Improve Breastfeeding Practices Research Articles

Improving breastfeeding support through the implementation of the baby friendly hospital and community initiatives: a scoping review protocol.

Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. Exclusively breastfeeding infants for the first six months would lead to the largest infant mortality reduction. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund (UNICEF), which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) is an extension of the BHFI's 10 th step of the Ten Steps to Successful Breastfeeding and of the BFHI overall. Its focus is on community-based breastfeeding supports for women. There have been no known attempts to synthesise the overall body of evidence on the BFHI in recent years, and no synthesis of empirical research on the BFCI. This scoping review asks the question: what is known about the implementation of the BFHI and the BFCI globally? Methods and analysis: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria will follow the Population, Concepts, Contexts approach. A data charting form will be developed and applied to all the included articles. Qualitative and quantitative descriptive analysis will be undertaken. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) methodological framework will be used to analyse and report review findings. Conclusion: This review will establish gaps in current evidence which will inform areas for future research in relation to this global initiative.

Improving breastfeeding support through the implementation of the baby friendly hospital and community initiatives: a scoping review protocol

Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. Exclusively breastfeeding infants for the first six months would lead to the largest infant mortality reduction. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund (UNICEF), which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) is an extension of the BHFI’s 10 th step of the Ten Steps to Successful Breastfeeding and of the BFHI overall. Its focus is on community-based breastfeeding supports for women. There have been no known attempts to synthesise the overall body of evidence on the BFHI in recent years, and no synthesis of empirical research on the BFCI. This scoping review asks the question: what is known about the implementation of the BFHI and the BFCI globally? Methods and analysis: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria will follow the Population, Concepts, Contexts approach. A data charting form will be developed and applied to all the included articles. Qualitative and quantitative descriptive analysis will be undertaken. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) methodological framework will be used to analyse and report review findings. Conclusion: This review will establish gaps in current evidence which will inform areas for future research in relation to this global initiative.

Breastfeeding Education and Support to Improve Early Initiation and Exclusive Breastfeeding Practices and Infant Growth: A Cluster Randomized Controlled Trial from a Rural Ethiopian Setting.

Although peer-led education and support may improve breastfeeding practices, there is a paucity of evidence on the effectiveness of such interventions in the Ethiopian context. We designed a cluster-randomized trial to evaluate the efficacy of a breastfeeding education and support intervention (BFESI) on infant growth, early initiation (EI), and exclusive breastfeeding (EBF) practices. We randomly assigned 36 clusters into either an intervention group (n = 249) receiving BFESI by trained Women’s Development Army (WDA) leaders or a control group (n = 219) receiving routine care. The intervention was provided from the third trimester of pregnancy until five months postpartum. Primary study outcomes were EI, EBF, and infant growth; secondary outcomes included maternal breastfeeding knowledge and attitude, and child morbidity. The intervention effect was analysed using linear regression models for the continuous outcomes, and linear probability or logistic regression models for the categorical outcomes. Compared to the control, BFESI significantly increased EI by 25.9% (95% CI: 14.5, 37.3%; p = 0.001) and EBF by 14.6% (95% CI: 3.77, 25.5%; p = 0.010). Similarly, the intervention gave higher breastfeeding attitude scores (Effect size (ES): 0.85SD; 95% CI: 0.70, 0.99SD; p < 0.001), but not higher knowledge scores (ES: 0.15SD; 95% CI: −0.10, 0.41SD; p = 0.173). From the several growth and morbidity outcomes evaluated, the only outcomes with significant intervention effect were a higher mid-upper arm circumference (ES: 0.25cm; 95% CI: 0.01, 0.49cm; p = 0.041) and a lower prevalence of respiratory infection (ES: −6.90%; 95% CI: −13.3, −0.61%; p = 0.033). Training WDA leaders to provide BFESI substantially improves EI and EBF practices and attitude towards breastfeeding.

Improving breastfeeding support through the implementation of the baby friendly hospital and community initiatives: a scoping review protocol

Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. Exclusively breastfeeding infants for the first six months would lead to the largest infant mortality reduction. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund (UNICEF), which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) is an extension of the BHFI’s 10th step of the Ten Steps to Successful Breastfeeding and of the BFHI overall. Its focus is on community-based breastfeeding supports for women. There have been no known attempts to synthesise the overall body of evidence on the BFHI in recent years, and no synthesis of empirical research on the BFCI. This scoping review asks the question: what is known about the implementation of the BFHI and the BFCI globally? Methods and analysis: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria will follow the Population, Concepts, Contexts approach. A data charting form will be developed and applied to all the included studies. Qualitative and quantitative descriptive analysis will be undertaken. In order to address equity of access to the BFHI/BFCI, the Levesque et al. (2013) access to health care framework will be used as a lens to analyse the charted data in relation to this aspect of the review. An already established group of stakeholders with experience of infant feeding policy and implementation in Malawi will be consulted, to obtain expert views on the findings of the scoping review. Conclusion: This review will establish gaps in current evidence which will inform areas for future research in relation to this global initiative.

Prevalence of prelacteal feeding and associated risk factors in Indonesia: Evidence from the 2017 Indonesia Demographic Health Survey

Prelacteal feeding (PLF) is a recognised challenge to optimal breastfeeding but remains common in Indonesia. Meanwhile, PLF-related epidemiological research is limited, particularly in this setting. This study examines the prevalence and determinants of overall PLF as well as common PLF types (formula, other milk, and honey) in Indonesia. Data from 6127 mothers whose last child was ≤23-month-old were drawn from the 2017 Indonesia Demographic and Health Survey. Multivariable modified Poisson regression was used to measure the prevalence ratio (PR) for selected PLF risk factors. PLF was defined as anything to drink other than breast milk within three days after birth, before breastmilk flows. Additional analyses were performed on mothers who gave formula, other milk, and honey. About 45% babies in Indonesia received PLF with formula being the most frequent (25%), followed by other milk (14%), plain water (5%), and honey (3%). Factors associated with higher prevalence of any PLF were higher wealth quintiles in rural area (PR 1.07; 95% CI 1.03-1.11 per increase in quintile), baby perceived to be small at birth (PR 1.23; 95% CI 1.12-1.35), caesarean deliveries at either public (PR 1.27; 95% CI 1.13-1.44) or private facilities (PR 1.15; 95% CI 1.01-1.31), and not having immediate skin-to-skin contact after birth (PR 1.32; 95% CI 1.23-1.42). PLF was less prevalent among mothers who gave birth to second/subsequent child (PR 0.82; 95% CI 0.76-0.88) and who had an antenatal card (PR 0.89; 95% CI 0.80-0.99). These patterns did not apply uniformly across all PLF types. For example, honey was more common among home births than deliveries at health facilities, but formula and other milk were more common among caesarean deliveries. Mapping risk factors for PLF, especially by types, could help to design more targeted interventions to reduce PLF and improve breastfeeding practices in Indonesia.

Improving Breastfeeding Practices: The Role of Community Breastfeeding Guardians (BFGs) in Lagos State

Abstract Objectives Research by the Alive &amp; Thrive Program (A&amp;T) in Nigeria to demonstrate that repeated exposures of pregnant women and mothers of infants to Breastfeeding Guardian (BFG) services - including counseling, home visits and problem solving – led to improvements in breastfeeding (BF) practices in intervention communities. Methods BFGs comprise community influencers such as teachers, religious leaders, and community health workers. BFGs were engaged, trained and equipped by A&amp;T to support pregnant women and lactating mothers with key messages at critical decision-making points about: ANC, breastfeeding management, early initiation of BF in the first hour of birth (6 contacts in 3rd trimester); and exclusive BF (EBF) including problem-solving (6 contacts in first six months). The intervention lasted 12 months and included counseling of pregnant women and home visit support for newly delivered mothers. Assessments of EI and EBF rates were conducted in 40 health facilities (HF) using Alive &amp; Thrive routine project data comparing rates pre and post BFG deployment. Key Informant Interviews (KII) were also conducted with pregnant women in their 3rd trimester and post-delivery with the same cohort targeting women with infants 4–8 months. Results EI rates improved from 72% to 93% while EBF rates improved from 67% to 84% across the 40 health facilities. Findings from KIIs indicated that support mothers received through the BFGs, such as home visits, were perceived to be helpful in preparing women for breastfeeding exclusively and managing challenges associated with feeding newborns. Fifty-three of 60 mothers interviewed said they were able to exclusively breastfeed for 6 months, and their infants had no cause to visit the clinic for treatment of any illnesses. Conclusions Repeated contacts by BFGs to support pregnant women and breastfeeding mothers at the community level could be effective in improving breastfeeding practices. It can also serve as a viable way of bridging the skilled health attendant gap in underserved communities. It would be interesting to observe how beneficial the BFGs innovation would be on a larger scale and longer term. Funding Sources The Bill and Melinda Gates Foundation.

Enhancing Connections and Providing Support to Improve Breastfeeding Practices in Benin

Abstract Objectives To measure the impact of a community-based approach in improving breastfeeding practices in Benin. Methods Pregnant and lactating women participated in monthly peer support group sessions and received household counseling. Husbands were engaged in couples counseling to improve household communication and decision making. Leadership groups (elder women, religious and traditional leaders) were established to promote optimal breastfeeding practices during household visits, traditional ceremonies and religious services. Women were counseled by midwives and breastfeeding counselors during antenatal and post-natal visits. Key decision makers from national to village level were engaged to ensure buy-in and alignment with national policies. A final evaluation was carried out in villages representing the Bariba, Peulh, and Nateni ethnic groups. Study participants were a convenience sample of the project beneficiaries and health and nutrition administrative offices. Using a mixed methods approach, Focus Group Discussions and Key Informant Interviews were selected for qualitative methods, while a survey was used for quantitative methods. Results There were substantial increases in adoption of early initiation and exclusive breastfeeding (18% and 34%, respectively). Knowledge of the benefits of colostrum and breastmilk improved among a wide range of project beneficiaries. Protecting the infant's health, increased intelligence of the infant, and healthier relationships between men and women were common motivations for adopting these practices. Traditional practices of discarding colostrum, and provision of herbal tea, water and porridge to supplement breastmilk were reduced. Barriers and enablers such as workload burden, illness and hunger of the mother, and traditional feeding practices, and support provided through the various project platforms, were identified. Conclusions A multi-pronged community-based approach can increase adoption of early initiation and exclusive breastfeeding practices. Engaging household influencers (husbands, grandmothers) and community leadership (traditional and religious leaders, community volunteers, health workers), coupled with engaging key decision makers (national, district and commune leadership) was key to the success. Funding Sources Catholic Relief Services.

Community-Based Management of Acute Malnutrition in Infants Under 6 Months of Age

Abstract Objectives To examine the outcomes of acutely malnourished infants under 6 months (u6m) who could not be hospitalized or exclusively breastfed and were instead treated under the community management of acute malnutrition (CMAM) model using ready to use therapeutic food (RUTF) or a supplemental food. Methods The study was a retrospective chart review of 323 infants u6m with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) seen across 20 CMAM clinics in rural southern Malawi who could not be admitted to inpatient care, which is the established standard of care for acute malnutrition in infants u6m. Infants with SAM were given 175 kcal/kg/day of RUTF and those with MAM were given 75 kcal/kg/day RUTF or supplemental food, based on availability. Nutritional counseling was provided to the caregivers of all participants, and mothers were counseled about improved breastfeeding practices. Infants were reassessed every two weeks. Outcomes included successful nutritional recovery (achieving WHZ of ≥−2 without edema), failure to achieve recovery after 12 weeks, hospitalization, death, and loss to follow up. Demographic information was also collected. Continuous variables were compared using Student's t test. Categorical variables were compared using Fisher's exact test. Results 130 infants u6m with SAM and 193 with MAM were treated using the same CMAM model used in 6–59 month-old children. About 90% of children in both groups were breastfeeding. Mean duration of therapy was 31.5 days for SAM and 20.8 days for MAM. Recovery rates were high in both groups (SAM 75%; MAM 81%). Recovery rates and other outcomes were similar to older children who were being treated contemporaneously at the same sites in the context of randomized clinical trials. Conclusions When inpatient care is not possible, therapeutic and supplementary foods provided to infants u6m with acute malnutrition is a viable treatment option. Making this option available has the potential to massively scale up the number of infants treated, with acceptable recovery rates, and at a relatively low cost to the health care system. Funding Sources None.

Are we doing enough? Improved breastfeeding practices at 14\u2009weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa

BackgroundKwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period.MethodsTwo cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13- < 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points.ResultsAt KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January–August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion exclusively breastfeeding was 44.6 and 50.5% (p = 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p = 0.02). There were reductions in mixed breastfeeding among all infants (23.2% vs 16.3%; p = 0.016). Although there was no change in the proportion of carers who reported not breastfeeding (31.9% vs 32.8%; p = 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p = 0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (adjusted odds ratio [AOR] 3.76; 95% CI 3.1–4.6), as were HIV positive mothers (AOR 2.1; 95% CI 1.7–2.6).ConclusionDespite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.

Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study

IntroductionThe early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast...

The Effect of Health Worker Training on Early Initiation of Breastfeeding in South Sudan: A Hospital-based before and after Study

Globally, suboptimal breastfeeding contributes to more than 800,000 child deaths annually. In South Sudan, few women breastfeed early. We assessed the effect of a Baby-Friendly Hospital Initiative training on early initiation of breastfeeding at Juba Teaching Hospital in South Sudan. We carried out the training for health workers after a baseline survey. We recruited 806 mothers both before and four to six months after training. We used a modified Poisson model to assess the effect of training. The prevalence of early initiation of breastfeeding increased from 48% (388/806) before to 91% (732/806) after training. Similarly, early initiation of breastfeeding increased from 3% (3/97) before to 60% (12/20) after training among women who delivered by caesarean section. About 8% (67/806) of mothers discarded colostrum before compared to 3% (24/806) after training. Further, 17% (134/806) of mothers used pre-lacteal feeds before compared to only 2% (15/806) after training. Regardless of the mode of birth, the intervention was effective in increasing early initiation of breastfeeding [adjusted prevalence ratio (APR) 1.69, 95% confidence interval CI (1.57-1.82)]. These findings suggest an urgent need to roll out the training to other hospitals in South Sudan. This will result in improved breastfeeding practices, maternal, and infant health.

Breastfeeding advice for reality: Women's perspectives on primary care support in South Africa.

Breastfeeding education and support are critical health worker skills. Confusion surrounding infant feeding advice linked to the HIV epidemic has reduced the confidence of health workers to support breastfeeding. High antiretroviral therapy coverage of breastfeeding women living with HIV, and an Infant Feeding policy supportive of breastfeeding, now provides an opportunity to improve breastfeeding practices. Challenges remain in restoring health worker confidence to support breastfeeding. This qualitative study presents findings from focus group discussions with mothers of young infants, exploring their experiences of health worker breastfeeding counselling and support. Analysis followed the thematic framework approach. Six researchers reviewed the transcripts, coded them independently, then jointly reviewed the codes, and agreed on a working analytical framework. Although mothers received antenatal breastfeeding messages, these appeared to focus rigidly on the importance of exclusivity. Mothers described receiving some practical support with initiation of breastfeeding after delivery, but support and advice for post‐natal breastfeeding challenges were often incorrect or absent. The support also ignored the context in which women make infant feeding decisions, including returning to work and pressures from family members. Despite improved breastfeeding policies, restoring confidence in health workers to support breastfeeding remains a challenge. The post‐natal period, when mothers experience breastfeeding difficulties, is particularly critical, and our findings reinforce the importance of continuity of care between communities and health facilities. This research has implications for how health workers are trained to support breastfeeding. Greater attention is needed on developing skills and confidence in identifying, assessing, and supporting women experiencing breastfeeding challenges.

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.

Demand for Lactation Leads to Flowing Supply of Success: Support Requested from States to Improve Breastfeeding Practices.

Demand for Lactation Leads to Flowing Supply of Success: Support Requested from States to Improve Breastfeeding Practices.

Breastfeeding exclusivity and duration: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015.

BackgroundBrazil has made substantial improvements in the duration of breastfeeding. We use data from four population-based cohorts to examine how trends and inequalities in breastfeeding indicators changed over time in a Brazilian city.MethodsData from four birth cohorts, each including all births in a calendar year (1982, 1993, 2004 and 2015) in the city of Pelotas were used. Information on breastfeeding was collected when children were aged between 3 and 20 months. The prevalences of continued breastfeeding at 1 year of age and of exclusive breastfeeding at 3 months were calculated according to family income, maternal skin colour and sex.ResultsPrevalence of breastfeeding at 12 months increased from 16% to 41% in the 33-year period. The prevalence of exclusive breastfeeding at 3 months increased from 7% in 1993 to 45% in 2015. Increases in exclusive breastfeeding at 3 months were seen in all socioeconomic groups, but the 2015 rates remain highest (57.2%) among the women in the richest quintile, and lowest among those in the poorest quintile (34.6%). Black mothers were more likely to breastfeed at 12 months than Whites in the four cohorts. In the earlier cohorts, breastfeeding at 12 months was more common among the poor, but by 2015 these differences had disappeared.ConclusionsThere were important positive changes in breastfeeding practices during this period, but less than half of the children in 2015 were receiving the full benefits of breast milk. Improved breastfeeding practices are being adopted by high-income women to a greater extent than by poor women.

Early Breastfeeding Cessation Among HIV-Infected and HIV-Uninfected Women in Western Cape Province, South Africa.

As part of the Mother-Infant Health Study, we describe infant feeding practices among HIV-infected and HIV-uninfected mothers over a 12-month period when the Western Cape Province prevention of mother-to-child transmission (PMTCT) program was transitioning from a policy of exclusive formula feeding to one of exclusive breastfeeding. Two hundred pairs of mother and HIV-uninfected infant were included in the analysis, among whom 81 women were HIV uninfected and breastfeeding. Of the 119 HIV-infected mothers, 50 (42%) were breastfeeding and 69 (58%) were formula feeding. HIV-infected mothers predominantly breastfed for 8.14 (7.71-15.86) weeks; HIV-uninfected mothers predominantly breastfed for 8.29 (8.0-16.0) weeks; and HIV-infected mothers predominantly formula fed for 50.29 (36.43-51.43) weeks. A woman's HIV status had no influence on the time to stopping predominant breastfeeding (P = 0.20). Our findings suggest suboptimal duration of breastfeeding among both HIV-infected and HIV-uninfected mothers. Providing support for all mothers postdelivery, regardless of their HIV status, may improve breastfeeding practices.

Breastfeeding experience, challenges and service demands among Chinese mothers: A qualitative study in two cities

Breastfeeding rates remain low in China despite decades of efforts at improving breastfeeding practices. The study aimed to explore mothers' breastfeeding experience throughout the breastfeeding period and to understand their challenges and support service needs at each stage. Qualitative research methods, individual in-depth interviews and focus group discussions were carried out with mothers and people who played various roles regarding breastfeeding such as service provider, researcher and policy maker. Mothers' breastfeeding practices can be categorized into five stages. In the ‘preparatory stage’, pregnant women had high intention towards breastfeeding but had inadequate knowledge and skills preparation. In the ‘initial stage’ in hospital for childbirth, mothers received inadequate support from hospital professionals due to the short hospital stay. In the ‘self-exploratory stage’ after being discharged from hospital, mothers mostly relied on non-professionals’ support. In the ‘transitional stage’ between four and six months postpartum, most mothers gave up exclusive breastfeeding due to the lack of a supportive environment at workplace. At the ‘complementary feeding stage’, most mothers stopped breastfeeding and switched to formula between six and 12 months for reasons such as perceived non-nutritious value of breast milk after six months, returning to work, desiring returning to former lifestyle. This study shows that mothers encounter different problems and have specific needs for support at different stages of breastfeeding. Tailored support could be provided to encourage exclusive breastfeeding for the first six months and continued breastfeeding for up to 2 years.

Improved rates of exclusive breastfeeding at 14\xa0weeks of age in KwaZulu Natal, South Africa: what are the challenges now?

BackgroundIncreasing the rate of exclusive breastfeeding (EBF) to 50% in the first six months of life is one of six major global targets set by the United Nations Decade of Nutrition, and is essential to achieve the sustainable development goals to eradicate hunger and end malnutrition by 2030.MethodsA survey using multistage random sampling design included 99 primary health care (PHC) clinics in all 11 districts in KwaZulu-Natal (KZN). All mothers and caregivers of infants 14 weeks of age attending the clinics in the study period were requested to participate in a structured interview to explore feeding practices since birth. As non-maternal caregivers may not have detailed knowledge of feeding practices, they provided limited information about current feeding practices. Respondents who consistently reported giving no other food or fluids except breastmilk since birth were classified as practising exclusive breastfeeding (EBF), and those who were currently breastfeeding but had given other food or fluids since birth were categorised as practising mixed breastfeeding (MBF).ResultsA total of 4172 interviews were conducted with mothers and caregivers of 14 week old infants. Among mothers 49.8% were EBF, 23.1% were MBF and 27.0% were not breastfeeding. Among non-maternal caregivers 11.8% reported EBF, 23.4% MBF and 62.3% were not giving breastmilk. Higher education (OR 0.6, 95% CI 0.4–0.8) and being in the highest socio-economic tertile (OR 0.7, 95% CI 0.6–0.9) were risk factors for not practising EBF, while returning to work (OR 0.3, 95% CI 0.2–0.3) or school (OR 0.2 95% CI, 0.1–0.3) was associated with less EBF. HIV-positive mothers were more likely to have never started breastfeeding (OR 3.6, 95% CI 2.7–4.8). However, they were similar in having stopped breastfeeding by 14 weeks (OR 1.1, 95% CI 0.9–1.4) compared to HIV-negative mothers, and, they had similar rates of EBF at 14 weeks of age (OR 1.0, 95% CI 0.9–1.3).ConclusionsEstimates of breastfeeding practices at 14 weeks in KZN are higher than previously shown. However, particular challenges that should be addressed if international targets for EBF are to be achieved include improving breastfeeding practices of HIV positive mothers and supporting all mothers, particularly working or schooling mothers to continue giving breastmilk while they are away from their children.

Engaging men to promote and support exclusive breastfeeding: a descriptive review of 28 projects in 20 low- and middle-income countries from 2003 to 2013

BackgroundLay support has been associated with improved breastfeeding practices, but studies of programs that engage men in breastfeeding support have shown mixed results and most are from high-income countries. The purpose of our research is to review strategies to engage men in exclusive breastfeeding (EBF) promotion or support in 28 project areas across 20 low- and middle-income countries. This information may be used to inform program implementers and policymakers seeking to increase EBF.MethodsWe tested the difference between baseline and final EBF proportions using Pearson’s chi-square (a = 0.05) and identified project areas with a significant increase. We categorized male engagement strategies as low- and high-intensity, using information from project reports. We looked for patterns by intensity and geography and described strategies used to engage men in different places.ResultsTwenty-eight projects were reviewed; 21 (75%) were in areas where a statistically significant increase in EBF was observed between the beginning and end of the project. A variety of high- and low-intensity male engagement strategies was used in areas with an increase in EBF prevalence and in all geographic regions. High-intensity strategies engaged men directly during home or health visits by forming men’s groups and by working with male community leaders or members to promote EBF. Low-intensity strategies included large community meetings that included men, and radio messages, and other behavior change materials directed towards men.ConclusionMale engagement strategies took many forms in these project areas. We did not find consistent associations between the intensities or types of male engagement strategies and increases in EBF proportions. There is a gap in understanding how gender norms might impact male involvement in women’s health behaviors. This review does not support the broad application of male engagement to improve EBF practices, and we recommend considering local gender norms when designing programs to support women to EBF.

Improving Breastfeeding Practices at the Community Level: Result from Sinazongwe District, Zambia

Improving Breastfeeding Practices at the Community Level: Result from Sinazongwe District, Zambia