOR = 1.363, 95% CI: 1.153, 1.612), having first birth order (AOR = 1.592, 95% CI: 1.275, 1.992), and having family size six and above (AOR = 2.187, 95% CI: 1.769, 2.707). The increment of family size increases the risk of U5CM.Conclusion Multivariate logistic analysis reflected that place of residence, mothers' educational level, religion, current breastfeeding status, type of birth, sex of child, birth order, and family size were found to be significant predictors of under-five child mortality. So, government policy, nongovernmental organizations, and all concerned bodies should be focused on the major determinants of under-five child mortality and put in a lot more effort to reduce under-five child mortality, and health intervention policies should be revised.

Pathogen-specific risk of seizure in children with moderate-to-severe diarrhoea: Case control study with follow-up.

To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings. This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset. The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR=5.34, 95% CI=2.37-12.04) particularly S. flexneri (OR=3.34, 95% CI=1.48-7.57), S. flexneri 6 (OR=23.24, 95% CI=2.79-193.85), S. sonnei (OR=6.90, 95% CI=2.34-19.85); norovirus (OR=6.77, 95% CI=1.69-27.11), fever (OR=16.75, 95% CI=1.81-154.70) and loss of consciousness (OR=35.25, 95% CI=1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P=0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P<0.001) and WAZ (P<0.05), whereas deterioration in HAZ (P<0.001) in both cases and controls. Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.

Investigating Relationships Between Breastfeeding Status and Infant Vegetable Experience on Infants’ Acceptance of Novel Vegetables

Abstract Objectives Early life flavor exposure is important in shaping lifelong eating habits. We examined relationships among maternal current breastfeeding status, infant vegetable experience and acceptance of a novel vegetable. Methods Caregivers (n = 106, 82% White) and children (n = 106, 54% male) aged 6–12 months (n = 46; infants), 12–18 months (n = 40; younger toddlers) and 18–24 months (n = 20; older toddlers), participated in a videotaped laboratory visit during which infants tasted up to 8 offers of a novel vegetable (pureed kale). Caregivers completed questionnaires on breastfeeding (BF) status (currently BF or pumping milk, 0 = no; 1 = yes), and infant vegetable experience (21 items, 0 = no; 1 = yes). Infant vegetable experience (VE) was scored as the sum of vegetables tasted by the infant to date (range 0–21). Acceptance of the novel vegetable was coded (0 = refusal; 1 = enforced; 2 = acceptance; 3 = anticipation) by trained coders using feeding videos. Descriptive statistics (mean ± s.d.) were calculated and regression analyses were conducted for models predicting VE and acceptance using current BF status and child age (months) as predictors. T-tests were conducted to ascertain differences in VE by current BF status. Significance was set at P &amp;lt; .05. Results Half (50%) of children were currently receiving breastmilk (77% for infants, 47.5% for younger toddlers, 21% for older toddlers). Children had been exposed to an average of 13.6 ± 5.3 vegetables and this differed by age of child (10.1 ± 5.2 for infants, 15.8 ± 3.5 for younger toddlers, 17.4 ± 2.9 for older toddlers). Child age (F = 10.8, P = .000, R2 = .426) was associated with acceptance of kale (1.5 ± 0.7); older children were less accepting (β = –.381). BF status was not significantly associated with acceptance. Child age was predictive of VE (F = 28.6, P = .000, R2 = .376; β = .638). Follow up analyses comparing infants’ and toddlers’ VE by current BF status revealed that older toddlers who were breastfed had greater VE than those not currently breastfed (t = 2.3, P = .036; 20.0 ± 1.1 vs 16.7 ± 2.9). Conclusions Despite introduction to a greater variety of vegetables with age, acceptance of a novel vegetables declined during toddlerhood. Infants and toddlers continued to consume breastmilk, and older toddlers had greater VE; these factors were not associated with greater novel vegetable acceptance. Funding Sources The Sugar Association.

An assessment of anemia status of child-mother pairs in Bangladesh

Anemia (e.g. iron deficiency anemia) is a serious public health concern that often coexists within the same household, particularly threatening child-mother pairs. Despite the high prevalence, there is a paucity of research to understand the anemia status of child-mother pairs in Bangladesh. This study aimed to explore the anemia status of child-mother pairs and associated factors using data from the 2011 Bangladesh Demographic and Health Survey (BDHS). Multinomial logistic regression was used to estimate the association between factors and different pairs. Among the child-mother pairs, about 26% was both anemic, followed by child anemic-mother nonanemic (25%) and child nonanemic-mother anemic (17%). Several factors were significantly associated with anemia status of child-mother pairs. Current breastfeeding status was associated with greater odds of different anemia status pairs. Mothers’ undernutrition was related to greater odds of child-mother anemic pairs (adjusted odds ratio [AOR] 1.775, 95% confidence interval [CI] 1.216–2.593, p = 0.0030). Living in wealthier households was associated with lower odds of child-mother anemic pairs (AOR 0.519, 95% CI 0.320–0.842, p = 0.0080). Overall, the findings from this study show the importance of simultaneous consideration of children and mothers for anemia-related health programs as well as cohort-specific tailored interventions to reduce anemia burden.

Minimum Meal Frequency Practice and Its Associated Factors among Children Aged 6-23 Months in Amibara District, North East Ethiopia.

Background Minimum meal frequency, a proxy indicator for a child's energy requirements, examines the number of times children received foods other than breast milk. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and increased morbidity and mortality. In Ethiopia, only 45% of children had fed with an age-appropriate minimum meal frequency. Objective The study was aimed to assess the minimal meal frequency practice, and its associated factors among children aged 6–23 months in Amibara district, North East Ethiopia. Methods A community-based cross-sectional study was conducted from May 07–May 23, 2018. Systematic random sampling technique was applied to select 367 children aged 6–23 months. The univariable and multivariable binary logistic regression analyses model was used to identify potential predictors of meeting minimum meal frequency. All variables with P values <0.25 in the univariable analysis were taken to multivariable analysis, and variables at P values <0.05 were considered as statistically significant. Results The study revealed a prevalence of minimum meal frequency 69.2% (95% CI: 0.64–0.74). Timely initiation of breastfeeding (AOR = 2.2, 95% CI (1.17, 4.18)), current breastfeeding status (AOR = 7.5, 95% CI (3.95, 14.4)), meeting minimum dietary diversity (AOR = 3.7, 95% CI (1.85, 7.44)), and household hunger scale (AOR = 5.3, 95% CI (1.5, 12.5)) were some of the significant predictors to achieve minimum meal frequency. Conclusion The prevalence of minimum meal frequency practice is low in the study area. Current breastfeeding status, timely initiation of breastfeeding, no/little household hunger scale, and meeting minimum dietary diversity were found as significant predictors for minimum meal frequency practice. Mothers having children aged 6–23 months should be aware and practice appropriate infant and young child feeding practices including timely initiation of breastfeeding, breastfeeding till the child celebrate his/her second birthday, recommended meal frequency, and dietary diversity practice. In addition, households should be assessed and strengthened for food security.

Water Source Correlates with E. Coli Contamination and Markers of Environmental Enteric Dysfunction in Rural Ugandan Infants (P10-123-19)

ObjectivesTo examine associations among water source, E. coli contamination, and environmental enteric dysfunction (EED) in a cohort of infants participating in the Uganda Birth Cohort Study (UBCS). MethodsInfants (n = 729) from 16 sub-counties in rural northern and southwestern Uganda were included in this cross-sectional secondary analysis. Water source and other covariate data were derived from the UBCS 6-month visit, which included a compartment bag test (CBT, Aquagenx, Chapel Hill, NC) to measure E. coli contamination of drinking water. Safe water was defined as no E. coli detected. EED was assessed at age 6 months using serum concentrations of antibodies to the bacterial components flagellin and lipopolysaccharide (LPS) via ELISA. EED biomarkers were natural-log transformed; associations were assessed using cluster-robust adjusted linear regression models. ResultsHalf of infants were female; 95% were breastfeeding at 6 months of age. Most households (72.8%) relied primarily on an improved water source; i.e., piped water, public tap, tubewell/borehole, or protected well. While 2.6% relied primarily on rain water harvesting, 45.1% practiced it to some degree. Per CBT results, 33.5% of households had safe water, with large variations in quality observed by source [source (% with safe water): piped (50.0%), public tap (17.1%), tubewell/borehole (40.5%), protected well (20.8%), unprotected well (33.0%), rain water (68.4%), surface water (31.6%)]. In adjusted linear regression models (controlling for child sex, current breastfeeding status, and household wealth index), infants from households relying primarily on rain water had significantly lower anti-flagellin IgG levels compared to those relying on improved sources, including piped water (P < 0.001), public tap (P = 0.05), or tube well/borehole (P = 0.03). Furthermore, infants from households that practiced any rain water harvesting had significantly lower EED biomarkers compared to those that did not [anti-flagellin IgG: -0.08 (-0.13, -0.02, P = 0.008); anti-LPS IgG: -0.07 (-0.11, -0.03, P = 0.003)]. ConclusionsIn rural Uganda, E. coli contamination and infant EED differed significantly by water source; intervention trials involving rain water harvesting may be warranted. Funding SourcesFeed the Future Innovation Lab for Nutrition at Tufts University, supported by USAID; CD also supported by NIH.

Maternal Malnutrition, Breastfeeding, and Child Inflammation in India (P11-025-19)

ObjectivesPrevious research has demonstrated a relationship between maternal nutrition and inflammatory mediators in breast milk which may stimulate an immune response in breastfed children. The objective of this study is to explore the relationship between maternal malnutrition, breastfeeding, and child inflammation in a sample of children in India. MethodsData were collected from a cross-section of 401 mothers and children 12 to 23 months of age in India. Anthropometric information was collected from mothers and used to compute body mass index (BMI). Household demographics and information on breastfeeding practices were collected as part of a survey. Blood samples were drawn from mothers and children and tested for hemoglobin (mother and child) and C-reactive protein (CRP; child only). Anthropometric measurements were performed on children and used to compute length-for-age z-scores (LAZ). Logistic regression models were fit to estimate unadjusted and adjusted associations between current breastfeeding status (yes or no) and child inflammation (CRP > 3 mg/L), stratified by maternal underweight status (BMI < 18.5). The adjusted model included controls for child’s age, mother’s age, household wealth, a food insecurity index, and mother and child hemoglobin level. Additional models were fit to estimate associations between child inflammation and stunting (LAZ < -2). ResultsAmong children of underweight mothers, those who were breastfed at the time of the assessment were significantly more likely to have inflammation (adjusted odds ratio (aOR) 4.08 [95% CI: 2.71, 6.16]; P < 0.001). There was no relationship between current breastfeeding and inflammation in children whose mothers were not underweight (aOR 1.18 [0.94, 1.49]; P = 0.152). Child inflammation was significant associated with stunting (aOR 1.95 [1.88, 2.01]; P < 0.001). ConclusionsOur findings suggest that breast milk from malnourished mothers may stimulate inflammation in breastfed children. Consistent with previous research, we find that inflammation is significantly associated with stunted growth in children under two years old. Funding SourcesThis study was supported by grant funding from the Allen Foundation. Supporting Tables, Images and/or Graphs▪▪

Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success

Introduction: Hospitals are in a unique position to promote, protect, and support breastfeeding. However, the association between in-hospital events and breastfeeding success within population-based samples has not been well studied. Materials and Methods: A stratified (by education and birth weight) systematic sample of 5,770 mothers taking part in the Utah Pregnancy Risk Assessment Monitoring System, 2012-2015, were included. Mothers, 2-4 months postpartum, completed the 82-item questionnaire, including if they had ever breastfed their new baby, and if so, current breastfeeding status. Relationships between in-hospital experiences and breastfeeding termination and duration were evaluated via Poisson and Cox proportional hazard regression models, respectively, adjusting for other in-hospital experiences, maternal age, race/ethnicity, maternal education, marital status, smoking, physical activity, delivery method, pregnancy complications, and length of hospital stay. Results: Of all, 94.4% of mothers self-reported breastfeeding initiation, of whom 18.8% had breastfed <2 months, having breastfed on average 3.2 weeks (standard error: 0.07). In fully adjusted models, mothers who reported receiving a pacifier, receiving formula, or had staff help them learn how to breastfeed had a higher prevalence of terminating breastfeeding before 2 months (adjusted prevalence ratio [aPR] = 1.13, 95% confidence interval [CI]: 0.97-1.32; aPR = 1.20, 95% CI: 1.07-1.36; and aPR = 1.25, 95% CI: 1.08-1.34). Conversely, mothers who reported starting and feeding only breast milk in the hospital and receiving a phone number to call for help with breastfeeding had a lower prevalence of breastfeeding termination before 2 months (aPR = 0.72, 95% CI: 0.61-0.86; aPR = 0.57, 95% CI: 0.51-0.64; and aPR = 0.91, 95% CI: 0.80-1.03). Adjusted Cox models showed similar direction of associations. Conclusions: Encouraging mothers to exclusively breastfeed in the hospital, and reducing gift packs containing pacifiers and formula, may be key areas United States hospitals can focus on to increase breastfeeding success. Prospective assessment in other geographical regions is needed to corroborate these findings.

Higher breastfeeding performance index is associated with lower risk of illness in infants under six months in Ethiopia.

BackgroundBreastfeeding performance index is an explanatory attempt to summarize key breastfeeding practices by summarizing the different dimensions of breastfeeding practices into a single summary variable. Breastfeeding performance index is used to assess optimal breastfeeding practices by constructing a single composite index that includes timely initiation of breastfeeding, prelacteal feeding, current breastfeeding status, bottle feeding, any liquid given(except medicine) in the last 24 h, formula given in the last 24 h, any solid food given in the last 24 h. This study aimed to assess optimal breastfeeding practices of 0–6 month infants using breastfeeding performance index (BPI) and its association with childhood illness in Ethiopia.MethodsA secondary data analysis was carried out based on the Ethiopia Demographic and Health Survey (EDHS) 2011 data. The BPI was created using seven components by giving equal weight for all components during scoring. The data were described using descriptive statistics and analyzed using multivariable logistic regression.ResultsThe prevalence of low, medium, and high BPI was 18.41, 57.96 and 23.63 % respectively. The mean BPI score was 4.38 (SD 1.25; 95 % CI 4.31, 4.45). Multivariable logistic regression analysis showed that those infants who had low BPI score were 2.22 times (AOR = 2.22; 95 % CI 1.20, 4.11) and medium BPI category had 2.15 times at higher odds (AOR = 2.15; 95 % CI 1.23, 3.75) of developing diarrhea compared to infants in the highest BPI category. Being in the lower BPI category was significantly associated with higher odds of having fever (AOR = 1.73; 95 % CI 1.06, 2.80). Being in the medium index category was also associated with higher odds of having short and rapid breaths (AOR = 2.02; 95 % CI 1.01, 4.04).ConclusionMore than 80 % of the infants did not receive optimal breastfeeding practices based on the Breastfeeding Performance Index. Lower BPI was statistically associated with diarrhea, fever and short and rapid breaths illness in the last 2 weeks. This study implicates the importance of optimal breastfeeding to reduce childhood illness.

Sodium and potassium intakes among US infants and preschool children, 2003–2010

Data are limited on usual sodium and potassium intakes relative to age-specific recommendations and the sodium:potassium ratio in infants and preschoolers, especially among those aged <2 y, who are black or breastfed. The usual sodium intake above the Tolerable Upper Intake Levels (ULs), potassium intakes above Adequate Intakes (AIs), the sodium:potassium ratio, and sodium density (mg/kcal) among US infants and preschoolers by age group, as applicable, were estimated and compared by race-ethnicity and current breastfeeding status. Data were analyzed among 3 groups of children (aged 7-11 mo, 1-3 y, and 4-5 y) from the NHANES 2003-2010 by using measurement error models. Seventy-nine percent of children aged 1-3 y and 87% of those aged 4-5 y exceeded their sodium UL; among non-Hispanic black children, the estimates were 84% and 97%, respectively. For potassium, 97% of infants, 5% of children aged 1-3 y, and 0.4% aged 4-5 y met their AIs. Compared with non-Hispanic whites and Mexican Americans, non-Hispanic black infants and preschoolers had higher mean sodium density and sodium:potassium ratios. Currently breastfed infants and children consumed, on average, less sodium than those who were not breastfed (382 ± 53 compared with 538 ± 22 mg in those aged 7-11 mo and 1154 ± 88 compared with 1985 ± 24 mg in those aged 1-3 y, respectively), but the sodium:potassium ratio did not differ. Most US preschoolers, particularly non-Hispanic blacks, consume too much sodium, and nearly all do not consume enough potassium. Data that suggest that currently breastfed infants consume less sodium than do those who are not breastfeeding merit further investigation.

Determinants of Anemia in Pre-School Children in the Occupied Palestinian Territory

This paper presents the main findings of an analysis linking the dependent variable - anemia in pre-school children - to its determinants, to identify priority groups for action. The study was a cross sectional survey of randomly selected pre-school children 6-59 months (n = 3331) in the occupied Palestinian territory during the current uprising. Anemia (Hb <11 g/dl) in children was determined by a blood sample. Other indicators were examined; 24 variables related to the family, housing, maternal and child characteristics, in addition to changes in income and food intake that occurred during the uprising. Multivariate analysis revealed that anemia was independently related to reduction in income, iron intake, infrequent gastrointestinal infections, stunting and current breast feeding status. In addition, region was an independent risk factor for anemia - in the West Bank there were fewer anemic children in the age group 6-35 months compared to children from the same age group living in the Gaza Strip.

Breastfeeding and Use of the Health Care System in Bahia State, Brazil: Three Multivariate Analyses

Three multivariate methods--deviation from total proportion breastfeeding, polynomial regression, and proportional hazards--are used on current status breastfeeding data to explain an inverse relationship between use of the health care system and breastfeeding in Bahia State, Brazil. Among the intervening variables analyzed--urban/rural residence, educational attainment, age of woman, and place of last live birth--education and place of last live birth are found to have a net effect on breastfeeding by all three methods of analysis. The advantages and disadvantages of each method are described.