Higher Rates Of Exclusive Breastfeeding Research Articles

Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial.

Parental health literacy is important to children's health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. This study aimed to determine the effects of a WeChat official account (WOA)-based intervention on parental health literacy of primary caregivers of children aged 0-3 years. This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children's health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention's effect. After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children's health outcomes. Furthermore, despite slight subgroup differences in the intervention's effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Using a WHO literacy model-based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes.

A case-control study of the risk factors for fistula-in-ano in infants and toddlers

BackgroundLimited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.ObjectivesThe purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.Design and settingsA retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.Independent variables(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.ResultsMothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).ConclusionBased on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.

Implementation of early essential neonatal care for newborns delivered by cesarean section in Jiaxing: a single-center prospective randomized controlled trial

BackgroundAs an essential part of Early Essential Newborn Care, 90 minutes of mother-infant skin-to-skin contact is significant in improving maternal and infant outcomes. However, due to human resource constraints and the consideration of maternal and infant safety, it is difficult to achieve continuous uninterrupted skin-to-skin contact for at least 90 minutes during and after cesarean delivery. The aim of this study was to investigate the efficacy and safety of the continuous uninterrupted skin-to-skin contact for at least 90 minutes during and after cesarean section for exclusive breastfeeding rate during hospitalization and maternal and infant health indicators during and after cesarean delivery.MethodsThis is a single-center, prospective randomized controlled trial conducted in one tertiary care hospital in China. We selected 280 cases of elective cesarean delivery in a tertiary maternal and child specialty hospital in Zhejiang Province from September 2018 to August 2022, which were randomly divided into two groups: in the conventional group, doulas performed at least 30 minutes for early continuous SSC within 10–30 minutes during and after cesarean delivery. In the EENC group, with immediate continuous SSC within 5–10 minutes of neonatal delivery until surgery is completed and continued SSC after returning to the ward. Exclusive breastfeeding rate during hospitalization and maternal and infant health indicators were compared between the groups.ResultsA total of 258 cases were analyzed. Compared with the control group, the EENC group had earlier first breastfeeding initiation (13.7 ± 3.6 vs 62.8 ± 6.5 minutes, P < 0.001), longer duration of first breastfeeding (42.6 ± 9.0 vs 17.9 ± 7.5 minutes, P < 0.001), earlier onset of lactogenesis II (73.7 ± 3.6 vs 82.5 ± 7.4 hours, P < 0.001), higher breastfeeding self-efficacy score (128.6 ± 8.9 vs 104.4 ± 8.5, P < 0.001), higher Exclusive breastfeeding rate during hospitalization (88% vs 81%, P = 0.018), higher maternal satisfaction scores (18.9 ± 1.1 vs 14.0 ± 2.7, P < 0.001). Meanwhile the EENC group showed lower incidence of neonatal hypothermia (0% vs 4.6%, P = 0.014), lower neonatal hypoglycemia (0% vs 5.4%, P = 0.007) and less cumulative blood loss within 24 hours postpartum (254.2 ± 43.6 vs 282.8 ± 63.8 ml, P < 0.001).ConclusionThe implementation of EENC up to 90 minutes by caesarean doula company nurses is feasible and beneficial to maternal and infant health.Trial RegistrationChiCTR1800018195(2018-09-04).

Examining the Benefits of Water Births in a Hospital Setting: Perspectives from Midwives and Nurses

Objective: This study aimed to investigate the impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health in a hospital setting. Specifically, the study sought to compare the effects of midwifery-led care to standard care models, assess maternal preparedness for childbirth, explore rates of medical interventions, evaluate maternal satisfaction, and examine newborn health outcomes. Methods: A total of 200 expectant mothers receiving prenatal care at a tertiary hospital were recruited and randomly assigned to two groups: Group A (midwifery-led care) and Group B (standard care). Participants' demographic information, medical history, and preferences related to prenatal care were collected using a structured questionnaire. Validated surveys, including the Edinburgh Postnatal Depression Scale (EPDS), were used to assess postpartum depression. Medical records and prenatal visits were reviewed throughout the pregnancy, and postpartum follow-ups were scheduled to assess maternal outcomes. Statistical analyses were performed to compare outcomes between the two groups. Results: Participants in the midwifery-led care group reported significantly higher levels of birth preparedness (p &lt; 0.001), and rates of medical interventions during childbirth, including cesarean sections, were significantly lower compared to the standard care group (p &lt; 0.05). Maternal satisfaction scores were significantly higher in the midwifery-led care group (p &lt; 0.001). Additionally, the midwifery-led care group showed lower rates of postpartum depression (p &lt; 0.01) and higher rates of exclusive breastfeeding at six weeks postpartum (p &lt; 0.05). Neonates born to mothers in the midwifery-led care group had significantly lower rates of neonatal complications (p &lt; 0.01). Conclusion: The findings of this study provide strong evidence for the positive impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health. The personalized and woman-centered approach of midwifery-led care contributes to improved maternal preparedness, reduced medical interventions, increased maternal satisfaction, lower rates of postpartum depression, and better newborn health outcomes. These results highlight the potential benefits of integrating midwifery-led care models into maternity services, aiming to enhance the overall birthing experience and improve maternal and infant health outcomes.

Comparative Assessment of Exclusive Breastfeeding Rates From 24-Hour Recall and Since Birth Methods in Southwestern Pennsylvania Using Ecological Momentary Assessment.

Accurate measurement of exclusive breastfeeding is important in maternal and child health research. Exclusive breastfeeding is often measured using the 24-hour recall or the since birth method for the first 6 months. These methods can produce different estimates, introducing problems in interpreting breastfeeding behavior and making accurate comparisons across settings or countries. Our aim was to compare the exclusive breastfeeding rates between the 24-hour recall and since birth methods among a diverse cohort of birthing people using the ecological momentary assessments method. In addition, we compared the exclusive breastfeeding rates between the two methods across race and other maternal characteristics. This study is a secondary analysis using data from the Postpartum Mothers Mobile Study (PMOMS), a prospective longitudinal study which recruited participants during pregnancy and followed them for 12 months after delivery. Participants completed surveys in real-time via ecological momentary assessment. Individual exclusive breastfeeding rates from months 1-6 were computed using 24-hour recall and since birth methods for 284 participants. We calculated the percentage point difference between the two methods across child age and maternal characteristics. We used a two-sample test of proportions to determine if the differences observed in the proportions were significant. Exclusive breastfeeding rates from the 24-hour recall were higher than the since birth rates across all ages and maternal characteristics. The difference between the two methods at 3 months was 25.7 percentage points and at 6 months was a 17.2 percentage points. Irrespective of the method used to measure exclusive breastfeeding, White participants had higher exclusive breastfeeding rates than Black participants. The 24-hour recall and the since birth methods of assessing exclusive breastfeeding provided substantially different estimates. These findings highlight the importance of specificity in measuring and reporting exclusive breastfeeding.

Examining the Benefits of Water Births in a Hospital Setting: Perspectives from Midwives and Nurses

Objective: This study aimed to investigate the impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health in a hospital setting. Specifically, the study sought to compare the effects of midwifery-led care to standard care models, assess maternal preparedness for childbirth, explore rates of medical interventions, evaluate maternal satisfaction, and examine newborn health outcomes. Methods: A total of 200 expectant mothers receiving prenatal care at a tertiary hospital were recruited and randomly assigned to two groups: Group A (midwifery-led care) and Group B (standard care). Participants' demographic information, medical history, and preferences related to prenatal care were collected using a structured questionnaire. Validated surveys, including the Edinburgh Postnatal Depression Scale (EPDS), were used to assess postpartum depression. Medical records and prenatal visits were reviewed throughout the pregnancy, and postpartum follow-ups were scheduled to assess maternal outcomes. Statistical analyses were performed to compare outcomes between the two groups. Results: Participants in the midwifery-led care group reported significantly higher levels of birth preparedness (p &lt; 0.001), and rates of medical interventions during childbirth, including cesarean sections, were significantly lower compared to the standard care group (p &lt; 0.05). Maternal satisfaction scores were significantly higher in the midwifery-led care group (p &lt; 0.001). Additionally, the midwifery-led care group showed lower rates of postpartum depression (p &lt; 0.01) and higher rates of exclusive breastfeeding at six weeks postpartum (p &lt; 0.05). Neonates born to mothers in the midwifery-led care group had significantly lower rates of neonatal complications (p &lt; 0.01). Conclusion: The findings of this study provide strong evidence for the positive impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health. The personalized and woman-centered approach of midwifery-led care contributes to improved maternal preparedness, reduced medical interventions, increased maternal satisfaction, lower rates of postpartum depression, and better newborn health outcomes. These results highlight the potential benefits of integrating midwifery-led care models into maternity services, aiming to enhance the overall birthing experience and improve maternal and infant health outcomes.

Healing at Home: Impacting Postpartum Outcomes Utilizing Clinical Practice Changes and Augmented Intelligence [ID: 1379350

INTRODUCTION: The fourth trimester is a time of great physical and emotional challenge. To help patients navigate this period, we created the Healing at Home (H@H) program, which combined expedited discharge with a 24/7 bidirectional postpartum support chatbot. METHODS: Clinical outcomes, abstracted from medical record and patient report via text message, were evaluated for patients enrolled in H@H (March 2020 to September 2021) compared to patients delivering prior to program implementation (July to December 2019). Enrolled patients had a full-term singleton vaginal delivery of a non-small-for-gestational-age infant without postpartum hemorrhage (&gt;1,000 cc), a low-risk sepsis risk score, a low- to intermediate-risk bilirubin, and lack of significant maternal comorbidities (eg, preeclampsia, preexisting diabetes). Institutional review board waiver for this quality improvement study was obtained. RESULTS: There were 490 patients enrolled in H@H versus 309 in preintervention group. The groups were similar in parity, race, ethnicity, and insurance status. There was no difference in the primary outcome, postpartum visit attendance (76.9% versus 76.1%, P=.77). H@H patients had a shorter postpartum length of stay (33.3 versus 46.7 hours, P&lt;.001), higher rates of exclusive breastfeeding at 1 week (59.2% versus 57.0%, P=.02), and a higher rate of contraceptive use (55% versus 44%, P=.01), with no difference in maternal unscheduled visits or hospital readmissions. CONCLUSION: This innovative postpartum program was associated with a shorter length of stay and improvement in contraceptive acceptance and breastfeeding without increasing unscheduled visits. Future studies should evaluate the cost-effectiveness of this program and expansion to higher-risk patients including those with cesarean delivery and medical comorbidities.

The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study

In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development. This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse.

Breastfeeding in Mothers with Multiple Sclerosis: The German Experience.

Background: Many female people with multiple sclerosis (pwMS) are in childbearing age; however, only few data exist about the situation of breastfeeding in pwMS. Objective: Our study analyzed breastfeeding rate and duration, reasons for weaning, and the impact of disease severity on successful breastfeeding in pwMS. Methods: The study included pwMS giving birth within 3 years before study participation. Data were collected by structured questionnaire. Results: Compared to published data, we found a significant difference (p = 0.0007) between the nursing rate in the general population (96.6%) and females with MS (85.9%). However, a higher rate of exclusive breastfeeding could be observed in our study population for 5-6 months in 40.6% of pwMS versus 9% for 6 months in the general population. In contrast, total breastfeeding duration in our study population was shorter (18.8% for 11-12 months) than in the general population (41.1% for 12 months). Reasons for weaning were predominantly (68.7%) related to breastfeeding barriers based on MS. No significant impact of prepartum or postpartum education on the breastfeeding rate could be observed. Prepartum relapse rate and prepartum disease-modifying drugs had no effect on breastfeeding success. Conclusion: Our survey provides an insight into the situation of breastfeeding in pwMS in Germany.

The effect of family integrated care on the prognosis of premature infants

BackgroundThe purpose of this study was to investigate the effect of family integrated care (FICare) on the prognosis of children hospitalized with preterm infants.MethodsTwo hundred thirty preterm infants admitted to our hospital from January 2019 to April 2021 were enrolled in a prospective randomized study and divided into 115 cases in the intervention group and 115 cases in the control group according to the random number table method, and given the FICare and the conventional care, respectively. The duration of nasogastric tube retention, time to achieve total enteral nutrition, rate of weight gain, exclusive breastfeeding rate, length of hospital stay, growth and development, readmission rate, parental self-efficacy, family functioning and complications related to prematurity were compared between the two groups.ResultsCompared with the control group, the intervention group had shorter nasogastric tube retention time, shorter time to achieve total enteral nutrition, higher exclusive breastfeeding rate, shorter time of hospital stay and better growth rate. Before the intervention, there was no difference in parental self-efficacy and family functioning between the two groups; after the intervention, the intervention group had higher parental self-efficacy and higher ratings of family functioning, and the difference was statistically significant. Compared with the control group, the intervention group had a lower readmission rate and significantly lower incidence of infection and choking.ConclusionThe FICare can shorten the time of nasogastric tube retention, shorten time to achieve total enteral nutrition and hospital stay, increase the rate of exclusive breastfeeding and the rate of weight gain, finally improve the prognosis of preterm infants and have a positive effect on parents.

Successful breastfeeding following a level II NICU stay in Qatar – a longitudinal study

BackgroundExclusive breastfeeding is an essential need for mothers and newborn babies, but cultural practices and employment demands significantly influence feeding practices. The association between neonatal intensive care unit (NICU) admission and breastfeeding outcomes are variable. Data for Qatar and Middle East, in particular, are limited. Hence, this study aims to estimate the rate of breastfeeding at the time of NICU discharge and the rate of successful breastfeeding after NICU discharge in Qatar during well-baby follow-ups.MethodsThis quantitative longitudinal study was conducted over 18 months from January 2019 and included neonates born in Al Wakra Hospital admitted to the NICU. Demographic data, feeding during NICU stay and at discharge were obtained from lactation charts. Data regarding feeding practices after discharge were obtained through a questionnaire administered at 4 weeks and 8 weeks in well-baby clinics. Descriptive statistics and logistic regression analyses were performed to determine the rates of breastfeeding and the association between the various factors.ResultsOf the 678 participants screened, 364 were eligible for analysis. The rates of exclusive breastfeeding were 20% (73/364), 54% (197/364) and 42% (153/364) at discharge, 4 weeks and 8 weeks, respectively. Any breastfeeding was 64% (233/364), 40% (146/364) and 43% (157/364) at discharge, 4 weeks and 8 weeks, respectively. Logistic regression analysis showed that neonates who had NICU stays longer than 4 days had a higher rate of exclusive breastfeeding at discharge (adjusted odds ratio 3.000; 95% CI 1.25, 7.198) but had a reduced rate of breastfeeding and higher rate of formula feeding during follow-ups. Although breastfeeding rates were better in preterm infants at NICU discharge, regression analysis showed that none of the other factors, including gestation and maternal education had a significant association with the rate of exclusive breastfeeding at the time of discharge or during follow-ups.ConclusionsThe overall breastfeeding rates from this level II NICU in Qatar are better than previously available data. Studies with extended follow-up and assessment of intervention methods should be planned to improve and sustain the practice of exclusive breastfeeding.

A Pilot Randomized Controlled Trial of an Online Educational Program for Primiparous Women to Improve Breastfeeding.

There are different approaches to breastfeeding interventions, but the global 6-month exclusive breastfeeding rates remain suboptimal. The COVID-19 pandemic has brought extra difficulties in promoting breastfeeding. To test the feasibility and effectiveness of a theory-based, real-time online educational and support program for breastfeeding related outcomes. An assessor-blinded, prospective pilot randomized controlled trial with parallel-group, repeated-measures design was used. The sample was low-risk primiparous mothers (N = 40) who delivered in the local public hospitals. Study outcomes consisted of exclusive breastfeeding rate, breastfeeding self-efficacy, and other breastfeeding outcomes measured by a self-reported questionnaire, including the Breastfeeding Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Comparisons between the differences in the intervention and control groups were carried out. Thirteen participants in the intervention group successfully completed the program. They had a higher exclusive breastfeeding rate, breastfeeding self-efficacy, breastfeeding initiation rate, and longer exclusive breastfeeding duration than the control group. Additionally, the intervention group had a lower partial breastfeeding rate, and a higher maternal postnatal depression score and infant's morbidity at postnatal 2 months. However, all the results were not statistically significant (p > .050). Overall, the intervention was highly valued by all participants who appreciated the regular postnatal follow-ups. Despite showing the satisfactory feasibility of the program, no significant improvements were found in all study outcomes. Considering the participants' comments, we suggest refining and further testing the intervention with a larger sample size over a longer-term follow-up to confirm its effectiveness.This study has been registered at ClinicalTrials.gov (NCT04741425).

O47 - What modifiable factors improve breastfeeding exclusivity and duration in Australian women?

Australian breastfeeding rates, particularly exclusive breastfeeding rates, are low and have been low for many years because strategies to increase them have been inadequate. New approaches for promoting and supporting breastfeeding are required. Data collected in 2008 suggested that Australian Breastfeeding Association (ABA) members had much higher exclusive breastfeeding rates (41.2% at 5 to 6 months) than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted (EMBER) project was undertaken 1) to determine whether ABA volunteer trainees had better breastfeeding outcomes and were, in fact, positive deviants regarding breastfeeding practices, 2) to explore attitudes, characteristics and behaviours underpinning beneficial breastfeeding practices and 3) to identify modifiable characteristics to inform breastfeeding promotion and support. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with ABA and analysed using descriptive statistics. Participants in this project had much higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Modifiable factors that positively influenced breastfeeding outcomes included knowledge of and motivation to breastfeed, birthing outcomes, immediate skin-to-skin contact, lack of in-hospital formula supplementation and partner and peer support. EMBER participants can be defined as positive deviants with positive attitudes, characteristics and behaviours towards breastfeeding that lead to much better breastfeeding outcomes compared to the general Australian population. Many of the modifiable factors that positively impacted their breastfeeding outcomes can be influenced by midwives supporting pregnant women, women giving birth and breastfeeding mothers. Midwives are uniquely positioned to provide breastfeeding education and information, and timely and well-informed breastfeeding support to mothers, to give them the best chance to breastfeed exclusively and breastfeed for longer.

Breastfeeding and complementary feeding in fragile settings: the case of Syrian refugees and their host communities in North Lebanon

BackgroundAdequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities.MethodsUsing two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6–24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis.ResultsAmong breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees’ children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p < 0.05). Among refugees, education and spouse’s employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months.ConclusionBreastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding

ObjectiveAssess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. MethodCross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. ResultsThe kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. ConclusionThe self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

Predicting Risk for Early Breastfeeding Cessation in Israel.

This study aimed to 1) Examine factors associated with cessation of exclusive breastfeeding in Israel and 2) Develop predictive models to identify women at risk for early exclusive breastfeeding cessation. The study used data from longitudinal national representative infant nutrition survey in Israel (n = 2119 participants). Logistic regression was used to identify risk factors and build predictive models. The rate of exclusive breastfeeding cessation increased from 45.4% at 2months to 85.7% at 6months. Five factors were significantly associated with higher odds of exclusive breastfeeding cessation at 2months: being a primapara, low educational level, lack of previous breastfeeding experience, negative attitude towards birth, and lack of intention to breastfeed. Six factors were significantly associated with higher odds of exclusive breastfeeding cessation at 6months: younger age, being in a relationship with a partner, lower religiosity level, cesarean delivery, not taking folic acid during pregnancy, and negative attitude towards birth. Both 2 and 6-months models had good predictive performance (C-statistic of .72 and .68, accordingly). This nationwide study successfully identified several predictors of exclusive breastfeeding cessation and created breastfeeding cessation prediction tools for two time periods (2 and 6months). The resulting tools can be applied to identify women at risk for stopping exclusive breastfeeding in hospitals or at community clinics. Further studies should examine practical aspects of applying these tools in practice and explore whether applying those tools can lead to higher exclusive breastfeeding rates.

Breastfeeding Supportive Services in Baby-Friendly Hospitals Positively Influenced Exclusive Breastfeeding Practice at Hospitalization Discharge and Six Months Postpartum.

Background: Studies have shown that implementing the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative can protect, promote, and support breastfeeding. However, few studies have valuated the quality of breastfeeding supportive services provided by Baby-Friendly Hospitals from the perspective of service users. Methods: This was a hospital-based prospective study, conducted at eight Baby-Friendly Hospitals with a total of 707 pregnant women in Shanghai, China between October 2016 and September 2021. Breastfeeding supportive services during hospitalization were assessed at childbirth discharge using a 12-question questionnaire based on the Chinese “Baby-Friendly Hospital Evaluation Standards”. Women were followed up on six months postpartum. The impact of breastfeeding supportive services during hospitalization on the exclusive breastfeeding at discharge and six months postpartum were assessed. Results: Of the 707 mothers who completed the survey at discharge, 526 were followed up on six months after delivery. The overall exclusive breastfeeding rate among participants was 34.4% at discharge and 52.1% at six months postpartum. Mothers who received better breastfeeding supportive services during hospitalization were more likely to practice exclusive breastfeeding at hospitalization discharge compared with mothers who received poorer services (aOR: 3.00; 95% CI: 2.08, 4.35; p < 0.001). Furthermore, they were also more likely to exclusively breastfeed at six months postpartum (aOR: 1.50; 95% CI: 1.03, 2.22; p = 0.033). Conclusion: Better breastfeeding supportive services during hospitalization were significantly associated with higher rate of exclusive breastfeeding at discharge and six months postpartum. More effective measures should be adopted to improve the implementation of the breastfeeding supportive services in Baby-Friendly Hospitals to promote exclusive breastfeeding and better maternal and child health.

Exclusive Breastfeeding Practice in Indonesia: A Population-Based Study.

BackgroundIt is a well-known fact that exclusive breastfeeding benefits both mothers and their babies. The aim of this study is to assess the associated factors influencing exclusive breastfeeding of babies until 6 months of age. MethodsThe study used data from the 2017 Indonesia Demographic and Health Survey. Overall, 1,542 women who had infants aged below 6 months were included in the study. Sociodemographic and maternal health service utilization factors were examined for association with exclusive breastfeeding, using logistic regression for a complex sample design. ResultsThe proportion of exclusive breastfeeding was 52.3% (95% confidence interval [CI], 0.498–0.548). Parity, antenatal care visits, early initiation of breastfeeding, low-income households, and rural areas were significant factors associated with the increased likelihood of exclusive breastfeeding. However, working status (adjusted odds ratio [aOR], 0.70; 95% CI, 0.57–0.86) and caesarean delivery or C-section (aOR, 0.75; 95% CI, 0.57–0.99) were factors for a lower likelihood of exclusive breastfeeding. ConclusionWorking women are at risk of discontinuation of exclusive breastfeeding. Mothers who had a normal vaginal delivery and practiced early initiation of breastfeeding had a higher rate of exclusive breastfeeding. These findings have important implications for developing comprehensive guidance and resources for women regarding the importance of exclusive breastfeeding during the early postpartum period.

Evaluation of an e-Learning Breastfeeding Program for Postpartum Mothers of Moderately High-Risk Newborn Infants Admitted to the Special Care Nursery.

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

LATCH Score at Discharge: A Predictor of Weight Gain and Exclusive Breastfeeding at 6 Weeks in Term Healthy Babies.

World Health Organization recommends exclusive breastfeeding (EBF) for 6 months after birth. However, problems with the baby failing to latch properly are common in the postpartum period contributing to breastfeeding cessation. The aim of the study was to evaluate the utility of LATCH score to predict EBF and weight gain at 6 weeks postpartum along with an optimum LATCH score cutoff. This prospective cohort study was conducted in India. Ninety-three mother-infant dyads at term gestation were enrolled. Two LATCH score assessments were done by a lactation consultant: first within 24 hours of birth and second at discharge. Mothers with low LATCH scores were counselled before discharge. EBF rate and weight gain velocity were analyzed at 6 weeks. LATCH score ≥6 at discharge has the highest sensitivity (92.1%) and specificity (66.7%) for predicting EBF at 6 weeks postpartum (RR, 95% CI; 5.63 [4.32-12.65], P = 0.0003). Receiver operating characteristic (ROC) of LATCH score at discharge and EBF at 6 weeks had an area under the curve of 0.785 with a cutoff ≥5.5, showing the highest sensitivity of 93.6% with a false-positive rate of 30.1%. LATCH score >6 at discharge was significantly associated with higher EBF rate (RR, 95% CI; 0.61 [0.39-0.94]) and appropriate weight gain (≥ 20 grams/day) at 6 weeks of age (RR, 95% CI; 0.44 [0.25-0.75]). After counselling, the LATCH score significantly improved at discharge in mothers (n = 62) with an initial score <6 (P < 0.001). LATCH score is a simple tool to identify mothers who require breastfeeding support and counselling before discharge from the hospital to prevent early breastfeeding cessation.