Early Breastfeeding Practices Research Articles

The Relationship Of Mother's Knowledge And Characteristics On The Slowness Of The Process Of Early Breastfeeding Initiation in the Practiceof Midwifer Feronika Hutajulu

A mother can prevent her baby from dying in the first month of life if she breastfeeds her baby within 60 minutes after birth. However, the lack of knowledge and understanding of parents, doctors or health workers about the importance of IMD, as well as the reluctance to implement IMD, makes its implementation difficult. One of the reasons for the success or failure of IMD lies in the midwife. Because they are the ones who encourage and educate postpartum mothers to implement IMD. This research is included in the type of analytical research using a cross-sectional research design. The general aim of the research is to determine the relationship between maternal characteristics and early breastfeeding practices after giving birth. Meanwhile, specifically, this research seeks to identify the relationship between maternal knowledge, attitudes, age and parity of postpartum mothers who practice early breastfeeding at the Feronika Hutajulu Midwife Practice. Sampling was carried out using a non-probability sampling technique with a total sampling method of 26 people. Data collection uses a questionnaire. From analysis of research data using the chi-square test with a confidence level of 5% (a=0.05) knowledge data had a p value of 0.000, attitude data had a p value of 0.000, age data had a p value of 0.014, and parity data had a p value of 0.020. So it can be concluded that there is a relationship between maternal knowledge, maternal attitude, maternal age and maternal parity on the implementation of IMD.

Intensified Nutrition Interventions in Antenatal Care Services Increased Consumption of Iron and Folic Acid Supplements and Early Breastfeeding Practices in Burkina Faso: Results of a Cluster-Randomized Program Evaluation

BackgroundAlive & Thrive supported the Government of Burkina Faso to strengthen the provision of iron and folic acid (IFA) supplementation and interpersonal counseling on maternal nutrition and breastfeeding through antenatal care (ANC) services and community-based contacts in 2 regions. ObjectivesWe assessed the impacts of intensified nutrition interventions during ANC compared with standard ANC services on intervention coverage and maternal nutrition practices. MethodsA cluster-randomized evaluation compared 40 health center catchment areas in intervention areas with 40 in control areas. Repeated cross-sectional surveys in 2019 and 2021 (960 pregnant women and 1920 women with children 0–5 mo of age per survey round) provided data on impact indicators, intervention exposure, and other factors. We derived difference-in-difference (DID) effect estimates, adjusted for geographic clustering, for maternal dietary diversity, IFA consumption, and early breastfeeding practices. ResultsMore women in intervention areas had 4+ ANC visits (DID: 8.3 percentage points [pps]) and started ANC during the first trimester (DID: 10.5 pp), compared with control areas. Improvements were achieved in exposure to nutrition counseling on dietary diversity (DID: 44.4 pp), food quantity (DID: 42.9 pp), adequate weight gain (DID: 35.1 pp), and breastfeeding (DID: 25.9 pp). Women in intervention areas consumed more IFA supplements during pregnancy (DID: 21 tablets). Early initiation of and exclusive breastfeeding also improved (DID: 17.0 and 8.3 pp, respectively). However, dietary diversity (4 out of 10 food groups) and mean probability of adequacy of micronutrient intake (14%) among pregnant women remained low in both areas. ConclusionsStrengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in improving maternal nutrition practices. Continued efforts to strengthen the delivery and use of maternal nutrition services may be required for greater behavior changes, and to address family support, social norms, and other factors to improve women’s diets during pregnancy.

Multiple modifiable maternal, household and health service factors are associated with maternal nutrition and early breastfeeding practices in Burkina Faso.

Low coverage of effective nutrition interventions in many high-burden countries, due to service provision and demand factors, result in poor uptake of recommended practices and nutrition outcomes. We examined the factors that influence maternal nutrition and early breastfeeding practices and determined the extent that the key factors could improve these practices in two regions in Burkina Faso. We used household survey data among pregnant (n = 920) and recently delivered women (n = 1840). Multivariable regression analyses were conducted to identify the determinants of a diverse diet and iron-folic acid (IFA) supplement consumption, weight monitoring during pregnancyand early initiation of breastfeeding (EIBF). Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal conditions of interventions that address the modifiable determinants. During pregnancy, 21% of women achieved minimum diet diversity (MDD-W), 70% consumed 90+ IFA tabletsand 65% were weighed 4+ times; EIBF was 40%. Nutrition knowledge was associated with MDD-W (odds ratio [OR]: 3.2), 90+ IFA (OR: 1.5)and EIBF (OR: 1.9). Positive social norms and family support were associated with 90+ IFA (OR: 1.5). Early and 4+ ANC visits were associated with 90+ IFA (OR: 1.5 and 10) and 4+ weight monitoring (OR: 6.2). Nutrition counselling was associated with 90+ IFA (OR: 2.5) and EIBF (OR: 1.5). Under optimal programme conditions, 41% of women would achieve MDD-W, 93% would consume 90+ IFA, 93% would be weighed 4+ timesand 57% would practice EIBF. Strengthening the delivery and uptake of interventions targeted at these modifiable factors has the potential to improve maternal nutrition practices.

Birth and newborn care policies and practices limit breastfeeding at maternity facilities in Vietnam.

The prevalence of early and exclusive breastfeeding in Vietnam remains sub-optimal. The objective of this study was to determine factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding for the first 3 days after birth (EBF3D). We conducted a population-based, cross-sectional survey of 726 mothers with children aged 0-11 months in two provinces and one municipality from May to July 2020. Multinomial logistic regression was used to examine factors associated with EIBF and EBF3D. The prevalence of EIBF was 39.7% and EBF3D 18.0%. The EIBF prevalence is positively associated with immediate and uninterrupted skin-to-skin contact (SSC) for 10-29 min (aOR: 2.55; 95% CI: 1.49, 4.37), 30-59 min (aOR: 4.15; 95% CI: 2.08, 8.27), 60-80 min (aOR: 4.35; 95% CI: 1.50, 12.6), or ≥90 min (aOR: 5.87; 95% CI: 3.14, 10.98). EIBF was negatively associated with cesarean birth (aOR: 0.24; 95% CI: 0.11, 0.51), bringing infant formula to the birth facility (aOR: 0.49; 95% CI: 0.30, 0.78), purchased it after arrival (aOR: 0.37; 95% CI: 0.24, 0.60), or did both (aOR: 0.43; 95% CI: 0.21, 0.89). EBF3D was negatively associated with cesarean section birth (aOR: 0.15; 95% CI: 0.06, 0.39), vaginal birth with episiotomy (aOR: 0.40; 95% CI: 0.18, 0.88), bringing formula to the maternity facility (aOR: 0.03; 95% CI: 0.01, 0.07), purchased it after arrival (aOR: 0.02; 95% CI: 0.01, 0.06) or did both (aOR: 0.04; 95% CI: 0.02, 0.10). Receiving counseling from any source was not significantly associated with early breastfeeding practices. Policy and health service delivery interventions should be directed at eliminating infant formula from birthing environments, reducing unnecessary cesarean sections and episiotomies, providing immediate and uninterrupted SSC for all births, and improving breastfeeding counseling and support.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study.

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.

Strengthening Nutrition Interventions in Antenatal Care Services Improved Consumption of Iron-Folic Acid Supplements and Early Breastfeeding Practices in Burkina Faso

ObjectivesRoutine antenatal care (ANC) offers opportunities to receive a broad range of services including support for adequate nutritional care for pregnant women and their newborns. Alive & Thrive (A&T) aimed to strengthen provision of iron-folic acid (IFA) supplementation and interpersonal counseling on maternal nutrition and breastfeeding through government ANC services and community-based contacts in two regions in Burkina Faso. We assessed the impacts of intensified nutrition interventions during ANC (A&T) and standard ANC services (control) on intervention coverage and maternal nutrition practices.MethodsA cluster-randomized design compared 40 health center catchment areas in A&T areas to 40 in control areas. Repeated cross-sectional surveys in 2019 and 2021 (960 pregnant women and 1920 women with children 0–5 months of age per survey round) provided data on impact indicators and intervention exposure. We derived difference-in-difference effect estimates (DID), adjusted for geographical clustering, for maternal dietary diversity, IFA consumption, and early breastfeeding practices.ResultsMore women in A&T areas had 4 + ANC visits (DID: 8.5 percentage points [pp]) and 4 + community-based contacts during their last pregnancy (DID: 14.7 pp) and started ANC during the first trimester (DID: 11.3 pp), compared to control areas. A larger improvement in exposure to nutrition counseling during ANC was achieved in A&T areas than in control areas (DID: 39.5 pp). Women in A&T areas consumed more IFA supplements during pregnancy than in control areas (DID: 21 tablets). Both early initiation of breastfeeding and exclusive breastfeeding also improved (DID: 17.1 pp and 8.3 pp, respectively). However, dietary diversity (4 out of 10 food groups) and mean probability of adequacy of micronutrients intake (14%) among pregnant women remained low in both areas.ConclusionsStrengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in improving maternal nutrition practices, despite implementation during the COVID-19 pandemic. Continued efforts to strengthen the delivery and use of maternal nutrition services may be required for greater behavior changes, and to address family support, social norms, and other factors to improve maternal diet.Funding SourcesBMGF, through A&T, managed by FHI Solutions.

Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation.

ABSTRACTBackgroundMaternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services.ObjectivesWe compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices.MethodsWe used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018–2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices.ResultsDespite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7–14 percentage points (pp)] and counseling on core nutrition messages (DID: 10–23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron–folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A–rich foods (10 pp, 11 g/d), other vegetables and fruits (22–29 g/d), and gestational weight gain (0.4 kg).ConclusionsIntensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.

Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh?

Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh. We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders. The prevalence of EIBF practices were 69.6%(95% CI:67.8-71.3); 72.2%(95% CI:67.8-71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3-75.6) mother's in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35-0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12-0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding. This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.

Strengthening Nutrition Interventions in Antenatal Care Services Had Modest Impacts on Diet Diversity, Micronutrient Intake, and Breastfeeding in Uttar Pradesh, India

Abstract Objectives Interventions to improve maternal nutrition are poorly integrated into antenatal care (ANC) services in India. Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization implemented through government ANC services. We evaluated the impact of nutrition-intensified ANC (I-ANC) compared to standard ANC (S-ANC) on diet diversity, consumption of iron-folic acid (IFA) and calcium supplements, and early breastfeeding practices. Methods We used a cluster-randomized design with cross-sectional surveys at baseline (2017) and endline (2019) (n ∼660 pregnant women and 1800 recently delivered women per survey) and a process evaluation. We derived difference-in-difference effect estimates, adjusted for geographic clustering, gestational age, infant age, and sex. Results Coverage of interventions was high at endline; 70–90% women were contacted by frontline workers at home or nutrition centers. Women in the I-ANC arm were significantly more likely to have received counseling on core nutrition messages (10–18 percentage points [pp]) than those in the S-ANC arm. Dietary diversity improved modestly among pregnant women in the I-ANC arm compared to the S-ANC arm (effect: 8.3 pp). The number of food groups consumed increased slightly over time but remained low in both arms. The percentage of women who consumed 100 + IFA improved equally in both arms (from 8 to 25%). Small significant impacts were observed for any consumption of IFA and calcium supplements (effects 10.3 and 12.4 pp, respectively). Significant impacts were also observed for non-prelacteal feeding (effect: −6.3 pp) and exclusive breastfeeding (effect: 7.4 pp) but not for early initiation of breastfeeding. The process evaluation found that system-level and supply-chain challenges, household context, and local diet preferences affected implementation and uptake. Conclusions Intensifying nutrition in existing government ANC services resulted in modest improvements in maternal nutrition practices. Dietary diversity and consumption of supplements remained sub-optimal. Additional efforts are needed for further improvement of maternal nutrition services. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.

Mainstreaming and Scaling Up Nutrition Best Practices in a Nation-Wide Primary Healthcare Model of Bangladesh: Implementation Lessons Learned

Abstract Objectives The objective of the implementation research was to evaluate the effectiveness of a maternal and child nutrition-focused multi-component intervention, and assess the feasibility of incorporating it into an existing PHC program. Methods A cluster randomized impact evaluation compared the impact in terms of coverage of intervention, consumption of diversified foods and macro- and micronutrients during pregnancy, and early breastfeeding practices. A similar study was conducted among pregnant (n = 600) and recently delivered women (n = 2000) which examined factors influencing maternal nutrition practices. Cross-sectional surveys (2015 & 2016) were (n = 1000 women & 700 husbands) conducted to document the impact of husbands’ support on women's supplement intake and dietary diversity. Three subsequent cross-sectional studies (2013, 2014 & 2015) were conducted to evaluate the impact of a large scale SBCC program aimed at maternal dietary behavior and IYCF practices. A cRCT among 900 pregnant women assessed the relationship between maternal nutrition education and infant birthweight. Results Results showed that good nutrition knowledge was the key maternal factor associated with higher consumption of IFA (β = 32.5, 95% CI: 19.5, 45.6) and calcium (β 31.9, 95% CI: 20.9, 43.0) and diverse diet (OR = 1.8, 95% CI: 1.0 ± 3.1). The mean dietary diversity score of pregnant women increased from 4.28 + 1.08 to 4.76 + 1.16. About 83% of the respondents-initiated breastfeeding within an hour of childbirth, which was 62% at baseline. Less than a fifth (18%) of the children were eating a minimally acceptable diet at baseline, which reached to 52% by endline. Study showed that husbands support played a critical role for the women to increase supplement intake and dietary diversity. Nutrition counselling during pregnancy increased mean birthweight by 127.5 g (95% CI: 11.1 to 243.9; P = 0.032) and the risk of LBW was reduced by 54% (relative risk (RR): 0.43; 95% CI: 0.25 to 0.75; P = 0.003). Conclusions Integration of nutrition intervention into the existing health programme was feasible and well-implemented. Although differences in coverage and counselling quality most explained most impacts, all intervention elements particularly CHW training and performance were likely important to achieving impact. Funding Sources BRAC.

Early feeding practices and associated factors in Sudan: a cross-sectional analysis from multiple Indicator cluster survey

BackgroundIn efforts to reduce neonatal mortality, the World Health Organization (WHO) has included breastfeeding among its recommended packages of interventions. Early initiation of breastfeeding and avoidance of prelacteal feeding are key contributors to optimal feeding practices. This study aims to assess the prevalence and associated factors of early breastfeeding practices in Sudan.MethodsThis study utilises the cross-sectional nationally-representative Sudan Multiple Indicator Cluster Survey (MICS) conducted in 2014. The sample includes women who had a live birth in the two years before the survey and their self-report on early breastfeeding practices, namely early initiation and prelacteal feeding. Percentages of these early breastfeeding practices indicators were estimated accounting for the complex survey design. Multivariable logistic regression analyses were used to examine the factors associated with these outcomes.ResultsOf 5622 mothers, 69% initiated breastfeeding within one hour of birth, 72% avoided prelacteal feeding in the first three days after birth, and 51% met the criteria for both (i.e. practised optimal early feeding practice). Optimal early feeding varied across regions of Sudan. Birth by caesarean section (Adjusted Odds Ratio [AOR] 0.34; 95% CI 0.25, 0.47) and at a health facility (AOR 0.75; 95% CI 0.60, 0.94) were negatively associated with optimal early feeding practice. Mothers with secondary education (AOR 1.62; 95% CI 1.30, 2.02), those who desired their pregnancy at the time (AOR 1.31; 95% CI 1.08, 1.60), those who were assisted by a skilled birth attendant at birth (AOR 1.48; 95% CI 1.19, 1.83), and those who gave birth to female infants (AOR 1.16; 95% CI 1.02, 1.33) had higher odds of use optimal early feeding practice. Similarly, the odds of optimal early feeding increased with parity and maternal age.ConclusionsOnly half of Sudanese mothers practised optimal early feeding practice, with important differences between regions in the country. Early feeding practices in Sudan are associated with various maternal, child and community level factors. The findings suggest the need to develop breastfeeding promotion programs with consideration of regional variations and healthcare system interventions.

Early Breastfeeding Practices Promote Effective Parenting: An Analytical Study in Countries exposed to Conflict in the Middle East

Background: Breastfeeding is nurture and nutrition for every child, but the extent to which it influences parenting is controversial. Aim: To examine the effect of early breastfeeding practices in relation to child discipline and childcare. Methods: Global data from was examined from 52 provinces in four countries. The data included: early initiation of breastfeeding [EIBF] in the first hour and the first day, offering prelacteals, exclusive breastfeeding [EBF] and continued breastfeeding [CBF]. Parenting practices included exposure to psychological aggression and physical punishment and attitudes to physical punishment for rearing in children 1-14 years. Childcare indices included child left alone, with care of a child less than 10 years and with inadequate caregiver. Correlative studies and descriptive statistical analysis were done. Results: EBI within the first hour of birth was significantly correlated with non-violent discipline [r0.5] P<0.05 and being left alone in the past week [r0.7] P<0.01 and inversely with psychological aggression [r0.4] and minor physical punishment [r-0.4] at P>0.05. EBF inversely correlated with psychological [r-0.5] and minor physical punishment [r-0.4] and being left alone in the past week [r-0.5] at P<0.05. Longer duration of breastfeeding for 12 and 24 months correlated inversely with severe physical punishment [r-0.6 at P<0.01 and r-0.5 at P<0.05 respectively]. CBF for two years was also negatively correlated with being left alone [r0.5 at P>0.05]. Variations between countries in parenting styles and adequacy of childcare related to breastfeeding patterns. Conclusions: Breastfeeding is protective against violent parenting styles and enhances adequacy of childcare. Exposure to operative delivery with anesthesia may interfere with EIBF and negatively influence parenting.

The Effect of Cesarean Delivery on Child Survival and Early Breastfeeding Practices: Global Data from 103 Provinces in the Eastern Mediterranean Region

Background: Early initiation of breastfeeding (EIBF) plays an important role in the reduction of infant mortality. Although Cesarean section (CS) can save lives it delays EIBF and thereby increases risk of mortality.
 Aim: To examine the relationship between CS and EIBF with child mortality.
 Methods: Data was recruited from recent demographic health surveys for 129 provinces of seven Eastern Mediterranean countries. The data was analyzed for breastfeeding initiation (EBFI) rates in the first hour and the first day, feeding prelacteals, delivery by skilled birth attendant (SBA), and delivery by CS, also neonatal mortality (NMR), infant mortality rates (IMR) and under-five mortality rates (U5MR). Statistical analysis was done using Pearson correlation and descriptive statistics. The economic cost of unnecessary CS correlated to mortality rates and EBFI.
 Results: Overall CS was inversely associated with EBFI in the first hour after birth (r-0.2, P=0.1), intake of prelacteals (r-0.3, P=0.008) and NMR (r-0.3, P=0.1), IMR (r-0.4, P=0.0001), and U5MR (r-0.4, P=0.0001) at P<0.05 and positively associated with EBFI in first day (r0.2, P=0.06). CS below the recommended level by WHO (<15%) was inversely associated with IMR. Moderately high CS >18% was inversely correlated with EBFI and positively correlated with intake of prelacteals, NMR and IMR. Very high CS >40 was inversely correlated with mortality at P<0.01. Unnecessary CS was significantly inversely correlated with U5MR.
 Conclusions: CS when unnecessary or by unskilled birth attendant, is a threat to child survival. Breastfeeding initiation, as early as possible skin-to-skin, is recommended to alleviate the outcome of CS.

Relationship between caesarean section and breastfeeding: evidence from the 2013 Turkey demographic and health survey

BackgroundThe mode of delivery influences breastfeeding practices. High rates of caesarean section and low breastfeeding rates are important public health concerns for all developing countries. This study aimed to determine the relationship between caesarean section and early breastfeeding practices among primiparae.MethodsData for primiparae with a singleton birth (N = 777) obtained from the 2013 Turkey Demographic and Health Survey were used in this retrospective cohort study. Early initiation of breastfeeding within one hour of delivery and exclusive breastfeeding during the first three days following birth were evaluated. Standardised incidence rates and standardised rate ratios of non-early initiation of breastfeeding and non-exclusive breastfeeding were calculated according to the mode of delivery.ResultsThe late initiation of breastfeeding and non-exclusive breastfeeding incidence rates were 42.7 and 41.0%, respectively. The standardised incidence rate of late initiation of breastfeeding among women with vaginal delivery was 35.34%, versus 50.49% among those with caesarean delivery. The standardised rate ratios for late initiation of breastfeeding and non-exclusive breastfeeding were 1.428 (95% confidence interval (CI): 1.212–1.683) and 1.468 (95% CI: 1.236–1.762), respectively. Women who underwent caesarean section had a higher risk of late initiation of breastfeeding and non-exclusive breastfeeding during the three days following delivery, after controlling for sociodemographic and delivery-related factors.ConclusionsThis study provides useful evidence for the implementation of strategies to prevent unnecessary caesarean sections, which negatively affect not only maternal health but also neonatal health. The promotion of mother-friendly policies by healthcare institutions, implemented in a baby-friendly manner, is essential.

The effect of maternal health service utilization in early initiation of breastfeeding among Nepalese mothers

BackgroundThe World Health Organization (WHO) recommends early initiation of breastfeeding and exclusive breastfeeding for six months. Understanding the association of maternal health services and early initiation of breastfeeding might be useful on prioritizing the health services to promote early breastfeeding practices. The purpose of this study was to examine the association between utilization of maternal health services and early initiation of breastfeeding among Nepalese mothers.MethodsNationally representative data from the 2016 Nepal Demographic Health Survey (NDHS) was used to determine the association between early initiation of breastfeeding and variables related to maternal health services utilization. Association was measured by using Chi-square test followed by calculation of adjusted odds ratio (AOR) and 95% confidence intervals (CI) using multivariable logistic regression analysis.ResultsOut of 1,978 children, 55% were breastfed within an hour of birth. Early initiation of breastfeeding was associated among mothers who delivered at the health facilities (AOR 2.22; 95% CI 1.36, 3.60). Mothers who had a vaginal birth (AOR 6.70; 95% CI 4.30, 10.42) were significantly more likely to breastfeed within an hour of birth compared to mothers who had caesarean delivery. The odds of initiating early breastfeeding were higher among mothers from Province 5 (AOR 1.59; CI 1.02, 2.48), Province 6 (AOR 2.58; 95% CI 1.41,4.69) and Province 7 (AOR 2.30; CI 1.36, 3.87).ConclusionsHealth facility delivery and a vaginal delivery were strongly associated with early initiation of breastfeeding. It is vital to intensify maternal health service up to the community to aware pregnant women to utilize maternal health services to improve breastfeeding practices. Skilled Birth Attendant (SBA) training should include comprehensive breastfeeding counselling package to motivate mothers to initiate early breastfeeding especially for mothers having caesarean delivery.

Newborn physical condition and breastfeeding behaviours: Secondary outcomes of a cluster-randomized trial of prenatal lipid-based nutrient supplements in Bangladesh.

Prenatal nutritional supplements may improve birth outcomes. This study aims to examine the effect of prenatal lipid-based nutrient supplements (LNS), compared with iron and folic acid (IFA), on general newborn physical condition and feeding behaviours. We conducted a cluster-randomized effectiveness trial that enrolled 4,011 pregnant women at ≤20 gestational weeks. LNS and IFA were provided to women in 48 and 16 clusters, respectively, for daily consumption until delivery. We collected data on household socio-economic, food insecurity, and maternal characteristics during early pregnancy and on newborn condition and feeding within 72hr of delivery. We analysed intervention effects on these secondary outcomes using mixed models with analysis of covariance for continuous outcomes and logistic regression for dichotomous outcomes. Among 3,664 live births, intervention groups did not differ in newborn response, mother's rating of the general condition of her newborn, early initiation of breastfeeding (EIBF), suckling ability, or frequency and exclusivity of breastfeeding in the first 24hr. If the mother perceived her infant to be healthy, EIBF was more likely (OR [95% CI]: 2.08 [1.46, 2.97]) and frequency of breastfeeding in the first 24hr was greater (mean difference [95% CI]: 3.0 [1.91, 4.01]), but there was no difference in exclusive breastfeeding in the first 24hr. Newborn condition and early breastfeeding practices were not affected by giving mothers prenatal LNS versus IFA. However, early breastfeeding practices were related to maternal perception of her newborn's condition. Thus, interventions to improve breastfeeding practices for newborns with poorer perceived health status may be useful.

Effectiveness of facility-based personalized maternal nutrition counseling in improving child growth and morbidity up to 18 months: A cluster-randomized controlled trial in rural Burkina Faso.

The period from conception to 24 months of age is a crucial window for nutrition interventions. Personalized maternal counseling may improve childbirth outcomes, growth, and health. We assessed the effectiveness of facility-based personalized maternal nutrition counseling (from pregnancy to 18 months after birth) in improving child growth and health in rural Burkina Faso. We conducted a paired cluster randomized controlled trial in a rural district of Burkina Faso with 12 primary health centers (clusters). Healthcare providers in the intervention centers received patient-centered communication and nutrition counseling training. Pregnant women in the third trimester living in the center catchment areas and intending to stay for the next 2 years were prospectively included. We followed 2253 mother-child pairs quarterly until the child was aged 18 months. Women were interviewed about counseling experiences, dietary practices during pregnancy, and their child’s feeding practices and morbidity history. Anthropometric measurements were taken at each visit using standardized methods. The primary outcomes were the cumulative incidence of wasting, and changes in child weight-for-height z-score (WHZ). Secondary outcomes were the women’s prenatal dietary practices, early breastfeeding practices, exclusive breastfeeding, timely introduction of complementary food, child’s feeding frequency and dietary diversity, children’s mean birth weight, endpoint prevalence of stunting, and cumulative incidence of diarrhea, fever, and acute respiratory infection. All analyses were by intention-to-treat using mixed effects models. The intervention and control arms each included six health centers. Mothers in the intervention arm had a significantly higher exposure to counseling with 11.2% for breastfeeding techniques to 75.7% for counseling on exclusive breastfeeding. Mothers of infants below 6 months of age in the intervention arm were more likely to exclusively breastfeed (54.3% vs 42.3%; Difference of Proportion (DP) 12.8%; 95% CI: 2.1, 23.6; p = 0.020) as compared to the control arm. Between 6 and 18 months of age, more children in the intervention arm benefited from the required feeding frequency (68.8% vs 53.4%; DP 14.1%; 95% CI: 9.0, 19.2; p<0.001) and a larger proportion had a minimum dietary diversity (28.6% vs 22.0%; DP 5.9%; 95% CI: 2.7, 9.2; p<0.001). Birth weight of newborns in the intervention arm was on average 84.8 g (p = 0.037) larger compared to the control arm. However, we found no significant differences in child anthropometry or morbidity between study arms. Facility-based personalized maternal nutrition counseling was associated with an improved prenatal dietary practices, Infant and Young Child Feeding practices, and child birth weight. Complementary strategies are warranted to obtain meaningful impact on child growth and morbidity. This includes strategies to ensure good coverage of facility-based services and effective nutrition/care practices in early childhood.

In a rural area of Bangladesh, traditional birth attendant training improved early infant feeding practices: a pragmatic cluster randomized trial.

In rural Bangladesh, most births take place at home. There is little evidence regarding the influence of traditional birth attendants (TBAs) or community volunteers (CVs) on early infant feeding practices. We conducted a pragmatic cluster randomized controlled trial in Panchagarh District to examine the effects of training and post-training supervision of TBAs/CVs on early breastfeeding practices. Nine unions were randomized into three groups of three unions. We compared outcomes between mothers in a control group (CG), those living in unions where TBAs/CVs had received a 5-day training in early feeding practices (TG) and those living in unions where TBAs/CVs were both trained and supervised (SG). A total of 1182 mothers of infants aged 0-6 months were interviewed at baseline. After 6 months of intervention, an endline survey was conducted on a different sample of 1148 mothers of infants aged 0-6 months in the same areas. In both intervention areas, TBAs/CVs made regular home visits and attended births whenever possible. Rates of early initiation of breastfeeding, avoidance of prelacteal feeds and exclusive breastfeeding were compared between groups using cluster-controlled mixed model logistic regression. At endline, both intervention groups had significantly higher proportions of mothers who reported early initiation of breastfeeding (CG: 88%, TG: 96%, SG: 96%) and avoidance of prelacteal feeds (CG: 48%, TG: 80%, SG: 88%) compared with the control group; there were no significant differences between the two intervention groups. The endline rates of reported exclusive breastfeeding were not significantly different among groups (CG: 67%, TG: 76%, SG: 83%).

Father's involvement and its effect on early breastfeeding practices in Viet Nam.

Fathers have an important but often neglected role in the promotion of healthy breastfeeding practices in developing countries. A community-based education intervention was designed to mobilize fathers' support for early breastfeeding. This study aimed to evaluate an education intervention targeting fathers to increase the proportion of early breastfeeding initiation and to reduce prelacteal feeding. Quasi-experimental study design was used to compare intervention and control areas located in two non-adjacent rural districts that shared similar demographic and health service characteristics in northern Viet Nam. Fathers and expectant fathers with pregnant wives from 7 to 30 weeks gestational age were recruited. Fathers in the intervention area received breastfeeding education materials, counselling services at a commune health centre and household visits. They were also invited to participate in a breastfeeding promotion social event. After intervention, early breastfeeding initiation rate was 81.2% in the intervention area and 39.6% in the control area (P < 0.001). Babies in the intervention area were more likely to be breastfed within the first hour after birth [odds ratio (OR) 7.64, 95% confidence interval (CI) 4.81-12.12] and not to receive any prelacteal feeding (OR 4.43, 95% CI 2.88-6.82) compared with those in the control area. Fathers may positively influence the breastfeeding practices of mothers, and as a resource for early childcare, they can be mobilized in programmes aimed at improving the early initiation of breastfeeding.

Prenatal depression and baby low-birth-weight: Effects on early breastfeeding practices

Prenatal depression and baby low-birth-weight: Effects on early breastfeeding practices