Higher Rates Of Exclusive Breastfeeding Research Articles

Duration, Pattern of Breastfeeding and Postnatal Transmission of HIV: Pooled Analysis of Individual Data from West and South African Cohorts

BackgroundBoth breastfeeding pattern and duration are associated with postnatal HIV acquisition; their relative contribution has not been reliably quantified.Methodology and Principal FindingsPooled data from 2 cohorts: in urban West Africa where breastfeeding cessation at 4 months was recommended but exclusive breastfeeding was rare (Ditrame Plus, DP); in rural South Africa where high rates of exclusive breastfeeding were achieved, but with longer duration (Vertical Transmission Study, VTS). 18-months HIV postnatal transmission (PT) was estimated by Kaplan-Meier in infants who were HIV negative, and assumed uninfected, at age >1 month. Censoring with (to assess impact of mode of breastfeeding) and without (to assess effect of breastfeeding duration) breastfeeding cessation considered as a competing event. Of 1195 breastfed infants, not HIV-infected perinatally, 38% DP and 83% VTS children were still breastfed at age 6 months. By age 3 months, 66% of VTS children were exclusively breastfed since birth and 55% of DP infants predominantly breastfed (breastmilk+water-based drinks). 18-month PT risk (95%CI) in VTS was double that in DP: 9% (7–11) and 5% (3–8), respectively (p = 0.03). However, once duration of breastfeeding was allowed for in a competing risk analysis assuming that all children would have been breastfed for 18-month, the estimated PT risk was 16% (8–28) in DP and 14% (10–18) in VTS (p = 0.32). 18-months PT risk was 3.9% (2.3–6.5) among infants breastfed for less than 6 months, and 8.7% (6.8–11.0) among children breastfed for more than 6 months; crude hazard ratio (HR): 2.1 (1.2–3.7), p = 0.02; adjusted HR 1.8 (0.9–3.4), p = 0.06. In individual analyses of PT rates for specific breastfeeding durations, risks among children exclusively breastfed were very similar to those in children predominantly breastfed for the same period. Children exposed to solid foods during the first 2 months of life were 2.9 (1.1–8.0) times more likely to be infected postnatally than children never exposed to solids this early (adjusted competing risk analysis, p = 0.04).ConclusionsBreastfeeding duration is a major determinant of postnatal HIV transmission. The PT risk did not differ between exclusively and predominantly breastfed children; the negative effect of mixed breastfeeding with solids on PT were confirmed.

Exclusive and any breast-feeding rates of Pacific infants in Auckland: data from the Pacific Islands Families First Two Years of Life study

To present current breast-feeding rates for Pacific infants resident in New Zealand. Reasons for the introduction of complementary liquid foods were also explored. A longitudinal study using hospital discharge summary records and maternal home interviews undertaken at 6 weeks, 12 and 24 months postpartum. Turnbull's non-parametric survival analysis was used to model exclusive breast-feeding rates. Auckland, New Zealand. The cohort comprised 1376 infants at 6 weeks, 1223 infants at 12 months and 1142 infants at 24 months. Exclusive breast-feeding rates at hospital discharge, 6 weeks, 3 and 6 months postpartum were 84% (95% confidence interval (CI): 80-88%), 49% (95% CI: 43-55%), 37% (95% CI: 32-42%) and 9% (95% CI: 7-11%), respectively. Significant ethnic difference existed, with Samoan mothers having higher exclusive breast-feeding rates than Tongan mothers (P = 0.002). The percentage of infants receiving any breast milk at hospital discharge, 6 weeks, 12 and 24 months was 96% (95% CI: 94-97%), 95% (95% CI: 94-96%), 31% (95% CI: 28-34%) and 15% (95% CI: 13-17%), respectively. Again ethnic differences emerged. Common reasons cited for discontinuation of exclusive breast-feeding included uncertainty of breast milk supply (56%), problems with breasts (30%) and difficulties breast-feeding in work or educational environments (26%). However, 691 (50%) mothers sought no advice about their breast-feeding concerns within the first six weeks of life. Exclusive breast-feeding rates for Pacific infants are ethnically heterogeneous, have declined since the 1990s and fall short of the World Health Organization recommendations. The principal reasons cited for exclusive breast-feeding discontinuation echo those reported over a decade ago.

Impact of the special training of community health workers on breastfeeding counselling and support in KwaZulu-Natal

Objectives. To evaluate the impact of special training of community health workers (CHWs) on breastfeeding counselling and support.Design. A cross-sectional, observational study.Setting. The study was conducted in the area serviced by the Thukela District Child Survival Project, Bergville, KwaZulu-Natal.Subjects. Mother-infant pairs (N = 95) visited by specially trained CHWs formed the intervention group and were compared with a control group of mother-infant pairs (N = 64) visited by normally trained CHWs. Both groups of CHWs had been trained in the integrated management of childhood illnesses (IMCI).Outcome measures. To test for significant differences between the intervention and control groups in exclusive breastfeeding (EBF), feeding of colostrum, withholding of prelacteals, infant growth and diarrhoeal disease rates.Results. EBF rates of 71.6% and 59.4% were found in the intervention and control groups respectively (p = 0.1). Both study groups showed higher rates of EBF compared with other areas in KwaZulu-Natal. The prevalence of feeding colostrum was 88.4% in the intervention and 92.2% in the control groups (p = 0.4). The prevalence of withholding prelacteals was 77% in the intervention and 86% in the control groups (p = 0.1). At the time of the interview, infants in both groups showed consistent growth (weight-for-age z-scores: intervention = 0.13, control = 0.18; p = 0.7). Diarrhoea prevalence did not differ significantly between study groups and varied from 7.5% (in the 7 days before interview, p = 0.1) to 16% (in the previous 3 months for infants . 3 months, p = 0.5).Conclusion. The special training did not have the anticipated impact on measured parameters. Training CHWs in IMCI was as effective as special training. If generally applied, the former may increase rates of EBF, improve infant growth and reduce the risk of diarrhoeal illness in South Africa.

Comparison of the effect of two systems for the promotion of exclusive breastfeeding

Promotion of breastfeeding is an important child-survival intervention, yet little is known about which promotional strategies are the most effective. We aimed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil--a hospital-based system and the same system combined with a programme of home visits. In February, 2001, maternity staff from two hospitals in Pernambuco, Brazil, were trained according to the Baby-Friendly Hospital Initiative (BFHI). In a randomised trial between March and August, 2001, 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding (n=175) or no home visits (n=175). Breastfeeding practices were studied on days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers unaware of group allocation. The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months. Analyses were by intention to treat. The hospital-training intervention achieved a high rate (70%) of exclusive breastfeeding in the hospitals, but this rate was not sustained at home and at 10 days of age only 30% of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10-180 differed significantly (p<0.0001), with a mean aggregated prevalence of 45% among the group assigned home visits compared with 13% for the group assigned none. The BFHI achieves high rates of exclusive breastfeeding in hospital; however, in Brazil at least, the rates fall rapidly thereafter. Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed. A combination of promotional systems (hospital-based and in the community) is needed.

Prevalence and determinants of exclusive breastfeeding during hospital stay in the area of Athens, Greece

To assess breastfeeding practices, focusing on the prevalence and the determinants of exclusive breastfeeding during hospital stay. A cross-sectional study of 1603 healthy women, who delivered healthy infants weighing more than 2500 g, was conducted in the area of Athens, Greece. Participants completed a self-administered questionnaire on the day they were discharged from the maternity ward. Classification of breastfeeding and recall period from birth to discharge were in accordance with the WHO criteria. Hierarchical logistic regression analysis was used to study determinants of exclusive breastfeeding initiation. Breastfeeding initiation was reported by 96.1% of the participants. However, exclusive breastfeeding was initiated only in 19.1% and predominant breastfeeding in 7.2% of the cases. The univariate analysis showed that maternal younger age, low educational level, unemployment, vaginal delivery, infant birthweight >3000 g, multiparity, early initiation of breastfeeding, rooming-in and awareness on the existence of breastfeeding centres were associated with higher rates of exclusive breastfeeding. Logistic regression analysis revealed that rooming-in (OR 3.72, p<0.01), demand feeding (OR 2.18, p<0.01), type of delivery (OR 1.61, p<0.01) and the source of information received about breastfeeding are more important determinants of exclusive breastfeeding than the socio-demographic parameters. Exclusive breastfeeding during hospital stay in the area of Athens is low. Demand feeding and rooming-in positively influence exclusive breastfeeding initiation, while caesarean section and information by mass media have a negative impact.

Prevalence and determinants of exclusive breastfeeding during hospital stay in the area of Athens, Greece

To assess breastfeeding practices, focusing on the prevalence and the determinants of exclusive breastfeeding during hospital stay.A cross-sectional study of 1603 healthy women, who delivered healthy infants weighing more than 2500 g, was conducted in the area of Athens, Greece. Participants completed a self-administered questionnaire on the day they were discharged from the maternity ward. Classification of breastfeeding and recall period from birth to discharge were in accordance with the WHO criteria. Hierarchical logistic regression analysis was used to study determinants of exclusive breastfeeding initiation.Breastfeeding initiation was reported by 96.1% of the participants. However, exclusive breastfeeding was initiated only in 19.1% and predominant breastfeeding in 7.2% of the cases. The univariate analysis showed that maternal younger age, low educational level, unemployment, vaginal delivery, infant birthweight >3000 g, multiparity, early initiation of breastfeeding, rooming-in and awareness on the existence of breastfeeding centres were associated with higher rates of exclusive breastfeeding. Logistic regression analysis revealed that rooming-in (OR 3.72, p<0.01), demand feeding (OR 2.18, p<0.01), type of delivery (OR 1.61, p<0.01) and the source of information received about breastfeeding are more important determinants of exclusive breastfeeding than the socio-demographic parameters.Exclusive breastfeeding during hospital stay in the area of Athens is low. Demand feeding and rooming-in positively influence exclusive breastfeeding initiation, while caesarean section and information by mass media have a negative impact.

Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory.

To estimate the attributable ACT hospital system costs of treating selected infant and childhood illnesses having known associations with early weaning from human milk. We identified relative risks of infant and childhood morbidity associated with exposure to artificial feeding in the early months of life vs. breastfeeding from cohort studies cited by the American Academy of Pediatrics in 1997 as establishing the protective effect of breastfeeding. Data for ACT breastfeeding prevalence is assessed from a 1997 prospective population-based cohort study of 1,295 women. ACT Hospital Morbidity Data and DRG treatment costs were used to estimate the attributable fraction of costs of hospitalisation for gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. Although initiation rates were high (92%), less than one in 10 ACT infants are exclusively breastfed for the recommended six months, mainly due to supplementation or weaning on to formula within the first three months and the early introduction of solids by breastfeeding mothers. This study suggests the attributable hospitalisation costs of early weaning in the ACT are about $1-2 million a year for the five illnesses. Early weaning from breastmilk is associated with significant hospital costs for treatment of gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. These costs are minimum estimates of the cost of early weaning as they exclude numerous other chronic or common illnesses and out-of-hospital health care costs. Higher rates of exclusive breastfeeding would reduce these costs. Interventions to protect and support breastfeeding are likely to be cost-effective for the public health system.

An intervention study using a breastfeeding positioning and attachment tool

Objective: To investigate whether the introduction of a systematic positioning and attachment checklist in the postnatal ward can improve breastfeeding outcomes. Design: A longitudinal quasi-experimental between-groups design. Setting: A large maternity unit within a British general hospital covering a variety of rural, urban and inner-city areas. Participants: A total of 122 women were recruited with no refusals, 60 to the control and 62 to the intervention phases of the study. All were singleton pregnancies, had not previously breastfed and intended to breastfeed. Intervention: A printed checklist, including diagrams, demonstrating effective positioning and attachment was used every time the women received breastfeeding support from any member of the postnatal ward staff. Measurements: Outcome data was collected by questionnaire at seven days and six weeks. Key outcome measures were method of feeding and degree of nipple pain. Findings: There were trends towards higher rate of exclusive breastfeeding and less nipple pain in the intervention group at both seven days and six weeks, but these differences were not statistically significant. Key conclusions: The findings merit further research with a larger sample, as it has the potential to provide a cost-effective way to improve breastfeeding outcomes.

Effect of Breastfeeding Peer Counseling on Initiation and Duration of Breastfeeding among Adolescent Mothers

A breastfeeding initiation rate of 75% is a goal established by Healthy People 2000. Adolescent mothers are among the least likely to breastfeed their infants, thereby reducing their chance of meeting this goal. Peer counseling is an effective way to correct misinformation and to encourage breastfeeding among adolescent mothers. This study tested the hypothesis that peer counseling increases the rate at which breastfeeding is initiated and maintained to 6 weeks postpartum among adolescent mothers. Fifty-eight pregnant adolescents were recruited from the Teen Mother and Child Program (TMCP) to participate in a prospective randomized intervention trial. Informed consent was obtained from all teens who were considering breastfeeding. Women were randomly assigned to either a peer counselor intervention group (n=29) or control group (n=29). Peer counselors (n=6) ranging in age from 17 to 24 were trained through the WIC Program. Intervention group participants met individually with peer counselors during a prenatal clinic visit and received education and support for breastfeeding. They were contacted by telephone at least weekly after the birth of their baby. Breastfeeding was initiated by 100% and 96% of the intervention and control participants respectively, and maintained to 6 weeks postpartum by 54% and 40% of intervention and control group participants, respectively. Overall, TMCP initiation rates of 86% were reported. Compared to TMCP data collected between 1991-1996 which reported a 70% initiation rate, these results suggest a 16% increase in overall initiation rate. Exclusive breastfeeding was practiced by 75% and 42% of intervention and control participants, (p<.01) at one week postpartum. No participants introduced solid food before 6 weeks of age. Although significant differences were not seen between the intervention and control groups, trends towards increased initiation and duration were observed. Significantly higher rates of exclusive breastfeeding were demonstrated by those young women who received peer counseling. Adolescents receiving peer counseling exceeded breastfeeding initiation rates established by Health People 2000 by 25%.

Breastfeeding Among Low-Income Women With and Without Peer Support

This research examined the effect of peer support on breastfeeding duration and exclusivity (breastfeeding without supplements) in a population of low-income women during the first 3 months postpartum. Participants in the peer counselor group (n = 18) exhibited higher rates of exclusive breastfeeding across time than those without a counselor (n = 18), and more exclusive breastfeeding was associated with longer duration overall.