Mean Duration Of Exclusive Breastfeeding Research Articles

Duration and Sociodemographic Factors Associated with Exclusive Breastfeeding Among Mothers in Urban and Semi-Rural Areas of Libreville and Lambaréné in Gabon

Background: Exclusive breastfeeding from birth to six months of age has an unparalleled benefit on a child's growth and development. This survey aimed to assess the practice of exclusive breastfeeding (EBF) in Libreville and Lambaréné. Method: This is a prospective study, including mother-child pairs of infants taken to vaccination centers in Libreville (urban area) and Lambaréné (semi-rural area). The data collected included sociodemographic aspects of families, the children's characteristics, and the duration of EBF in months. Result: We included 552 mother-child pairs, 58% of whom were recruited (n = 320) in Libreville. The average age of mothers was 26.5 ± 6.4 years, while fathers were 33.3 ± 7.8 years. The mean age of children was 4.2 ± 3.1 months. Male participants were accounted for 52.2% (n = 288), while females 47.8% (n = 264). The mean duration of exclusive breastfeeding in the whole was 0.9 months. Six-month EBF was generally performed at 9.2% (n = 51, 95% CI = 7.1%-11.9%). The factors influencing the EBF were father’s level of education (all classes combined) (p = 0.025), marital status (p = 0.011), and residential area (OR = 3.40, p <0.001) Conclusion: The duration of exclusive breastfeeding in the two studied is lower than the WHO recommendations. The associated factors found are areas of work to be explored to encourage this important practice for our infants.

Breastfeeding challenges and support in a high initiation population

BackgroundThe breastfeeding initiation rate in Israel is approximately 90%, yet exclusive breastfeeding drops sharply in the early postnatal period. The study objective was to assess early postpartum professional breastfeeding support, its association with breastfeeding success and identification of risk factors for early breastfeeding discontinuation.MethodsAs part of a post-discharge newborn follow-up study, a convenience sample of 868 mothers attending Maternal and Child Health Centers (MCHCs) up to three months post-partum were interviewed using a 26-item questionnaire. Breastfeeding-related questions covered demographic variables, pregnancy and birth details; breastfeeding duration, lactation support in hospital and post-discharge; and problems experienced.ResultsMost mothers, 797 (91.8%), initiated breastfeeding in hospital. All women who initiated breastfeeding in the hospital reported exclusive breastfeeding; by two weeks postpartum, 70 women (13.2%) were supplementing with formula (partial breastfeeding). Kaplan–Meier Survival Analysis revealed an estimated mean duration of exclusive breastfeeding in the sample population of 66.8 ± 1.5 days. This duration was shorter for women with preterm births, low birthweight infants (LBW), cesarean births, and hospitalizations in neonatal intensive care units (NICU). A total of 472 (59.3%) breastfeeding mothers reported receiving in-hospital guidance. Of these, 290 (61.3%) were observed breastfeeding. Of all women who initiated breastfeeding, 280 (35.1%) attended MCHC follow-up within 72 h of hospital discharge. A higher proportion of women experiencing breastfeeding difficulties attended an MCHC within 72 h (131/297, 44.1%) compared to women not experiencing difficulties (148/499, 29.7%). The most frequently reported problems were mechanical (55.2%) or milk supply concerns (18.5%). First-time mothers were more likely to report problems, as were Jewish (vs Arab) mothers.ConclusionsEven in a population with high initiation rates of breastfeeding, breastfeeding duration, both exclusive and partial, is less than recommended. As much of this drop-off occurs during maternity leave, it is likely related to breastfeeding challenges other than employment. Breastfeeding support needs of women are currently not adequately met; staffing and time for both in-hospital and community-based counseling needs to be funded as well as mandated. Counseling hours should be tailored to assure adequate coverage of high-risk groups such as women after cesarean delivery and newborns requiring intensive care.

Importance of breastfeeding and complementary feeding for management and prevention of childhood diarrhoea in low- and middle-income countries.

BackgroundEarly and exclusive breastfeeding have been shown to protect young infants from all-cause and diarrhoea-related mortality. Ideally breastfeeding should be initiated within the first hour of birth. Despite efforts to increase rates of early and exclusive breastfeeding in low- and middle-income countries (LMICs), challenges with uptake remain. This analysis reviews trends in early and exclusive breastfeeding, and the impact of infant feeding interventions in reducing childhood diarrhoea.MethodsWe conducted a detailed review of articles written in English between 1990 and 2020 on the impact and efficacy of breastfeeding and complementary feeding on diarrhoea in children aged 0-2 years in LMICs. Using data from 86 countries and all WHO global regions collected from the mid-1980s through 2018 obtained from publicly available Demographic Health Surveys, we assessed trends in five-year intervals of timing of breastfeeding initiation, exclusive breastfeeding, median and mean duration of exclusive breastfeeding, and complementary feeding.ResultsThe literature search identified ten articles that described variable rates of early initiation of breastfeeding from 20% in Pakistan to 76% in Egypt. An analysis of 288 DHS studies found that the proportion of women who reported initiating breastfeeding within an hour of birth increased from 32% in the early 1990s to 55% between 2016 and 2020. Exclusive breastfeeding increased from 20% in the late 1980s to 48% between 2016 and 2020 and the mean duration of exclusive breastfeeding of 2-to-4-month-old infants doubled. Early initiation of breastfeeding and exclusive breastfeeding was associated with reductions in diarrhoea prevalence in the South East Asian, Western Pacific, Eastern Mediterranean, and African regions. Eight studies evaluating the effectiveness of different maternal education interventions, health care worker training, and media campaigns demonstrated improvements in exclusive breastfeeding, and most resulted in reductions in the incidence or duration of diarrhoea.ConclusionsDuring the last two decades, early and exclusive breastfeeding have increased. Nevertheless, the uptake of this basic, low-cost intervention remains suboptimal across all global regions. Given the potential benefits the in reduction of diarrhoea and diarrhoea-associated mortality, interventions for improving the uptake of early and exclusive breastfeeding in different sociological contexts need to be designed, implemented, and evaluated.

Breastfeeding frequency of primary healthcare professionals and effective factors.

To determine the frequency of breastfeeding of mothers working in primary care, the differences between different employment groups, and the effective factors. This descriptive research study was conducted with a self-report online survey design. The snowball sampling method was used for the sample selection, and 151 family physicians and 126 family health professionals were included in the study during the research period (June 2019-December 2019). A 35-item survey was used to collect data. The response rate was 44.9% (49.5% family physicians/40.3% family health professionals). The mean duration of exclusive breastfeeding was 3.9±2.0months, and the mean duration of total breastfeeding was 16.7±8.5months. There was no significant difference between the family physicians and family health professionals in terms of exclusive breastfeeding (P=.580) and total breastfeeding (P=.325) durations. The most common reasons for weaning were reduced milk supply (25.6%) and not being able to use breastfeeding leave (23.1%) due to problems at work. Of the sample, 41.3% had problems with their coworkers and 41.9% had problems related to patient care when taking breastfeeding leave. Working in a baby-friendly centre (P=.01), prolonged exclusive breastfeeding (P<.001), and increased hours of breastfeeding leave taken (P=.001) had a positive effect on breastfeeding for ≥24months while experiencing problems with coworkers in taking breastfeeding leave (P=.023) had a negative effect on this variable. All of the factors that were determined to affect the continuation of breastfeeding for ≥24months are modifiable. It is very important for relevant authorities to undertake necessary action to improve the conditions of working mothers based on these results. Health professional that can maintain the balance between family and work will work more efficiently.

Randomized clinical trial of the effect of the onset time of skin-to-skin contact at birth, immediate compared to early, on the duration of breastfeeding in full term newborns

BackgroundSkin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding.MethodsA randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate’s breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration.ResultsA total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28).ConclusionsThe percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators.Trial registrationClinicalTrials.gov NCT02687685.

Breastfeeding Pattern and its Associated Factors Among Mothers Working at Two Hospitals in Kathmandu

Introduction: Breastfeeding practices of women working at the hospital are likely to be modified by the facilities and support that they receive at the hospital. This study was done to evaluate the breast feeding practices and to analyse important factors that are associated with exclusive breast feeding till six months among women working at hospitals in Kathmandu, Nepal&#x0D; Methods: A total of 110 women, with a young child between the ages of six months and two years were recruited from two hospitals in Kathmandu. A predesigned structured, interviewer-administered questionnaire was used for data collection. &#x0D; Results: The mean age of the mothers was 29.85 ± 3.68 years. Ninety seven (88.2%) women were aware about initiation of breastfeeding within first hour of birth but only 64 (58.2%) women could practice it. Most women 100 (90.9%) were aware about exclusive breastfeeding but only 18 (16.3%) could practice exclusive breastfeeding till six months. Mean duration of exclusive breastfeeding was 2.86 ± 2.00 months and 20 (18.2%) mothers practiced mixed feeding since birth. The participants whose babies had prelacteal feeding had significantly shorter duration of mean exclusive breast feed {1.92 ± 2.18 (S.D)} compared to those who did not have prelacteal feed {3.33 ± 1.74 (S.D)} (p = 0.001). Those who delivered by normal vaginal delivery, initiated breastfeeding within first hour of delivery, expressed breast milk and got feeding breaks were associated with longer duration of mean exclusive breast feed.&#x0D; Conclusion: The breast feeding practices among working women at hospital is quite low compared to national statistics on IYCF. Breast milk expression and feeding breaks for lactating working women could improve feeding practices.

Factors Affecting the Behavior and Duration of Breastfeeding Among Physician Mothers.

Increasing breastfeeding duration may help physician mothers better counsel their patients. To improve the breastfeeding duration of physician mothers, the factors that may influence their breastfeeding duration should be known. To investigate the breastfeeding behavior and duration among physician mothers and to determine the factors that influence breastfeeding practices. This was an online prospective cross-sectional self-report survey. A 26-item author-created data-collecting tool inquiring sociodemographic and work characteristics, medical history of delivery, and breastfeeding history was sent to female physicians who had infants between 12 and 60 months of age via an online social group, "Physician Mothers," with 11,632 members. Participants (N = 615) responded, and descriptive statistics were analyzed. Participants' mean duration of exclusive breastfeeding was 4.8 months (SD = 1.9). The total breastfeeding length was a mean 15.8 months (SD = 7.6). The rate of breastfeeding duration for at least 24 months was 17.8% (n = 75). The most common reason for weaning from breastfeeding was workplace-related conditions (23.6%, n = 145). Participants reported that the mean time of resuming night shifts after delivery was 8.6 months (SD = 4.7). The rate of participants who were unable to use their breastfeeding leave rights partially or completely was 43.6% (n = 268). Although legislation is in place to allow working mothers to breastfeed their infants, these legal rights were not used properly. Physician mothers should be fully supported in using their breastfeeding leave rights, and workplace conditions should be improved to enable physician mothers to breastfeed their infants for extended periods.

Socio-Demographic and Clinical Correlates of Exclusive Breastfeeding practices up to Six Months of Age.

BackgroundAccording to the recommendations from The World Health Organization, exclusive breast feeding (EBF) should be given to infants for the first six months for healthy growth and development. However, developing countries have a wide range of variation in the practice of EBF. From this study, we aim to estimate the duration of EBF and find the impact of socio-demographic characteristics on EBF.Materials and MethodsThis study was conducted at PSG Institute of Medical Sciences and Research, Coimbatore in the month of July 2018. Mothers with children aged below 4 years attending the paediatric outpatient department were included in the study. Kaplan-Meier curve analysis and logistic regression analysis were employed.ResultsOur analysis indicates that the prevalence of EBF was 58.4% among infants up to 6 months of age with mean duration of EBF 4.52 months. It was observed that mothers of a younger age (15-24 years) and with lower socio-economic status were negatively associated with the practice of providing EBF to infants up to six months of age.ConclusionThe findings clearly indicate that the interventions related to EBF up to six months of age should be targeted at women in the lower socio-economic status and at younger ages.

Breastfeeding practices among currently married women of selected tribes of Jharkhand, India

Background: An exclusive breastfeeding for 6 months and an extended breastfeeding for 24 months protects the infant from infectious disease and promotes child spacing. Therefore, the knowledge, attitude and practice about infant and child feeding is important to overcome morbid conditions prevailing among mothers and her child. The present study aimed at investigating the factors influencing an exclusive breastfeeding among currently married tribal women in Jharkhand, India.Methods: A cross sectional study was conducted among the 919 currently married Santal, Oraon, Mahli and Ho women in the age group of 15-29 years from forty villages of Purbi Singhbhum district of Jharkhand using interview schedule method.Results: The mean duration of exclusive breastfeeding and breastfeeding up to 24 months was found to be 4.1 and 12.9 months respectively. Also, not much difference in the average duration of exclusive breast feeding was found between working and non-working women. The results of multinomial regression showed maternal age (OR=1.92, p&lt;0.05), place of delivery (OR=2.3, p&lt;0.05), distance from health facility (OR=4, p&lt;0.01) and sex of last child born (OR=2.5, p&lt;0.01) among the significant determinants for exclusive Breastfeeding.Conclusions: The duration and initiation of breastfeeding in a marginalised society depends to a great extent on how family members participate and decide on the type of feeding for new-borns. Also, several public health education campaigns should be launched aiming at increasing the familiarity of family relations on exclusive breastfeeding.

Factors Affecting Breastfeeding and Complementary Feeding Choices for Children Aged 24 to 48 Months.

Objectives:The aim of this study was to evaluate factors that affected decisions regarding breastfeeding and complementary feeding practices in children aged 24 to 48 months.Methods:Children aged 24 to 48 months who were presented at the outpatient clinic of a single hospital over a 6-month period were included in the study. Children who were born prematurely, hospitalized in the neonatal intensive care unit, and those with a chronic disease were excluded. A questionnaire was administered to parents who provided consent. Data related to demographic characteristics, socioeconomic status, and infant nutrition practices were collected and analyzed.Results:A total of 100 cases were included. The distribution of the gender of the children was 49% female and 51% male, and the mean age was 36.2±7.8 months. The mean duration of exclusive breastfeeding was 4.83±1.23 months, the mean length of total breastfeeding was 17.65±8.44 months, and the mean initiation of complementary feeding was 5.71±1.23 months of age. The most frequent reason provided for the cessation of breastfeeding was the mother’s decision to wean. The duration of exclusive breastfeeding and the total length of breastfeeding feeding was significantly shorter among children who were born by cesarean section, and those who used a pacifier and or feeding bottle. Non-working mothers used formula for a longer period (p=0.043) and introduced solid foods and the use of utensils later than other mothers (p=0.001, p=0.03, respectively). Complementary food was provided to the infants of families whose monthly income level was less than TL 1000 earlier than in higher income level groups (p=0.04). The results of this study also showed that complementary food choices were most influenced by older members of the family and members of the mother’s immediate circle (42%) and healthcare professionals (36%). Mothers who received information about the addition of complementary food did not demonstrate a significantly different length of time devoted to exclusive breastfeeding; however, the duration of breastfeeding overall, alone and in combination with solid foods, increased (p=0.03).Conclusion:Before the birth, families should be informed and prepared regarding the necessity of exclusive breastfeeding for the first 6 months and the continuation of breastfeeding until 2 years of age, the potential impact of relevant factors related to the type of birth, and the potentially negative effects of the use of a pacifier or bottle. All members of the family, particularly mothers and close relatives, should be advised about proper complementary feeding techniques, including the need to increase the consistency of food gradually, introducing solid foods before the 10th month, and using natural, home-cooked items instead of prepared foods. The appropriate information and guidance should be provided to all families with consideration for their education level, social environment, and life conditions.

Overview of Optimal Breast-feeding Practices and a Study of Breast-feeding Practices among Suburban Mothers in South India

Background: The status of breast milk practices is dismal in India in spite of specialized nutrient to newborns by way of breast milk. Culture influences breastfeeding decisions of mothers which have an influence on overall growth, development, health and nourishment of infants and children. Objectives: Assessing the maternal information, approach, and practices towards breastfeeding among mothers. Breastfeeding correlation with a number of antenatal visits, hospital education, maternal education, parity, mode of delivery, holding the baby after delivery, socioeconomic status, employment, religion and sex of the child, and prelacteal feeds. Methods: In a study, 400 mothers with children up to 2 years attending hospitals over a one year period. Data was collected using a self-administered standardized questionnaire. Statistical Analysis: The data was analysed regarding mean, frequencies, percentages, Chi-Square test and Spearman’s correlation test. Results: Breast feeding was deferred in mothers who delivered by Caesarean section due to mothers being kept for observation. Forty-three point eight % of mothers initiated first breast feeds within an hour. Eighty-eight point six % had initiated breastfeeds within one to four hours, however, it was. Prelacteal feeds were given by twenty-seven % mothers. Most mothers fed colostrum to the infants. Mean duration of exclusive breastfeeding was four and a half months. There was no association between duration of exclusive breastfeeding with parity, hospital education, holding of baby socioeconomic status and sex of the child. 34% of mothers administered in addition to breast feeding bottle-feeding. The mean age of starting complementary foods was 6 and half months. Conclusion: Due to cultural factors and other social promotional activities, the majority of the mothers had adequate knowledge and a positive attitude towards infant breastfeeding practice. Delay in the initiation of breastfeeding will impact education programs and neonatal feeding practices.

Developmental Nexus between Socio-Economic and Cultural Correlates of Exclusive Breastfeeding among Nursing Mothers in Ojo Local Government Area of Lagos State, Nigeria

Development as a social discourse, a construct that has been arguably conceptualized as a journey and not a destination, equally a many-sided process by pool of scholars and writers of both the antediluvian and in our contemporary time. The discourse touch light its curiosity on the nexus between socio-economic and cultural correlates of exclusive breastfeeding among nursing mothers in Ojo Local Government Area of Lagos State, Nigeria. Other specific interests of the paper are the pattern of exclusive breastfeeding, the level of literacy of nursing mothers and the socio-economic state of the nation, its effects, if any, on the lactating mothers in the study area. A survey of one hundred and fifty mothers were selected, using simple random sampling, questionnaires were administered. Chi-square statistical analysis was carried out to evaluate relationship among selected variables for the study. The study revealed 17.9% of mothers’ breastfed their children exclusively for the first 6 months, and the mean duration of exclusive breastfeeding (EBF) is 2.1 months. Complementary feeding was more commonly initiated around 4 – 6months (75.2%). The fact that 60.6% of mothers initiate breastfeeding and 21.6% of mothers are found to breastfeed up to 2 years, the practice of EBF for the first 6 months is low (17.9%). Causal factors militating EBF, are type of delivery, occupation of the mothers, education, and thorough awareness. Therefore, the strongest thrust of this paper is that proper initiation programmes by the relevant agencies of health practitioners should endeavour more orientation about the benefit of exclusive breastfeeding to the community (Ojo).

Van ilinde 0-12 aylık bebeği olan anneler bebeklerini nasıl besliyorlar?

Objective: This research was planned to evaluate how mothers with 0-12-month-old infants who had been admitted to health centers in the city center of Van. Methods: The data of this descriptive research were collected by face-to-face interviews with 635 mothers. The data were evaluated by chi-square and logistic regression analysis. Results: The mean duration of exclusive breastfeeding of infants was 4 months. While 47.9% of 1-6-month-old infants were still being breastfed, 53.5% of 7-12-month-old infants were being fed with proper nutrition in addition to breast milk. It was confirmed that infants of 6 months or younger are four times better fed than babies of 7 months and older, infants breastfed in the first postnatal hour are fed 1.6 times better than those breastfed after the first hour, and that infants not given pacifiers are two times better fed compared to those that are not given these aids. Conclusion: In the present study, the frequency of exclusive breastfeeding was higher than that indicated average of Turkey. Additionally, a negative relationship was found between using pacifiers and proper nutrition. Our study showed that the aims that WHO and of the United Nations Children’s Fund (UNICEF) suggest could not be reached but results were still found to be better compared to those of TNSA-2008 and TNSA-2013. Keywords: Exclusively breastfed, infant, education, proper nutrition

Mothers' restrictive eating and food neophobia and fathers' dietary quality are associated with breast-feeding duration and introduction of solid foods: the STEPS study.

The purpose of the present study was to examine the association between parental eating behaviours and dietary patterns and feeding practices of infants and young children. Data on infant-feeding practices were collected from each infant's birth via parentally self-administered follow-up diaries. Three questionnaires, the Three-Factor Eating Questionnaire, the Food Neophobia Scale and the Index of Diet Quality, were administered when the children were aged 4 and 13 months. South-western Finland. Families participating in the STEPS longitudinal cohort study (n 1797). Mean duration of exclusive breast-feeding was 2.4 months and total duration of breast-feeding averaged 8.1 months. The first solid food was introduced into children's diets at the age of 3.9 months, on average. Mothers with highly restrictive eating were more likely to introduce solid foods sooner than mothers who ranked lower in these behaviours (3.8 months v. 4.0 months, P = 0.012). Neophobic mothers breast-fed exclusively (2.0 v. 2.6 months, P = 0.038) and in total (7.2 v. 8.5 months, P = 0.039) for shorter times than average mothers, even after adjusting for various demographic characteristics. Fathers' diet quality was associated with total breast-feeding duration and with introduction of complementary foods in unadjusted analyses and with total breast-feeding duration also after adjusting for confounding factors. Mothers' and fathers' eating patterns and practices are associated with the feeding practices of infants and young children. Health promotion interventions seeking to improve parents' eating patterns might lead to more favourable feeding practices for infants and young children.

Breastfeeding self-efficacy: a cohort study

Objective Evaluate the clinical use of the Breastfeeding Self-Efficacy Scale as predictive of early weaning and verify if women who had higher self-efficacy scores breastfed for longer periods. Methods Cohort study developed with 100 postpartum mothers. Research instrument used: Breastfeeding Self-Efficacy Scale-Short Form. The feeding was monitored on the 7th, 15th, 30th, 45th and 60th day, by phone. Results The mean duration of exclusive breastfeeding was 53.2 days (SD 14.2). Most mothers (82.3%) had scores compatible with high self-efficacy for breastfeeding, none had low efficacy. There was no statistically significant difference in the comparison of mean duration of exclusive and non-exclusive breastfeeding, with the scores of medium and high efficacy. Conclusion Findings did not enable the confirmation of the use of the scale as a predictor of risk of early weaning. No relation was observed between higher scores of high efficacy and longer periods of exclusive breastfeeding.

The impact of health workers' training on breastfeeding and complementary feeding practices

This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazil's Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56±1.91 months in the FHP intervention and 2.32±1.63 months in the HCC intervention) compared to the HCC control group (1.91±1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

Cesarean Delivery and Risk of Childhood Obesity

To investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity. Healthy, full-term infants were recruited. Overweight and obesity were defined using measured weight and height according to World Health Organization reference data. Associations between cesarean delivery and being overweight or obese were investigated at age 2, 6, and 10 years (n = 1734, 1244, and 1170, respectively) by multivariate logistic regression models adjusted for socioeconomic status, child characteristics, and maternal prepregnancy characteristics. Mothers who gave birth by cesarean delivery (∼17%) had a higher mean prepregnancy body mass index (23.7 kg/m(2) vs 22.5 kg/m(2)), greater mean gestational weight gain (15.3 kg vs 14.5 kg), and shorter mean duration of exclusive breastfeeding (3.4 months vs 3.8 months) compared with those who delivered vaginally. The proportion of obese children was greater in the cesarean delivery group compared with the vaginal delivery group at age 2 years (13.6% vs 8.3%), but not at older ages. Regression analyses revealed a greater likelihood of obesity at age 2 years in the cesarean delivery group compared with the vaginal delivery group at age 2 years (aOR, 1.68; 95% CI, 1.10-2.58), but not at age 6 years (aOR, 1.49; 95% CI, 0.55-4.05) or age 10 years (aOR, 1.16; 95% CI, 0.59-2.29). Cesarean delivery may increase the risk of obesity in early childhood. Our results do not support the hypothesis that an increasing rate of cesarean delivery contributes to obesity in childhood.

Effects of exclusive breastfeeding intervention on child growth and body composition: theMINIMat trial,Bangladesh

Exclusive breastfeeding (EBF) for 6months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition. In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54months and assessment of body composition at 54months. The mean duration of EBF in the BFC group was 111days compared to 76days in the UHM group (mean difference: 35.0days, 95% CI 30.6-39.5, p<0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54months. Children exposed to prenatal multiple micronutrients (vs 60mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference -0.17 SD score, p<0.01). Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0-54months, which raises questions about possible negative effects of MMS.

An Assessment of the Breastfeeding Practices and Infant Feeding Pattern among Mothers in Mauritius.

Proper breastfeeding practices are effective ways for reducing childhood morbidity and mortality. While many mothers understand the importance of breastfeeding, others are less knowledgeable on the benefits of breastfeeding and weaning. The aim in here is to assess breastfeeding pattern, infant formula feeding pattern, and weaning introduction in Mauritius and to investigate the factors that influence infant nutrition. 500 mothers were interviewed using a questionnaire which was designed to elicit information on infant feeding practices. Statistical analyses were done using SPSS (version 13.0), whereby chi-square tests were used to evaluate relationships between different selected variables. The prevalence of breastfeeding practice in Mauritius has risen from 72% in 1991 to 93.4% as found in this study, while only 17.9% breastfed their children exclusively for the first 6 months, and the mean duration of EBF (exclusive breastfeeding) is 2.10 months. Complementary feeding was more commonly initiated around 4–6 months (75.2%). Despite the fact that 60.6% of mothers initiate breastfeeding and 26.1% of mothers are found to breastfeed up to 2 years, the practice of EBF for the first 6 months is low (17.9%). Factors found to influence infant feeding practices are type of delivery, parity, alcohol consumption, occupation, education, and breast problems.

Financial incentives and coverage of child health interventions: a systematic review and meta-analysis

BackgroundFinancial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years.MethodsWe conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available.ResultsOur searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health check-up including growth control); management of diarrhoeal disease (ORS use during diarrhea episode, continued feeding during diarrhea, healthcare during diarrhea episode) and other preventive health interventions (iron supplementation, vitamin A, zinc supplementation, preventive deworming). The quality of evidence on the effect of financial incentives on breastfeeding practices was low but seems to indicate a potential positive impact on receiving colostrum, early initiation of breastfeeding, exclusive breastfeeding and mean duration of exclusive breastfeeding. There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization. There was low quality evidence of impact of CCT on healthcare use by children under age 5 (Risk difference: 0.14 [95%CI: 0.03; 0.26]) as well as low quality evidence of an effect of user fee removal on use of curative health services (RD=0.62 [0.41; 0.82]).ConclusionsFinancial incentives may have potential to promote increased coverage of several important child health interventions, but the quality of evidence available is low. The more pronounced effects seem to be achieved by programs that directly removed user fees for access to health services. Some indication of effect were also observed for programs that conditioned financial incentives on participation in health education and attendance to health care visits. This finding suggest that the measured effect may be less a consequence of the financial incentive and more due to conditionalities addressing important informational barriers.