Improve Infant Feeding Practices Research Articles

Evaluating the Relationship Between Maternal Postpartum Depression, Infant Feeding Practices, and Infant Nutritional Status at a Maternity Hospital in Uasin Gishu County, Kenya

Postpartum depression is a major maternal mental problem that has been shown to contribute to malnutrition in infants. This cross-sectional study explores the association between maternal postpartum depression (PPD) and infant feeding practices as well as infant nutritional status among infants aged 6-14 weeks at Eldoret West Maternity Hospital (EWMH) in Uasin Gishu County, Kenya. The study involved 257 women of reproductive age with infants aged 6-14 weeks postpartum attending postnatal and maternal and child health clinics at EWMH. Data was collected using a modified Edinburgh Postnatal Depression Scale (EPDS) to screen for PPD and other questionnaires to gather sociodemographic information, feeding practices, and infant nutritional status. Multivariate logistic regression analyses were conducted to assess associations between maternal PPD, infant feeding practices, and nutritional status. The prevalence of maternal PPD was 17.5%, with 1 in 6 mothers affected. Exclusive breastfeeding was practiced by 94.6% of mothers, exceeding the national level of 60%. Mothers with PPD were more likely to practice nonexclusive breastfeeding and were 1.4, 1.8, and 1.6 times more likely to have stunted, wasted, and underweight infants respectively than mothers without PPD though the association was not statistically significant after adjusting for confounders.Maternal PPD is prevalent among mothers at EWMH and is more likely to influence infant feeding practices particularly non-exclusive breastfeeding and nutritional status. Stunting, wasting and underweight were prevalent in infants of mothers with PPD. These findings underscore the importance of integrating mental health and nutritional support services for mothers and infants in maternal healthcare settings. Early identification and intervention for maternal PPD can help improve infant feeding practices and nutritional outcomes, promoting the well-being of both mothers and their infants.

Perceptions of Adolescent Mothers on Feeding and Nutrition of their Children aged 0-3 Years in Rural Bangladesh

Proper feeding practices at an early age are the key to improving a child’s overall health and achieving developmental milestones. In Bangladesh, a large portion of rural girls become mothers before the age of 18. Past records show that most interventions are designed to improve infant and young child feeding practices targeting older mothers. That is why, this study has been designed with an aim to explore the perceptions and practices of infant and young children feeding among rural Bangladeshi mothers aged <19 years old. Data was collected through in-depth interviews and group discussions with a total of 40 adolescent mothers who have children aged 0-3 years. Data has revealed that the majority of the mothers hold very limited knowledge of nutrition and child nutrition but those who are educationally a bit ahead hold a little better knowledge. Participants are aware of breastfeeding but they all misinterpret the term ‘exclusive breastfeeding’ with other liquid food. It has also emerged that most of the mothers know the ideal timing of starting complementary feeding but very few of them actually understand what to feed children. In spite of having misconceptions and superstation rural adolescent mothers practice responsive feeding instead of force-feeding. No gender discrimination has been found regarding child feeding. The findings of the study pinpointed that mothers are unable to practice proper infant and child feeding due to a lack of knowledge and limited affordability. Educating girls & young mothers and improving financial security could be an effective way to promote improved infant feeding practices.

The Baby Bites Text Messaging Project with randomized controlled trial: texting to improve infant feeding practices.

Rapid weight gain and overweight in infancy are associated with childhood obesity. Thus, effective, accessible interventions to promote healthy infant feeding practices to prevent early obesity are essential. This mixed-methods study involved diverse parents of infants in an urban, low-income pediatric clinic. Qualitative interviews explored parental attitudes towards feeding, early obesity, and communication with the pediatrician. A pilot, randomized controlled trial (RCT) informed by feedback provided by clinic parents compared text messages delivered for 12 months promoting healthy feeding practices to usual care to prevent early pediatric obesity. A computer-generated randomization schedule with balanced distribution for sex was used to place infants into groups. Weight-for-length percentiles and z-scores and feeding practices were measured at 0-2 weeks (baseline), 2-4 months, 6-9 months, and 12 months. Interviews were recorded, transcribed, and coded using thematic analysis. Weight for length percentile, Weight for length z scores, and feeding practices were compared between groups using repeated measures mixed analysis of variance (ANOVA). Participants in the interviews were 15 parents of infants less than 1 month old. RCT participants were 38 parents of newborns (17 control; 21 intervention). Most parents in the qualitative evaluation viewed breastfeeding positively but also discussed barriers. Most also wanted practical information regarding infant feeding. There were no differences in weight-for-length percentile (F=0.52; P=0.60) or z-scores (F=0.7922; P=0.79), breastfeeding persistence χ2[1] =1.45, P=0.23, or age of introduction of solids in the intervention (statistical analysis not possible due to low counts) compared to the control group; however, low response to surveys limited the study's power. Text messaging has potential to extend the healthcare provider's communication beyond clinic. However, texting interventions should be flexible to mitigate barriers such as loss of phone service and challenges customizing messages to parent needs.

P088 A Feasibility Trial of an Asynchronous Web-based Infant Feeding Course for Child and Adult Care Food Program Providers

<h3>Background</h3> The Child and Adult Care Food Program (CACFP) provides meals and snacks to children at eligible, participating locations. Previous nutrition interventions for providers presented improved knowledge of CACFP nutrition standards, behavioral intentions, and confidence about feeding practice. However, few studies focusing on infant feeding for providers have been reported. <h3>Objective</h3> To describe the development and implementation of an asynchronous virtual training course aiming to improve infant feeding practices of providers and report program outcomes. <h3>Study Design, Settings, Participants</h3> This study was a single group, pretest-posttest quasi-experimental design. A three-module course was developed and implemented through a partnership between the State Department of Education and an Extension system. Each module consisted of 2-3 sessions and was offered through the Canvas platform. Providers completed pre-survey (n = 51) and/or post-survey (n = 57), respectively. Participants (n = 32) who completed both were included for analysis. <h3>Measurable Outcome/Analysis</h3> Self-confidence and knowledge related to infant feeding were measured. Recommended changes were assessed qualitatively. Descriptive statistics and a marginal homogeneity test were used for analysis. <h3>Results</h3> Approximately 37% of participants were teachers and 24% were center directors or owners. After the course, participants' self-confidence significantly improved (<i>P</i> <0.001). In particular, they became very confident in describing breast milk storage (<i>P =</i> 0.001), when a child should switch from a bottle to a cup (<i>P =</i> < 0.001), and when a baby is ready to start eating solid foods (<i>P =</i> < 0.001). Also, participants significantly improved knowledge of infant feeding (<i>P</i> < 0.001). Qualitative responses emphasized the importance of educating staff to feed in response to hunger cues, rather than at set times. The participants mentioned that providing refresher training, and posting signage about breast milk and formula feeding and storage guidelines in classrooms would be beneficial. Constant communication with families was perceived to be important as well. <h3>Conclusions</h3> An asynchronous virtual training course implemented through an Extension was feasible and effective for improving self-efficacy and knowledge related to infant feeding. It also has potential for program sustainability. <h3>Funding</h3> USDA; US Department of Agriculture Child and Adult Care Food Program Meal Service Training Grant through the Maryland State Department of Education.

Influences on Infant Feeding Practices: An Ecological Perspective

Nutrition in infancy contributes to a significant portion on the notion of the importance of nutrition during the first 1000 days of life. A vast pool of literature exists on the importance of nutrition during this phase of life with future diseases, obesity and mental health. However, despite the availability of many guidelines and policies revolving around infant feeding practices, adherence to it remains poor. This review explains factors that influence infant feeding practices from an ecological point of view. A Bronfenbrenner ecological model was used to argue the influence and interaction of various ecological factors on infant feeding practices. The review highlights that the way these factors affect infant feeding differs according to populations and settings. This review suggests the need for more robust and population sensitive interventions to improve infant feeding practices globally.

Infant feeding, growth monitoring and the double burden of malnutrition among children aged 6 months and their mothers in KwaZulu-Natal, South Africa.

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual‐, household‐ or population level, has implications for both health and the economic development of a community and country. This paper describes a large‐scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu‐Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children.

Minimum acceptable diet among children aged 6\u201323\u2009months in South Kivu, Democratic Republic of Congo: a community-based cross-sectional study

BackgroundSuboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6–23 months old.MethodsCommunity-based cross-sectional study including 742 mothers with children aged 6–23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis.ResultsOverall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet.ConclusionActions targeting these factors are expected to improve infant feeding practices in South Kivu.

The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study

BackgroundMaternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index.MethodsThis study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors.ResultsReports of higher postnatal depressive symptoms (ß = − 1.03, P = 0.001) and IPV (ß = − 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index.ConclusionsOverall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.

Breastfeeding practices after a counselling intervention for factory workers in Bangladesh.

Breastfeeding may be particularly challenging for female factory workers who have long working hours and inadequate access to health information and care. In Chattogram, Bangladesh, a peer counselling intervention was undertaken to improve infant feeding practices of factory workers. Counselling started during pregnancy and continued until children were 18 months old. This article presents the results of a cross‐sectional survey undertaken during 2 weeks in March–April 2017, after the project's conclusion. The aim was to compare breastfeeding practices, specifically early breastfeeding initiation and exclusive breastfeeding (EBF), among factory workers who had received peer counselling in the intervention areas (IA) with those of non‐counselled factory workers in the nearby comparison areas (CA). Six female interviewers, trained over 3 days, conducted interviews at the workers' homes. Data were analysed to assess the association of peer counselling with infant feeding practices. Factory workers (N = 382) with infants between 0 and 18 months of age participated in the survey, in IA (n = 188) and in CA (n = 194). Although there were more health facility deliveries among the CA workers, only 43 (22%) of those workers had initiated breastfeeding within 1 h of birth versus 166 (88%) of the IA workers (p < .001). EBF prevalence on 24‐h recall in infants aged 0–6 months was only 7/83 (8%) for the CA workers versus 73/75 (97%) for IA workers (p < .001). The survey showed that breastfeeding practices of factory workers in the IA after the intervention were significantly better than those of factory workers in the CA.

Breastfeeding and complementary feeding practices in Mexico: results from Ensanut 2018-19

To update the prevalence of infant and young child feeding indicators (IYCFI) in children under 24 months in Mexico. Ensanut 2018-19 national representative survey with probabilistic design. Popu-lation: Women 12-59 years and their children <24 months. The indicators proposed by the World Health Organization were assessed by sociodemographic variables of the mothers using the sample design. Wald's test was used to compare between categories. The prevalence of exclusive breastfeeding in children under six months was 28.3%, 42.9% of children under 12 months consumed infant formula and 29% continued breastfeeding at two years. Around 30% of children between 6 and 11 months did not meet the recom-mended minimum dietary diversity and only 49.4% consumed iron-rich foods. There are improvements in breastfeeding practices in Mexico, although the figures are low. The coordinated contribution from all sectors of society is required to improve infant feeding practices.

Exploring how and why Care Groups work to improve infant feeding practices in low- and middle-income countries: a realist review protocol

BackgroundWithin our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The ‘Care Group model’ is an approach primarily used in international development settings, whereby social and behaviour changes are promoted through supported peer-to-peer (mostly mother-to-mother) knowledge sharing. The aim of most Care Groups is to promote improved infant nutrition, improve hygiene and increase the number of children who are fully vaccinated and exclusively breastfed for the first 6 months. The behavioural changes promoted by Care Groups (such as safe infant feeding, frequent hand washing, consistent mosquito net usage, providing suitable complementary foods from 6 months old) have the potential of averting preventable deaths particularly among children under five.While a variety of approaches are used to promote improved health and nutrition for children under five, the Care Groups model was best known and frequently referenced during our discussions with key stakeholders regarding the delivery at community level of Malawi’s National Multi-Sector Nutrition Policy 2018-2022. A better understanding of how Care Groups achieve their social and behaviour change results and how community-based efforts are sustained can potentially help to ensure more effective planning and budgeting for Care Group interventions and enable greater sustainability and increased coverage of infant feeding support countrywide. This realist review is designed to improve our understanding of how, why, to what extent and under what circumstances Care Groups improve infant feeding practices in low- and middle-income countries (LMICs).Methods and analysisA realist review is a theory-driven approach to evidence synthesis. To undertake this realist review, we will gather evidence by conducting peer-reviewed and grey literature database searches in order to find peer reviewed articles, programme guidelines and evaluation reports, among other texts, associated with the implementation of Care Groups in low- and middle-income countries. Our review process has five key steps: (1) locating existing theories; (2) searching for evidence in literature; (3) selecting articles and other suitable evidence; (4) extracting data, identifying configurations of context-mechanism-outcomes; and (5) synthesising the evidence, drawing conclusions.DiscussionThe results of this realist review will be written up according to RAMESES guidelines and disseminated through a stakeholder workshop in Malawi, through conference presentations and peer-reviewed publications. It is intended to improve the understanding of the potential and limits of working through Care Groups globally and among relevant Malawi Ministry of Health staff and the donor and NGO community, both internationally and within Malawi. This systematic review protocol has been submitted for registration on the PROSPERO database (receipt number: 170261).

Effectiveness of an educational manual to promote infant feeding practices in primary health care

Abstract Background Breastfeeding and adequate complementary feeding in the first years of life provide short- and long-term benefits for child health. However, breastfeeding and adequate complementary feeding prevalence's are low. In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of the assistance provided by primary healthcare teams to ultimately improving infant feeding practices in the Brazilian population. In primary healthcare units, continuing education in breastfeeding and complementary feeding is facilitated by EAAB tutors. A Manual to Support EAAB Tutor (the Manual) was developed following a problem-based learning methodology. This study aimed to evaluate the effectiveness of using the Manual by analyzing exclusive breastfeeding and complementary feeding indicators. Methods A before and after study was conducted at primary healthcare units in Embu das Artes, Brazil. The intervention consisted in the use of the Manual by EAAB tutors who performed some comprehensive training activities with healthcare teams, in a period of 8 months. Subjects consisted of mothers of infants under one year of age attended at primary healthcare units. 561 mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions The Manual is a continuing educational strategy that improved complementary feeding practices in primary health care. Key messages The use of a continuing education strategy grounded on a problem-based learning methodology was effective to produce improvements in complementary feeding practices in primary health care. The 'Manual to Support EAAB Tutor' consists of a tool that has the potential to be adapted for different contexts and easy to disclose to all EAAB tutors in the country.

Effectiveness of the baby-friendly community initiative in promoting exclusive breastfeeding among HIV negative and positive mothers: a randomized controlled trial in Koibatek Sub-County, Baringo, Kenya

BackgroundAlthough the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya.MethodsA community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression.ResultsAt 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively.ConclusionsBFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.

Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa

BackgroundWorldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers.MethodsThe study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method.ResultsBetween March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth.Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming ‘spoilt’. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work.Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers’ ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace.ConclusionMothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support feeding and childcare if global nutrition and development goals are to be met.

Effects of Telephone and Short Message Service Support on Infant Feeding Practices, “Tummy Time,” and Screen Time at 6 and 12 Months of Child Age

There is limited information as to whether telephone or short message service (SMS) support is effective in improving infant feeding practices and tummy time and reducing screen time. To determine the effectiveness of either nurse-led telephone or SMS support in improving infant feeding practices and tummy time and reducing screen time. This study was part of a 2-year, 3-group parallel, randomized clinical trial conducted from February 23, 2017, to November 30, 2018, among 1155 women in the third trimester of pregnancy in New South Wales, Australia. It reports the main outcomes at 6 and 12 months of child age. All analyses were conducted on an intention-to-treat principle. The intervention consisted of staged information booklets mailed to the intervention groups, each followed by either a nurse-led telephone support session or SMS intervention, antenatally and at 1, 3, 5, 7, and 10 months after birth. The primary outcomes were infant feeding practices at both 6 and 12 months and tummy time at 6 months. The secondary outcome was screen time at 12 months. Of 1155 mothers, 947 (82%; mean [SD] age, 32.5 [5.0] years) completed follow-up surveys at 6 months; 920 mothers (80%) completed follow-up surveys at 12 months. Compared with the control group, telephone support led to higher odds of appropriate timing of introducing solid foods (adjusted odds ratio [AOR], 1.68 [95% CI, 1.22-2.32]), cup use (AOR, 1.54 [95% CI, 1.12-2.13]), and early-start tummy time (AOR, 1.63 [95% CI, 1.18-2.25]) at 6 months and higher odds of having no screen time (AOR, 1.80 [95% CI, 1.28-2.53]) and no bottle at bedtime (AOR, 1.73 [95% CI, 1.23-2.42]) at 12 months. Use of SMS also led to higher odds than the control group of having no screen time (AOR, 1.28 [95% CI, 1.08-1.52]) and having no bottle at bedtime (AOR, 1.29 [95% CI, 1.10-1.51]) at 12 months. No significant differences were found in breastfeeding rates between the telephone support, SMS support, and control groups. Both the nurse-led telephone support and SMS interventions were effective in reducing screen time and bottle use at bedtime. Telephone support was also effective in promoting the appropriate timing of the introduction of solid foods, early-start tummy time, and cup use. http://anzctr.org.au Identifier: ACTRN12616001470482.

Early infant feeding practices in Ireland; current and secular analyses of infant feeding in two prospective birth cohort studies

AbstractRecognised as the optimum infant feeding method, breastfeeding affords substantial health benefits to mother and infant. Exclusive breastfeeding is recommended to 6 months, with continuation thereafter. In Ireland, data indicates that 60% breastfeed to any extent at hospital discharge and 40% do so at 3 months. However, nationally collected data is limited in detail, particularly with regard to breastfeeding continuation. The ongoing Cork-based COMBINE birth cohort study recruited 456 participants between 2015 and 2017. Through interviewer-led questionnaires, research midwives collected feeding data at hospital discharge, 1, 2, 4, 6 and 9 months of age. Infant feeding was classed as breast (breastmilk as main milk source), combination (both breastmilk and infant formula daily) or infant formula only feeding. Adherence to the World Health Organisation (WHO) recommendation to exclusively breastfeed (breastmilk only, no infant formula, supplementary fluids or solid foods) was examined longitudinally. To explore secular changes, breastfeeding rates in COMBINE were compared to the BASELINE birth cohort study, which recruited participants (n = 2116) between 2008 and 2011 in the same setting. In COMBINE, 75% of mothers provided any breastmilk (breast or combination) at hospital discharge, of whom 44% breastfed only. Two-fifths (40%), one-third (33%) and one-quarter (24%) breastfed at 1, 4 and 6 months, respectively. Combination feeding of breastmilk and infant formula was prevalent at discharge (31%) and 1 month (20%). Advice from healthcare professionals (31%) and concern baby was hungry (30%) were commonly reported reasons for this practice and throughout the study, mothers who combination fed were more likely to stop breastfeeding altogether than those who breastfed (all P &lt; 0.001). Infant formula only feeding increased from 25% at discharge to 40% at 1 month, 49% at 2 months and 74% at 9 months. Half (45%) of mothers who breastfed did so for less than 4 months and insufficient milk/growth faltering was the most commonly cited reason for cessation (27%). The rate of WHO-defined exclusive breastfeeding was 40% from birth to discharge, 22% to 1 month, 15% to 4 months and 2% to 6 months. The breastfeeding (breastmilk as main milk source) rate at discharge did not differ between our two birth cohorts (44 vs. 40%, P = 0.23), but was significantly higher in COMBINE compared to BASELINE at 2 (36 vs. 27%) and 6 (24 vs. 12%) months (both P &lt; 0.05). While these data provide evidence of some progress towards longer breastfeeding durations, there remains much scope to improve infant feeding practices in Ireland.

Use of Mother Child Protection Card for Improving Infant Feeding Practices

For the last four decades India had invested in interventions for improving household food security, supplementary feeding programmes and health care to pre-school children. However under-nutrition rates in under-five children continue to be high. Poor infant and young child feeding and caring practices had been identified as the major modifiable factors associated with under-nutrition especially in the critical first two years. Mother Child Protection Card (MCPC) was introduced as the critical intervention tool for combating these two factors and improving nutritional status of the children. A community based mixed longitudinal study was taken up in urban low middle income group mothers with under-three children to assess feasibility and impact of using MCPC as a supportive tool for nutrition and health education regarding infant and young child feeding and care during illness. Mothers readily accepted MCPC, kept it safely and produced it when requested. MCPC with authentic pictorial messages was used by all health and nutrition front line workers and research team; this practice ensured uniformity in nutrition and health education messages. Over 90% of infants at 2 months and over 2/3rd at 5 months were solely breast-fed. By 8th month almost all infants received semi-solid food. Almost all families accessed health care during illness and followed the advice regarding feeding during illness and convalescence. As a result the mean z scores for weight-for-age did not show any deterioration in the first year. MCPC is a useful tool in providing nutrition and health education and improving infant feeding practices.

Exploring Infant and Young Child Feeding Practices in the Royal Borough of Greenwich, London, to Improve Health and Nutrition Outcomes in Children Under 2 Years of Age

Introduction: The UK, like many other countries, is struggling to achieve two of the Global Nutrition Targets, namely increasing exclusive breastfeeding and halting the rise of childhood obesity. Identifying the infant feeding interventions that are having an impact could increase the effectiveness of cash strapped public health services in London. Improving infant feeding practices could also help halt the dangerous rise in childhood obesity.&#x0D; Study Aim: This study explored the Infant and Young Child Feeding (IYCF) practices and support in place to improve health and nutrition outcomes of children under 2 years of age in the Royal Borough of Greenwich, London&#x0D; Methodology: The study applied a qualitative methodology, supplemented with data on demographic characteristics of participants, collected via standardised questionnaires prior to the qualitative data collection. Categorical data are presented as absolute (n) and relative frequency (%). Qualitative data were collected using focus group discussions, semi structured interviews and key informant interviews and analysed using a thematic approach.&#x0D; Participants: The total sample included 35 participants: four focus groups with fifteen mothers, nine semi structured interviews, six with mothers and three fathers--all with at least one child in the target age group--and 11 key informants.&#x0D; Findings: Five main themes and twenty-five subthemes emerged from the qualitative data including a high level of awareness on the importance of infant feeding practices. However, only six of the key informants were aware of the borough IYCF Policy. Key informants felt that they personally would benefit from more training and resources, while more support from health workers, family and friends was very important for the other participants. Support services offered at the Children’s Centres appeared to be the most effective, in comparison to support at hospital and at home. There was a lack of cohesion among messages given at the different points of care of breastfeeding moms. Respondents reported that the Borough was implementing some aspects of its infant feeding support programmes effectively, especially through the breastfeeding support groups.&#x0D; Conclusions: Continuous monitoring and evaluation of current programmes and creation of sustainable links between all points of care from antenatal to postnatal period will help the Borough in achieving improved breastfeeding rates. This should improve health and nutrition outcomes for children under 2 years of age in the borough.

Acceptability of a text message-based intervention for obesity prevention in infants from Hawai\u2018i and Puerto Rico WIC

BackgroundLow-income and minority children are at increased risk for obesity. Text messaging offers advantages for delivering education, but few studies have assessed the acceptability of text messaging in interventions aimed at preventing excessive weight gain in infants. This study investigated the acceptability of a text message-based intervention for prevention of excessive weight gain in infants from Hawai‘i and Puerto Rico WIC clinics.MethodsThe four-month text message based intervention designed to improve infant feeding practices and reduce excessive weight gain was a randomized controlled trial that included mothers with infants ages 0–2 months at baseline. Participants in the intervention arm received 18 text messages (1/week) promoting breastfeeding and appropriate complementary feeding. Acceptability of the intervention was assessed from participant retention, satisfaction, and evidence of behavior change in a sequential multimethod approach, quantitatively from questions sent via text and qualitatively during the in-person exit interview. The final analysis included 80 mother-infant pairs from the intervention arm.ResultsWhen asked about messages liked and disliked the most, the majority of responses via text indicated that they liked all messages. From the qualitative analyses, most participants reported that all messages were useful and that the messages led them to make changes in the way they fed their infants. Participant retention was good at 78.4%.ConclusionsThe intervention was acceptable to participants based upon participant retention, measures of satisfaction, and reports of behavior change. Results may inform development of mobile health programs for minority childhood obesity prevention.Trial registrationClinicalTrials.gov Identifier; NCT02903186; September 16, 2016.

Pengaruh Penerapan Booklet Menu Seimbang Terhadap Peningkatan Berat Badan Bayi Usia 6-12 Bulan

Background: In infancy, breast milk is the best food. Since the age of 6 months, babies begin to be given complementary breast milk food (MP-ASI). Giving the wrong MP-ASI will have an impact on nutritional disorders. The Karanganyar Regency in 2016 was 413 (0.8%), while the cases of under-fives were malnutrition which were found in 22 children. The aim of this study was to determine the effect of applying a balanced menu booklet to increasing infant weight at the age of 6-12 months in Karanganyar Regency. The method used in this study is the method in this study. Method: This research uses a quantitative method with a Quasy experiment in the form of pre-post test design. The sample in this study was 6-12 months Mother and Baby in Karanganyar District who had fulfilled the Inclusion and Exclusion criteria as many as 20 samples per group. Data analysis using paired and T independent T test. Results: The results of the control group study showed an average baby weight of 6.74 (0.63) kg to 6.86 (0.62) kg. Similarly, in the intervention group the average baby weight from 6.88 (0.44) kg to 7.25 (0.43) kg. The group given the booklet had a difference in the average increase in body weight higher (0.390 (0.151) kg) when compared to the group given only lectures (0.125 (0.121) kg). Conclusion: The statistical test results ρ value &lt;0.001 which means there is an effect of the Implementation of a Balanced Menu Booklet Against the Increased Body Weight of 6-12 Months Babies in Karanganyar Regency. Health workers are advised to improve counseling skills to improve infant feeding practices that result in increased infant growth