Increase In Exclusive Breastfeeding Research Articles

Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People's Democratic Republic: Protocol for a Randomized Controlled Trial.

Children in Lao People's Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR. This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR. A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80% power to detect an increase in exclusive breastfeeding from the anticipated 21% in the control arm to 40% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information. As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93% have completed all visits. We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049. DERR1-10.2196/54768.

Effectiveness of an Enhanced Community Doula Intervention in a Safety Net Setting: A Randomized Controlled Trial.

Racial inequities in maternal health outcomes, the result of systemic racism and social determinants of health, require maternity care systems to implement interventions that reduce disparities. One such approach may be support from a community doula, a health worker who provides emotional support, peer education, navigation, and advocacy for pregnant, birthing, and postpartum people who share similar racial identities, cultural backgrounds, and/or lived experiences. While community support during birth has a long tradition within communities of Black Indigenous and People of Color (BIPOC), the reframing of community doula support as a social intervention that reduces disparities in clinical outcomes is recent. We conducted a pragmatic randomized trial at an urban safety net hospital, comparing standard maternity care with standard care plus enhanced community doula support. We tested the effectiveness of a community doula program embedded in a safety net hospital in improving birth outcomes and explored the association between community doula support and health equity. Participants were nulliparous, insured by publicly funded health plans, and had lower risk pregnancies. The primary outcome was cesarean birth. Secondary outcomes included preterm birth and breastfeeding outcomes. Exploratory subgroup analysis was conducted by race-ethnicity. Three hundred sixty-seven participants were included in the primary analysis. In the intent-to-treat analysis, outcomes were similar between groups. There was a trend toward increased breastfeeding initiation (p=0.08). There was a statistically nonsignificant 12% absolute reduction in cesarean birth and 11.5% increase in exclusive breastfeeding during delivery hospitalization among Black non-Hispanic participants. While outcomes for the study sample were similar between randomization groups, health outcomes were improved for Black birthing people in cesarean and breastfeeding rates. This study demonstrates the need for larger studies of community doula support for Black birthing people. Clinicaltrials.gov ID: NCT02550730.

Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia

BackgroundKangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of...

Penyuluhan dan Demonstrasi Tentang Perawatan Payudara pada Ibu Hamil Sebagai Upaya Persiapan Pemberian ASI Ekslusif

This study explains the importance of exclusive breastfeeding (EBF) for babies because it provides the necessary nutrients and antibodies to protect them from various diseases. Low EBF can increase infant mortality. Although there has been an increase in EBF globally, it is still below the 50% target set by the World Health Organization (WHO) for the period 2015-2020. In Indonesia, the percentage of EBF for infants aged 0-5 months has increased to 71.58% in 2021 from 69.62% in the previous year, but some provinces still have percentages below the national average. Lack of education, socialization, advocacy, and campaigning towards successful breastfeeding is a problem in achieving EBF. The method used in this study is counseling and demonstration methods about improper breast care can lead to insufficient milk supply, and mothers need support and information to prepare for breastfeeding. Proper breast care can help mothers produce enough milk, prevent breast infections, and detect breast abnormalities. Health education about breast care is most effective when given to pregnant women during the third trimester. The study concluded that providing health education about proper breast care during pregnancy is critical to encouraging EBF and improving infant health.

Neonatal Intensive Care Unit Interventions to Improve Breastfeeding Rates at Discharge Among Preterm and Low Birth Weight Infants: A Systematic Review and Meta-Analysis.

Background: While breast milk is widely accepted as the best source of nutrients for almost all newborns, breastfeeding can be especially challenging for preterm and low birth weight (LBW) infants. With increased risk of admission to neonatal intensive care units (NICUs) and separation from parents, this population experiences significant barriers to successful breastfeeding. Thus, it is crucial to identify interventions that can optimize breastfeeding for preterm and LBW infants that is continued from birth and admission, through to hospital discharge and beyond. Objectives: To identify and analyze evidence-based interventions that promote any and exclusive breastfeeding among preterm and LBW neonates at discharge and/or postdischarge from hospital. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Searches were performed in the following databases: MEDLINE Ovid, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health (CINAHL). Results: From the 42 studies included, 6 groups of intervention types were identified: educational and breastfeeding support programs, early discharge, oral stimulation, artificial teats and cups, kangaroo mother care (KMC), and supportive policies within NICUs. All groupings of interventions were associated with significantly increased rates of any breastfeeding at discharge. All types of interventions except artificial teats/cups and oral stimulation showed statistically significant increases in exclusive breastfeeding at discharge. KMC demonstrated the highest increased odds of breastfeeding at discharge among preterm and LBW infants. Conclusions: A variety of effective interventions exist to promote breastfeeding among hospitalized preterm and LBW infants. Hospital settings hold unique opportunities for successful breastfeeding promotion. PROSPERO registration: CRD42021252610.

Higher NICU admissions in infants born at ≥35 weeks gestational age during the COVID-19 pandemic.

Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic. This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes. A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19 n = 4,967, COVID-19 n = 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%, p < 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%, p < 0.001), metabolic acidosis (0.7% vs. 1.2%, p = 0.02), NICU admission (5.1% vs. 6.4%, p = 0.009), antibiotic (0.7% vs. 1.7%, p < 0.001), and nasal CPAP (1.2% vs. 1.8%, p = 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes. During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.

Relationship between Knowledge, Attitude and Family Support with Exclusive Breastfeeding

Exclusive breastfeeding is an important factor in infants, especially early breastfeeding (colostrum) because it's rich in antibodies which have an effect on reducing the risk of death. Government efforts to support an increase in exclusive breastfeeding have issued agreements or various recognition both globally and nationally aimed at protecting, and supporting breastfeeding. This is in accordance with the Sustainable Development Goals (SDGs) of the three second targets, namely 2030, ending preventable infant and under-five mortality. This study aims to determine the relationship between knowledge, attitudes and family support simultaneously with exclusive breastfeeding at Sungai Menang Health Center, Ogan Komering Ilir Regency in 2021. An analytical survey research with cross sectional. The population in this study were mothers who had babies aged 7-12 months totaling 389 respondents and the sample size was determined by the slovin formula. Obtained a sample of 79 respondents, the sample was taken by purposive sampling technique. Data analysis used chi square statistical test with research results p value value (0.05). The results of this study were from 33 respondents who had good knowledge of exclusive breastfeeding as many as 22 respondents (66.7%) with p value = 0.003, 31 respondents who got a positive attitude with exclusive breastfeeding as many as 19 respondents (61.3%) p value = 0.04, meanwhile, 26 respondents who received family support by exclusive breastfeeding were 19 respondents (73.1%) p value = 0.001. Midwives are expected to increase counseling and socialize the exclusive breastfeeding program to the community.

THE EFFECT OF OXYTOCIN MASSAGE ON BREAST MILK PRODUCTION AMONG BREASTFEEDING WOMEN AT RB CITRA LESTARI BOJONGGEDE BOGOR IN 2022

Efforts to support the increase in exclusive breastfeeding can be seen by the issuance of various recognitions or agreements, both global and national in nature, which aim to protect, promote and support breastfeeding for every baby throughout the world to obtain their right to breast milk. In Indonesia, infants who received exclusive breastfeeding in 2020 amounted to 69.62%. The Ministry of Health (KemKes) has set a target of 80% exclusive breastfeeding coverage every 2020-2024. To determine the effect of breast milk production before and after oxytocin massage at TPMB Bersama Citra Lestari Bojonggede, Bogor Regency, in 2022.Using pre-experimental with One Group PreTest-Posttest Designs research design. This study's sample number was 20 respondents with an accidental sampling technique that met the inclusion criteria. Shapiro Wilk carried out the normality test and found that the data were not normally distributed. Data analysis using a non-parametric test with Wilcoxon Signed Rank Test. The research results were conducted by pre-testing 20 respondents were breastfeeding women before oxytocin massage. Most of the milk production was less than 11 (55%). While the breast milk production after oxytocin massage is as sufficient as 12 (60%). It can be concluded that if the p value= 0.000 &lt; (0.05), Ho is rejected, and Ha is accepted. The conclusion of this study is the significant effect of oxytocin massage on breast milk production at RB Citra Lestari Bojonggede Bogor in 2022.

Recommendations For Improving Exclusive Breast Milk For Working Mothers With Health Action Process Approach (Hapa) In Batu Bara District

Mother's Milk (ASI) is the main and best food for babies that have no equal. The benefits of exclusive breastfeeding are enormous, especially for the baby's growth and development, immunity, psychology, and the economy of the baby's parents. Even though the benefits of exclusive breastfeeding are clear for mothers and their babies, the coverage of exclusive breastfeeding for babies is still low. The purpose of this study was to analyze the increase in exclusive breastfeeding for working mothers using the Health Action Process Approach (HAPA) in Batu Bara Regency. The sample of this research is working mothers who have babies 0-6 months in Batu Bara Regency. The sampling technique is Non-Probability Sampling using Total Sampling, where the number of samples is the same as the population of 100 people. The data processing method used Univariate, Bivariate, and Multivariate tests. Theresults showed that self-efficacy, outcome expectations, risk perception, planning, the effect of intention, maintenance, and planning strategies to overcome barriers had a significant effect on breastfeeding practices for working mothers in Batu Bara Regency as evidenced by the p-value of each variable 0.000 &lt;0.05. The multivariate test results show that together the independent variables have a significant effect on the dependent variable, with the most dominant variable being the maintenance variable with an average value of 10.66. The frequency of exclusive breastfeeding and the duration of breastfeeding has no effect on the practice of breastfeeding for working mothers in Batu Bara Regency.

The Academy of Breastfeeding Medicine27th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

The Academy of Breastfeeding Medicine27^th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

Hubungan Dukungan Petugas Kesehatan, Dukungan Keluarga dan Pengetahuan Ibu dengan Pemberian ASI Eksklusif

The Government's efforts to support the increase in exclusive breastfeeding have resulted in agreements or various recognitions, both globally and nationally, which aim to protect, promote, and support breastfeeding. It is hoped that every baby has the right to get exclusive breastfeeding and every mother can give breast milk. This study aims to determine the relationship between health worker support, family support and knowledge with exclusive breastfeeding for infants aged 7-12 months in the Tanjung Baru Health Center Work Area, Ogan Komering Ulu Regency in 2021. The design of this study was an analytical survey using a cross sectional research design. . The population in this study were all mothers who had babies aged 7-12 months in January-July 2021, which were 38 respondents and the number of samples was 38 respondents. The sampling technique used is accidental sampling. Data analysis used chi square statistical test with = 0.05. The results of this study found that there was a relationship between family support (p value = 0.02), support from health workers (p value = 0.01) and knowledge (p value = 0.003) with exclusive breastfeeding. The results of the research can be used as a reference to improve counseling and socialize the exclusive breastfeeding program to the community.

Behavior Change Communication Implemented at Scale in Nigeria Increases the Prevalence of Key Infant and Young Child Feeding Practices

ObjectivesThe objective of this study was to evaluate the impact of Alive & Thrive Nigeria’s infant and young child feeding (IYCF) behavior change communication (BCC) activities, including interpersonal communication in health facilities, community mobilization, and mass media, on early initiation of breastfeeding, exclusive breastfeeding, and minimum dietary diversity. MethodsLocal government areas in Kaduna and Lagos States were randomized to intervention or comparison and cross-sectional surveys of households with children aged 0–23 months [N = 6,266 baseline (2017), N = 7,320 endline (2020)] were conducted. Difference-in-differences and post-hoc baseline-endline models were used to measure intervention impacts. ResultsDifference-in-differences models showed no significant differences between the intervention and comparison areas in early initiation of breastfeeding (both states), exclusive breastfeeding (Kaduna), or minimum dietary diversity (both states). In Lagos, an 11.5 percentage point increase in exclusive breastfeeding in the intervention compared with the comparison area trended toward significance (P = 0.08). At endline, exposure to interpersonal communication, community mobilization, and mass media did not differ by study area in either state. Given the overall lack of differences in intervention exposure by study area, post-hoc baseline-endline analyses were performed with the study areas combined and increases were detected in early initiation of breastfeeding (Kaduna 40% to 46%, P = 0.05), exclusive breastfeeding (Kaduna 25% to 43%, P < 0.001), and minimum dietary diversity (Kaduna 20% to 41%, P < 0.001; Lagos 37% to 58%, P < 0.001). ConclusionsThis evaluation found minimal impacts of the Alive & Thrive intervention on IYCF practices in the difference-in-differences analysis because of intervention spillover to the comparison area. Increases in IYCF practices from baseline to endline were substantial and are likely attributable to the intervention, which was the major IYCF promotion activity in both states. Funding SourcesThis research was funded by the Alive & Thrive initiative, managed by FHI Solutions, and currently funded by the Bill & Melinda Gates Foundation, Irish Aid, the Tanoto Foundation, UNICEF, and the World Bank.

Diet and food insecurity among mothers, infants, and young children in Peru before and during COVID-19: A panel survey.

The COVID‐19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low‐income urban areas of Peru. We conducted a panel study, with one survey prepandemic (n = 244) and one survey 9 months after the onset of COVID‐19 (n = 254). We assessed breastfeeding and complementary feeding indicators and maternal dietary diversity in both surveys. During COVID‐19, we assessed household food insecurity experience and economic impacts of the pandemic on livelihoods; receipt of financial or food assistance, and uptake of health services. Almost all respondents (98.0%) reported adverse economic impacts due to the pandemic and 46.9% of households were at risk of moderate or severe household food insecurity. The proportion of households receiving government food assistance nearly doubled between the two surveys (36.5%–59.5%). Dietary indicators, however, did not worsen in mothers or IYC. Positive changes included an increase in exclusive breastfeeding <6 months (24.2%–39.0%, p < 0.008) and a decrease in sweet food consumption by IYC (33.1%–18.1%, p = 0.001) and mothers (34.0%–14.6%, p < 0.001). The prevalence of sugar‐sweetened beverage consumption remained high in both mothers (97%) and IYC (78%). In sum, we found dietary indicators had not significantly worsened 9 months into the COVID‐19 pandemic. However, several indicators remain suboptimal and should be targeted in future interventions.

Persiapan Laktasi pada Ibu Hamil di Puskesmas Pakuan Baru Kota Jambi

The World Health Organization (WHO) recommends giving exclusive breast milk (ASI) for 6 months. Breast milk is a source of nutrition with a balanced composition and adjusted to the baby's growing needs. Global exclusive breastfeeding in 2017 was 38%. WHO targets that by 2025 there will be an increase in exclusive breastfeeding by 50%. The achievement of exclusive breastfeeding in Indonesia is 65.16%, not yet reaching the target figure of 80%. Exclusive breastfeeding coverage in Jambi Province reached 68.64%, while exclusive breastfeeding coverage at Pakuan Baru Health Center was 73.04% from the target of 80%. The unachieved coverage of exclusive breastfeeding is influenced by many factors, including low knowledge of lactation management and lack of information to mothers and their families about the importance of exclusive breastfeeding. Therefore, it is necessary to provide education to increase the knowledge of mothers about exclusive breastfeeding, which is started during pregnancy. It is hoped that when the mother gives birth, the mother can breastfeed her baby exclusively. The implementation time is in July 2020. The target of this community service is pregnant women who visit the Pakuan Baru Community Health Center. Community service methods include survey and counseling approaches. The results obtained are that pregnant women understand about exclusive breastfeeding and are willing to give exclusive breastfeeding to their babies. It is recommended that the Puskesmas maintain the extension program related to exclusive breastfeeding that has been given

Analysis of the Role of the Midwife in Increasing Exclusive Breast Milk at UPT Puskesmas Mare

The kind of research that was utilized in this study was an analytical questionnaire. In this study, a cross-sectional design was employed to collect data. Sixty-six individuals were included in the samples that fulfilled the requirements. The findings revealed that 1) the midwife's attitude toward promoting exclusive breastfeeding at the UPT Puskesmas (Community Health Center) Mare had no impact on the outcomes of the study. The results of the chi square test revealed that the p-value was 0,089, indicating that the hypothesis was correct (0,05). There is an association between midwife assistance and an increase in exclusive breastfeeding at the University of Puskesmas Mare, according to the findings of the chi square test (p-value =0,007 for exclusive breastfeeding at the UPT Puskesmas Mare) (0,05). The rise in exclusive breastfeeding at the UPT Puskesmas Mare may be attributed to the midwifery program, according to the findings. The results of the chi square test reveal that the p-value is 0,0002, which indicates a significant difference (0,05). 4) Midwife assistance had a 12,7-fold higher impact on the rise in exclusive breastfeeding, with a p-value of 0.028 0.05 for the effect of midwife support. The midwife program, on the other hand, had a moderate impact on the rise in exclusive breastfeeding, with a p-value of 0,038 0.05 and a moderate effect of 11,1 times on the increase in exclusive breastfeeding.

Infant feeding and the energy transition: A comparison between decarbonising breastmilk substitutes with renewable gas and achieving the global nutrition target for breastfeeding

Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models.

Impact of early-onset sepsis guidelines on breastfeeding.

To evaluate the impact of changes to neonatal early-onset sepsis (EOS) guidelines on in-hospital breastfeeding. Asymptomatic neonates admitted to the Neonatal Intensive Care Unit (NICU) for sepsis evaluations over a 2-year period were identified. A retrospective chart review was conducted as part of a larger quality initiative on antibiotic stewardship. In Epoch 1, Epoch 2, and Epoch 3, there were 268 babies, 138 babies and 138 babies admitted to the NICU based on sepsis protocol, respectively. When comparing Epoch 1 to Epoch 3, there was a 14% increase in total breast milk consumption rates (p < 0.0001) and a 15% increase in exclusive breastfeeding at discharge (p < 0.002). By implementing new EOS protocols, we have decreased NICU length of stay. We suggest that the decrease in mother-infant separation time leads to an improvement in breastfeeding.

Breastfeeding counseling based on formative research at primary healthcare Services in Mexico

BackgroundBreastfeeding rates in Mexico are far from World Health Organization (WHO) recommendations with 28.8% of Exclusive Breastfeeding (EBF) under 6 months of age, according to the 2018 National Health and Nutrition Survey. Formative research has shown that culturally appropriate counseling is an effective breastfeeding intervention. The objective of the current study was to evaluate the effect of interpersonal counseling on EBF in a primary healthcare center in Tijuana, México.MethodsThis was a randomized controlled trial pilot with a sample of mothers with infants under 4 months of age from a primary care center. Participants were randomized into two groups: 1) Control group, received counseling on immunizations and standard infant feeding information, and 2) Intervention group, receiving breastfeeding counseling using a socio-ecological framework. Changes in breastfeeding attitudes, self-efficacy and EBF were evaluated at 2 months post-intervention.ResultsA total of 80 mothers completed the 2 month follow up assessment (40 in each group). The mean age at baseline was 26.4 years for mothers and 1.4 months for infants. There was a 30% increase in EBF at 2 months follow up in the intervention group and 15% decrease in the control group post-intervention. We observed a significant improvement in breastfeeding attitudes (P = 0.0001), self-efficacy (P = 0.046) and EBF (P = 0.0001) in the intervention group. Reported obstacles were discomfort of breastfeeding in public (23%), infant dissatisfaction (23%), pain (19%), insufficient milk supply (15%) and returning to work (8%).ConclusionsBreastfeeding counseling based on previous formative research improved breastfeeding attitudes, self-efficacy and practices in this population. These findings suggest that the promotion of breastfeeding utilizing a socio-ecological framework may improve breastfeeding rates by addressing the needs of women within their varying sociocultural contexts.Trial registrationACTRN: ACTRN12621000915853. Retrospectively registered.

Breastfeeding as a Quality Measure: Demonstrating Levers of the National Quality Strategy.

The purpose of this study is to explore the National Quality Strategy (NQS) levers (measurement and feedback, public reporting, learning and technical assistance, and certification) on state and national breastfeeding performance. The research evaluates the NQS levers of measurement and feedback and public reporting using secondary data analysis of publicly reported data from the National Immunization Survey and the Centers for Disease Control and Prevention Breastfeeding Report Cards between 2008 and 2018, the latest years available. Linear regression explores the association between the prevalence of state-level Baby-Friendly hospitals and state-level breastfeeding rates. Subsequent analyses use event study to test whether state-level Baby-Friendly hospital adoption is associated with higher breastfeeding rates. A 10% increase in Baby-Friendly hospitals at the state level is associated with increased population breastfeeding rates by nearly 5% and a decrease in early formula use (before 2 days of life) by 2% to 9%. Breastfeeding increased by 2% to 5% in the first 2 years following state-level Baby-Friendly initiatives, with subsequent increases up to 10% in the next 4 years. The National Quality Strategy levers of measurement and public reporting combined with certification and learning and technical assistance are associated with increases in exclusive breastfeeding, a national quality metric.

Effectiveness of the baby-friendly community initiative on exclusive breastfeeding in Kenya.

The baby‐friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby‐friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub‐county. Pregnant women aged 15–49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention group n = 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%; P < .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85; P < .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings.