Months Of Exclusive Breastfeeding Research Articles

Standardizing Patient and Provider Education to Address Breastfeeding Inequity

Introduction: Breastfeeding provides many infant, maternal and societal benefits. Breastfeeding reduces maternal and infant risks for a number of diseases, encourages maternal-infant bonding, is more environmentally friendly and lowers healthcare costs. Based on the most recent Women, Infants and Children (WIC) program data, the obstetrical patient population served by the Department of Ob/Gyn at Southern Illinois University School of Medicine (SIU-SM) was significantly lacking in breastfeeding initiation rates (~16% in 2020) when compared to the Healthy People 2020 goal for ever breastfed infants of 81.9%. We aimed to assess areas of patient care that could be improved upon when counseling our patients about breastfeeding. Purpose: Our primary goal was to evaluate current breastfeeding initiation rates and whether these improved after implementation of the standardized breastfeeding education materials that were to be provided to both healthcare professionals and patients. Methods: In partnership with the Illinois Public Health Institute (IPHI), all patients who received prenatal care at SIU-SM, Department of Ob/Gyn were offered standardized brochures that supplemented our prenatal counseling regarding breastfeeding. Nurses, residents, and other healthcare providers were also provided information on counseling patients. Breastfeeding rates were assessed in our prenatal population prior to and after implementing standardized breastfeeding educational materials (IRB# 22-133) and compared with Chi-square tests. Results: Patient demographics were as follows: 55.9% White, 31.8% Black/African American; 95.7% non-Hispanic; 93.4% utilized Medicaid services for insurance; the mean age was 26.8 ± 6.1 years of age. Baseline breastfeeding initiation rates of ever breastfed infants were significantly higher in the interventional group compared to the control group (75% vs.60%; p=0.002). Breastfeeding rates at the first postpartum visit were also significantly increased after the intervention (65% vs. 43%; p=0.008). A significant increase in the percentage of breast pumps provided in the prenatal clinic was also noted (28.4% vs. 0%; p<0.0001). Conclusions: Breastfeeding rates in our patient population were significantly lower than the Healthy People’s 2020 goal. Raising awareness through this initiative and improving our educational tools via the partnership with IPHI improved breastfeeding initiation rates. As obstetrical providers, we are optimistic about this data, but acknowledge additional interventions may be necessary to improve health equity across our disadvantaged patient population. Future directions include looking at data for ever breastfed infants vs. continuation of breastfeeding through the American Academy of Pediatrics recommended 6 months of exclusive breastfeeding. We would also like to explore how partner involvement and occupation type might impact breastfeeding initiation rates.

Breastfeeding and behavioral problems in five-year-old Japanese children: The Kyushu Okinawa Maternal and Child Health Study

PurposeThis prebirth cohort study examined the relationship between breastfeeding duration and behavioral problems in five-year-old Japanese children. MethodsStudy subjects were 1198 mother–child pairs. Data were collected using a self-administered questionnaire. Emotional, conduct, hyperactivity, and peer problems and low prosocial behavior were assessed using the Strengths and Difficulties Questionnaire (SDQ). ResultsNeither exclusive breastfeeding duration nor breastfeeding duration regardless of exclusivity was significantly associated with childhood emotional, conduct, hyperactivity, or peer problems or low prosocial behavior. In children with older siblings only, ≥ 4 months of exclusive breastfeeding was significantly inversely associated with hyperactivity problems (adjusted odds ratio [OR] = 0.57, 95 % confidence interval [CI]: 0.31−0.99). In children without older siblings, ≥ 4 months of exclusive breastfeeding was inversely significantly associated with low prosocial behavior (adjusted OR = 0.54, 95 % CI: 0.30−0.93). No interactions were observed between exclusive breastfeeding duration and the presence of older siblings regarding the two outcomes. ConclusionsNo associations were found between breastfeeding duration and any of the outcomes based on the SDQ. Exclusive breastfeeding for ≥ 4 months may be inversely associated with hyperactivity problems in children with older siblings and with low prosocial behavior in children without older siblings.

Determinants of exclusive breastfeeding among Chinese mothers in the first 6 months

Background/Aims Exclusive breastfeeding duration remains suboptimal among Chinese mothers. Understanding the factors that influence exclusive breastfeeding is essential for developing targeted interventions to promote breastfeeding practices. This study aimed to identify determinants of exclusive breastfeeding in the first 6 months after birth in Xuzhou City, China. Methods This prospective study enrolled 178 mothers, using structured questionnaires for data collection. Subsequent analysis used multiple linear regression to explore factors associated with exclusive breastfeeding duration. Results On average, participants exclusively breastfed for 67 days. Influencing factors included breastfeeding intention, perception of insufficient milk and maternity leave. Conclusions Targeted interventions have the potential to prolong exclusive breastfeeding duration, such as ensuring women develop accurate perceptions of their breast milk supply and extending maternity leave. Implementing these interventions is crucial to achieving the target of 6 months of exclusive breastfeeding, consequently contributing to optimal health benefits for mother–infant dyads in China.

Prenatal maternal stress, breastfeeding and offspring ADHD symptoms.

There is increasing evidence to suggest that environmental factors are associated with ADHD, but results regarding prenatal maternal stress, unwanted pregnancy, breastfeeding, and ADHD in children are controversial and few prospective studies have been conducted. Using prospectively collected data from the Northern Finland Birth Cohort 1986 (n = 7,910) we studied potential risk factors for ADHD symptoms at 8 and 16 years of age, including prenatal maternal stress and unwanted pregnancy, and protective factors including the duration of breastfeeding. Prenatal stress was associated with an increased risk of ADHD symptoms at the age of 16 (OR = 1.95, 95% CI: 1.34-2.80) and an unwanted pregnancy correlated with hyperactivity symptoms in the offspring at the age of 8 (OR = 2.08, 95% CI: 1.55-2.77). We did not find an association between prenatal maternal stress and hyperactivity symptoms in the offspring at the age of 8 (OR = 0.87, 95% CI: 0.69-1.08) or with unwanted pregnancy and ADHD symptoms at the age of 16 (OR = 1.13, 95% CI: 0.57-2.02). In relation to breastfeeding, over three months of exclusive breastfeeding was associated with lower hyperactivity symptoms in the 8-year follow-up (OR = 0.65, 95% CI: 0.46-0.92) and there was evidence of same kind of relationship concerning non-exclusive breastfeeding, but the association was not statistically significant (OR = 0.76, 95% CI: 0.54-1.06). In 16-year follow-up, under six months of non-exclusive breastfeeding showed an association with ADHD symptoms (OR = 0.68, 95% CI: 0.48-0.95) while exclusive breastfeeding did not (OR = 1.00, 95% CI: 0.66-1.55). In conclusion, our findings suggest that prenatal maternal stress increases the risk of more severe forms of ADHD symptoms in the offspring and breastfeeding can protect against such symptoms at the ages of 8 and 16.

Association between migraine and exclusive breastfeeding: A cross-sectional study.

Medical conditions may preclude a mother from exclusively breastfeeding her infant; however, the association between migraine and the duration of exclusive breastfeeding is not well known. To evaluate the association between migraine and the duration of exclusive breastfeeding in a representative sample of Canadian females. We used the Canadian Community Health Survey, a cross-sectional survey, to identify females aged 20-49 years who delivered a baby in the previous 5 years. History of migraine was self-reported. Females reported if they breastfed their baby, and among those who did, they further reported the duration of exclusive breastfeeding. We evaluated the association between migraine and the rate of breastfeeding, and the duration of exclusive breastfeeding adjusting for selected covariates. We included 5282 females, of whom 862 (16.3%) had migraine. Compared to females without migraine, females with migraine were less likely to have high income (annual income >$80,000: 362 [42.0] vs. 2276 [51.6]), and more likely to have comorbid mood (176 [20.5] vs. 378 [8.6%]) and anxiety (196 [22.8%] vs. 406 [9.2%]) disorders. Migraine was not associated with breastfeeding (proportion of females who did not breastfeed, migraine vs. no migraine: 114/862 [13.2%] vs. 498/4420 [11.3%]; adjusted odds ratio 1.03; 0.74-1.27); however, females with migraine had lower odds (≥6 months of exclusive breastfeeding: 216/688 [31.4%] vs. 1325/3561 [37.2%]; adjusted odds ratio from ordinal shift analyses 0.84; 0.71-0.99) of longer duration of exclusive breastfeeding than females without migraine. Females with migraine exclusively breastfeed their infants for a shorter duration compared to females without migraine, suggesting the need to better support this populationthrough education on the safety and benefits of exclusive breastfeeding and better access to safe and effective treatment of migraine in lactating females.

IJCM_25A: Effect of one-to-one counselling of mothers attending an immunization clinic on breastfeeding among infants- A Randomised Controlled Trial

Background: To improve breastfeeding practices, many interventions have been studied at various critical contact points. Our study aimed to improve exclusive breastfeeding by integrating a limited number of counselling sessions with routine immunization visits. Objective: To find out the effect of one-to-one counselling on six months of exclusive breastfeeding among infants attending immunization clinic. Methodology: An open-labelled, randomised controlled trial was conducted from September 2022 in the Immunization clinic at the Urban Health Training Centre of Dept of Community Medicine, UCMS, at Ghazipur, New Delhi. Mother-Child dyads visiting the clinic (child between 1 ½ to 3 ½ months) were recruited for the study based on certain appropriate inclusion and exclusion criteria. One-to-one counselling on breastfeeding and complementary feeding were provided, respectively, in the first visit (at the time of Pentavalent 1 or 2 vaccination,) and the second visit (at the time of Pentavalent 3 vaccination) to the intervention group. The control group received routine care. In the follow-up visit at 9 months for measles vaccination, a final assessment was done for both the groups. Analysis was done based on Intention to treat and per protocol approaches. Results: 92 Mother-child dyads were recruited in the study, of which 46 were randomized each in the intervention and control group. 6 were lost to follow-up on the second visit and 13 on the third (follow-up) visit. At the first visit, 56.5% of the mothers in the intervention group and 63% of mothers in the control group were exclusively breastfeeding. The proportion of mothers who exclusively breastfed their infant till six months of age were 65.2% in the intervention and 39.1% in the control group with an OR of 2.92(1.25, 6.81). Conclusion: One-to-one counselling at an immunization clinic has an effect on increasing rates of exclusive breastfeeding for 6 months.

Malnutrition in children under five years in a squatter settlement of Karachi: a case-control study

BackgroundMultidimensional factors such as socioeconomic or environmental factors influence malnutrition. Several studies have strongly linked malnutrition to poverty. Some international studies point to the worse nutritional status of urban slum children than rural children. Limited data is available regarding the nutritional status of slum children in Karachi. This study aimed to determine characteristics of malnourished children in an urban squatter settlement in Karachi, Pakistan.MethodsA case- control study was carried out at the primary healthcare center of a squatter settlement in Karachi, Pakistan. All children under five years of age visiting the primary healthcare center were recruited consecutively. Cases were defined as children with z scores < -2 SD of WHO reference measurements of WFA, HFA, WFH and OFC. The controls were similar in terms of age group but had z scores between − 2SD and + 2SD. A self- structured risk factor questionnaire that included information about sociodemographic, economic and environmental factors as well as child- related characteristics was researcher administered via face-to-face interviews with the mothers of children. Univariate and multivariate logistic regression analyses were conducted. Crude and adjusted odds ratios were calculated with 95% confidence interval.ResultsA total of 280 participants including 140 cases and 140 controls participated in the study. A larger proportion of the sample originated from individuals with low household income. After adjusting for the confounders, childhood malnutrition was significantly associated with a low education level of father (aOR 4.86, 95% CI 2.23–10.60), a monthly income less than 25,000 PKR (89 USD) per month (aOR 7.13, 95% CI 1.67–30.54), pour pit latrine type of toilet (aOR 4.41, 95% CI 2.67–7.3), less than six months of exclusive breast feeding (aOR 3.578, CI 1.58–8.08), inappropriate weaning age (aOR 3.71, 95% CI 1.53-9).ConclusionMalnutrition in children under five years of age in the community is associated with low family income, low paternal education, poor toilet facilities, lack of exclusive breastfeeding and inappropriate weaning age. The implementation of poverty reduction programs, sanitation provision at affordable rates, community-based breast feeding and weaning education intervention are urgently required to efficiently improve children’s nutritional status.

Vitamin d levels in pediatric epilepsy patients on the anti-epileptic drugs at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: Epilepsy is a common neurological disorder of childhood repeatedly necessitating prolonged use of anticonvulsants. This study was done to evaluate the status of vitamin D in epileptic children. We targeted to describe the prevalence and risk factors for vitamin D deficiency among children with epilepsy. &#x0D; Methods: A hospital-based descriptive cross-sectional study design with prospective data collection was used among children with epilepsy on anti-epileptic drugs attending the Pediatric Neurology Clinic and their primary caretakers. For this study, a sample of 226 children and adolescents were included in the study and a blood sample for the determination of serum vitamin D was taken. The participants were interviewed, and medical records were thoroughly reviewed. Descriptive statistics and binary logistic regression analysis was done to assess determinants of vitamin D deficiency. . &#x0D; Results: In this study, the prevalence of vitamin D deficiency was found to be 42%. Children on polytherapy (AOR = 4.3 (1.2 - 16)), 3 or more AEDs (AOR = 0.1 (0.0 - 0.8)), female sex (AOR = 1.8 (1.7 - 2.6)), age &gt;15 years (AOR = 2.12 (1.0 - 1.5)), 4 months of exclusive breastfeeding (AOR = 5.6 (4.9 - 36)), family diet (AOR = 0.3 (0.1 - 0.8)) and non-ambulation (AOR = 1.7 (1.8 - 3.6)) were factors associated with being in the vitamin D deficiency group.&#x0D; Conclusion: According to this study patients who take Anti-Epilepsy drugs are at a higher risk of a poor vitamin D status. Based on this finding, the need for timely and appropriate vitamin D supplementation and periodic follow-up seems to be very evident.

Breastfeeding and transpersonal values

This inquiry explored the impact of breastfeeding on mothers’ transpersonal values. It acknowledged societal obstacles mothers’ experience when attempting to breastfeed and included 12 participants who had a breastfeeding experience that reflects the current recommendations by the World Health Organization (WHO), meaning six months of exclusive breastfeeding followed by a combination of breastfeeding and solid foods for at least two years. The study followed an Organic Inquiry design which allowed for the incorporation of elements of feminism and environmental responsibility. Participant stories were collected through semi-structured online interviews, and the data was analysed using thematic analysis. Participants felt that breastfeeding enhanced transpersonal qualities at a personal level and noticed that these gave rise to transformative action at a community level. Six themes were identified: Transpersonal self-concept, spiritual insights, interconnectedness, discernment, alignment with nature and transformative changes. All participants regarded breastfeeding as a transformative experience which contributed to a sense of alignment with the natural world. Participants insights suggest a congruence of transpersonal psychology’s current focus on social engagement and environmental protection and global breastfeeding support efforts carried out by the WHO.

Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI.

Breastfeeding practices may protect against offspring obesity, but this relationship is understudied among women with obesity. We describe the associations between breastfeeding practices and child BMI for age z-score (BMIz), stratified by maternal BMI. We analyzed 8134 dyads from 21 cohorts in the Environmental Influences on Child Health Outcomes Program. Dyads with data for maternal pre-pregnancy BMI, infant feeding practices, and ≥1 child BMI assessment between the ages of 2 and 6 years were included. The associations between breastfeeding practices and continuous child BMIz were assessed by using multivariable linear mixed models. Maternal pre-pregnancy BMI category prevalence was underweight: 2.5%, healthy weight: 45.8%, overweight: 26.0%, and obese: 25.6%. Median child ages at the cessation of any breastfeeding and exclusive breastfeeding across the 4 BMI categories were 19, 26, 24, and 17 weeks and 12, 20, 17, and 12 weeks, respectively. Results were in the hypothesized directions for BMI categories. Three months of any breastfeeding was associated with a lower BMIz among children whose mothers were a healthy weight (-0.02 [-0.04 to 0.001], P = .06), overweight (-0.04 [-0.07 to -0.004], P = .03), or obese (-0.04 [-0.07 to -0.006], P = .02). Three months of exclusive breastfeeding was associated with a lower BMIz among children whose mothers were a healthy weight (-0.06 [-0.10 to -0.02], P = .002), overweight (-0.05 [-0.10 to 0.005], P = .07), or obese (-0.08 [-0.12 to -0.03], P = .001). Human milk exposure, regardless of maternal BMI category, was associated with a lower child BMIz in the Environmental Influences on Child Health Outcomes cohorts, supporting breastfeeding recommendations as a potential strategy for decreasing the risk of offspring obesity.

Breastfeeding and Weaning of Children: Identifying the Practice-relevant Issues in an Urban Area of Bangladesh

The initial six months of exclusive breastfeeding, followed by appropriate complementary feeding, are critical forchildren's optimal growth and development. Since the 1980s, numerous organizations in Bangladesh have beenpromoting breast feeding, yet age-old practices have not changed significantly. Still, approximately half of children inBangladesh are not breastfed exclusively for six months and do not receive adequate complementary food. This studysought to identify the barriers and facilitators to implementing proper Infant and Young Child Feeding (IYCF)practices. A cross-sectional descriptive study was conducted at the Department of Pediatrics at Bangabandhu SheikhMujib Medical College, Faridpur, from February to June 2021. This study included sixty-six mothers with infantsaged six to twenty-four months. Face-to-face in-depth interviews were used to collect qualitative data regarding thebarriers and facilitators. Transcripts of interviews were translated, transcribed, and examined to determine the primaryfactors. The most prevalent factor was a lack of knowledge and experience with breastfeeding and supplementalfeeding. In addition, contradictory feeding information from various sources and a lack of social support for pregnantand childbearing mothers with limited decision-making capabilities were significant obstacles. In contrast, motherswho received guidance from healthcare professionals before and after delivery and who were educated and receivedfamily support were more likely to follow the recommended practice. Interventions should be prioritized to encouragemothers to take timely antenatal and post-natal care and nutritional counseling during their visits. Educating andempowering them with adequate support from the family and society is essential. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):70-75

FRI448 Mother Versus Daughter Attitudes Toward Breastfeeding In American Indians: Implications For Reproductive Health Education

Abstract Disclosure: E.W. Seely: None. J.R. Demirci: None. L.E. Hebert: None. E. Kelty: None. M. heydarpour: None. K. Moore: Consulting Fee; Self; Novo Nordisk. D. Charron-Prochownik: None. Background: Breastfeeding has well established health benefits for mothers and their children, being associated with a reduction in incidence of type 2 diabetes and childhood overweight/obesity. Accordingly, the American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, followed by 1-2 years of continued breastfeeding. American Indian and Alaska Native (AIAN) women have among the lowest rates of breastfeeding of all races/ethnicities in the United States. The low rate is striking given the high rates of type 2 diabetes and obese/overweight AIAN children and young adults. To explore the low breastfeeding rates, we examined breastfeeding attitudes among AIAN mother-daughter dyads at 5 sites (Southwest, Northeast, Plains, and Northwest Coast, U.S.) in data from the Stopping GDM randomized controlled trial (NCT02723266). Methods: We used data collected among 149 mother-daughter dyads, who were asked 7 questions from the CDC’s Infant Feeding Practices Survey II focusing on the importance of breastfeeding and its potential health benefits. An additional question was asked: “If a child was breastfed, he/she will be less likely to get diabetes.” We compared mother/daughter attitudes using Chi-square tests. Results: Mean age + standard deviation of mothers was 44.1 + 9.3 and daughters 16.7 + 3.0 years. Eighty percent of both mothers and daughters agreed or strongly agreed that “Infant formula is not as good as breast milk.” However, attitudes that the best way to feed a baby is breastfeeding and that babies should be exclusively breastfed for the first 6 months were both statistically higher in mothers than daughters (74% vs. 59% and 68% vs. 40%, respectively). Mothers also had significantly higher agreement with the statements that breastfeeding was beneficial for prevention of ear infections (66% vs. 18%), respiratory illness (67% vs. 27%), diarrhea (48% vs. 22%), obesity (42% vs. 12%) and diabetes (35% vs. 13%) than daughters. Conclusion: Significant agreement between mothers/daughters exists for the belief that infant formula is not as good as breast milk. However, daughters’ attitudes toward the benefits of breastfeeding differ significantly from mothers with daughters endorsing weaker beliefs in infant health benefits of breastfeeding. This information is important to design early interventions to increase breastfeeding in AI women by increasing awareness of benefits and eliciting maternal support for adolescents and young adult women prior to planning a pregnancy. Presentation: Friday, June 16, 2023

Improved ambient air quality is associated with decreased prevalence of childhood asthma and infancy shortly after weaning is a sensitive exposure window.

The urban ambient air quality has been largely improved in the past decade. It is unknown whether childhood asthma prevalence is still increasing in ever top-ranking city of Shanghai, whether the improved air quality is beneficial for children's asthma and what time window of exposure plays critical roles. Using a repeat cross-sectional design, we analyzed the association between early life exposure to particles and wheezing/asthma in each individual and combined surveys in 2011 and 2019, respectively, in 11,825 preschool children in Shanghai. A significantly lower prevalence of doctor-diagnosed asthma (DDA) (6.6% vs. 10.5%, p < 0.001) and wheezing (10.5% vs. 23.2%, p < 0.001) was observed in 2019 compared to 2011. Exposure to fine particulate matter (PM2.5), coarse particles (PM2.5-10) and inhalable particles (PM10) was decreased in 2019 by 6.3%, 35.4%, and 44.7% in uterus and 24.3%, 20.2%, and 31.8% in infancy, respectively. Multilevel log-binomial regression analysis showed exposure in infancy had independent association with wheezing/DDA adjusting for exposure in uterus. For each interquartile range (IQR) increase of infancy PM2.5, PM2.5-10 and PM10 exposure, the odds ratios were 1.39 (95% confidence interval (CI): 1.24-1.56), 1.51 (95% CI:1.15-1.98) and 1.53 (95% CI:1.27-1.85) for DDA, respectively. The distributed lag non-linear model showed the sensitive exposure window (SEW) was 5.5-11 months after birth. Stratified analysis showed the SEWs were at or shortly after weaning, but only in those with <6 months of exclusive breastfeeding. Improved ambient PM benefits in decreasing childhood asthma prevalence. We firstly reported the finding of SEW to PM at or closely after weaning on childhood asthma.

Breastfeeding and room-sharing during COVID-19 in the Netherlands: The impact of perinatal healthcare support

AimThe recommendations of 6 months of exclusive breastfeeding (EBF) and parent-infant room-sharing (RS) are often not followed. As these early caregiving practices may have been affected by the COVID-19-related restrictions, we documented BF and RS practices in the Netherlands (2020−2021) and the effects of perceived perinatal healthcare support. MethodsPregnant women and mothers of an infant younger than 6 months (N = 784) completed online questionnaires (e.g., demographic information, the impact of COVID-19 on their lives aspects, infant childcare practices) twice: at the beginning of the pandemic and when the infant reached 6 months of age. ResultsThe pandemic EBF practices mirrored pre-pandemic Dutch reports (17.8 %; Mduration = 3.4 months), while RS rates and duration seemingly doubled (30.6 %; Mduration = 3.98 months). Higher maternal education (r = 0.18) and multiparity (r = 0.08) were significantly associated with longer EBF, and similarly for education (r = 0.17) and multiparity (r = 0.11) with RS durations. Higher perceived perinatal healthcare support predicted shorter RS duration [β = −0.509, t(5,596) = −2.27, p = .023]. ConclusionWhile the COVID-19 pandemic did not impact EBF, it may have promoted RS. The negative association between perinatal healthcare support and RS may suggest that parents who need more support from their providers also experience more challenges adhering to RS recommendations, yet this hypothesis remains to be corroborated.

Food handling practices, the prevalence of aflatoxin dietary exposure and its associated factors among children aged 6–23 months in Bukombe District, Tanzania

BackgroundComplementary foods are provided to newborns and early children to replace breast milk, which, after six months of exclusive breastfeeding, is no longer adequate to meet the child's nutritional needs. However, foods like dairy, grains like maize, sorghum, and millet, as well as nuts like groundnuts, which are frequently suggested as supplemental foods have all been linked to aflatoxin contamination. Understanding how caregiver preparation and storage practices of complementary flour affect children's aflatoxin exposure is crucial. ObjectiveTo determine the prevalence of dietary exposure to aflatoxin and its associated factors in children aged 6–23 months complemented with cereal-based foods in the Bukombe District of Geita Region in Tanzania. MethodologyAn analytical cross-sectional study was used to survey 342 households of children aged 6–23 months. Fifty complementary flour samples from 50 of the total households were chosen at random and tested for aflatoxin using the HPLC technique and standard methods. A semi-structured questionnaire was used to assess parents'/caregivers' food handling and preparation practices and the amount of food consumed. The obtained results were used to estimate aflatoxin dietary exposure of children in the study. ResultsMost of the children (86%) were exposed to aflatoxin through diet with a median value of 0.3 μg/kg-bw/day mainly linked to age and breastfeeding status. The majority of the exposed (86%) were above the reference limit of 0.04 μg/kg-bw/day. Most parents (98.5%) chose maize as the main component of complementary flour, either on its own or mixed with other cereals and winnowing and dehulling as the most and least common practices with the proportion of 78.9% and 9.4% respectively. Furthermore, a majority (88%) of flour samples were contaminated with aflatoxin B1 and total aflatoxin with log mean values of 1.2 ± 0.81 and 1.5 ± 0.68 μg/kg respectively which were above the Tanzania reference limit of 5 μg/kg and 10 μg/kg respectively. Contamination was significantly (p < 0.05) associated with location (Fisher's exact value = 6.68, p = 0.036), source of cereals (Fisher's exact value = 56.4 p = 0.025), and storage time (Fisher exact value = 23.8, p < 0.001). ConclusionIn view of the findings, aflatoxin contamination in flours used for complementary feeding was beyond tolerable limits, hence increasing the risk of children's dietary exposure. This suggests that strengthening strategies to control aflatoxin contamination of maize throughout the food chain and teaching parents about preparation and storage methods that reduce aflatoxin in cereals/flour are important.

Breastfeeding, Complementary Food, and the Risk of Stunting

Breastfeeding MedicineVol. 18, No. 5 EditorialFree AccessBreastfeeding, Complementary Food, and the Risk of StuntingArthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor-in-Chief Search for more papers by this authorPublished Online:17 May 2023https://doi.org/10.1089/bfm.2023.29244.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail My recent travels in war-torn East African countries, who are also suffering from years of severe drought, have only confirmed the conclusion that exclusive breastfeeding serves as the basis for successful infant nutrition, but that it alone cannot meet the vital needs of the growing and developing infant beyond 6 months of age.In these populations, the measure of significant chronic malnutrition is “stunting,” the relationship of height to age, and not the incidence of wasting, that is, the weight for age, or the weight for height relationship.All too often, examining a stunted child can be frequently falsely reassuring as their weight/height ratio is normal (they are proportional) and obvious clinical signs of malnutrition are not present. After a more careful examination and history taking, one realizes that the child being evaluated is not a 2-year-old, but rather a 4-year-old, that is, clearly stunted with a degree of irreversible damage to linear growth and brain development.This situation reflects the inability of mothers to provide adequate quality and quantity of “complementary” food to their infants beyond the first 6 months of exclusive breastfeeding. Simply put, even when mothers successfully continue to breastfeed for ≥2 years, the lack of sufficient protein- and mineral-rich food leads to the stunting inevitability. That 40% or more of children suffer from stunting is a measure of the consequences of a basic relatively nonmodern agricultural economy plus the negative effects of severe chronic drought and civil disturbances.For the past 10 years, I have participated in a nutritional supplemental program that was instituted for a targeted population in Ethiopia. A baseline evaluation of the total population noted a stunting rate of nearly 40%.1–3 Comparable statistics were noted in other areas of Ethiopia, and correlation with infant gender and associated gastrointestinal disease, maternal education, and socioeconomic level was noted.4 Most importantly, the availability of diverse complementary nutritional food was a critical variable in the stunting rate, whereas the frequency of breastfeeding or use of breast milk substitutes was not a variable in the development of stunting.4Simply put, an exclusive breast milk diet is not enough in these populations. As such, policies that focus on food availability, access, and supply are critical both on an individual maternal infant dyad level and as a national priority. What we should remember is that, in the end, it is infant nutrition that drives ultimate national economic success. As the World Bank has stated “ending undernutrition is an issue of equity and saving lives and also of boosting economies and prosperity and the prospect for all people around the world.”5

Effectiveness of a community-based support programme to reduce social inequality in exclusive breastfeeding: study protocol for a cluster-randomised trial

BackgroundBreastmilk is the ideal nutrition for infants, and breastfeeding protects infants and mothers from a range of adverse health outcomes. In Denmark, most mothers initiate breastfeeding but many cease within the first months resulting in just 14% reaching the World Health Organization recommendation of six months of exclusive breastfeeding. Furthermore, the low breastfeeding proportion at six months is characterised by a marked social inequality. A previous intervention tested in a hospital setting succeeded in increasing the proportion of mothers breastfeeding exclusively at six months. However, most breastfeeding support is provided within the Danish municipality-based health visiting programme. Therefore, the intervention was adapted to fit the health visiting programme and implemented in 21 Danish municipalities. This article reports the study protocol, which will be used to evaluate the adapted intervention.MethodsThe intervention is tested in a cluster-randomised trial at the municipal level. A comprehensive evaluation approach is taken. The effectiveness of the intervention will be evaluated using survey and register data. Primary outcomes are the proportion of women who breastfeed exclusively at four months postpartum and duration of exclusive breastfeeding measured as a continuous outcome. A process evaluation will be completed to evaluate the implementation of the intervention; a realist evaluation will provide an understanding of the mechanisms of change characterising the intervention. Finally, a health economic evaluation will assess the cost-effectiveness and cost-utility of this complex intervention.DiscussionThis study protocol reports on the design and evaluation of the Breastfeeding Trial – a cluster-randomised trial implemented within the Danish Municipal Health Visiting Programme from April 2022 to October 2023. The purpose of the programme is to streamline breastfeeding support provided across healthcare sectors. The evaluation approach is comprehensive using a multitude of data to analyse the effect of the intervention and inform future efforts to improve breastfeeding for all.Trial registrationProspectively registered with Clinical Trials NCT05311631 https://clinicaltrials.gov/ct2/show/NCT05311631

Investigating factors that influence the practice of exclusive breastfeeding among mothers in an urban general hospital in Ghana: a cross-sectional study

BackgroundIn Ghana, only 52% of mothers exclusively breastfeed their babies and the rate of increase has been steadily slow across all geographical areas of Ghana. The purpose of this study was to determine the various factors that influence exclusive breastfeeding (EBF) among mothers who visited the child welfare clinic at the Tema General Hospital, Accra, Ghana.MethodologyThis descriptive cross-sectional study was carried out at the Child Welfare Clinic of the Tema General Hospital, Accra, Ghana. A random sampling technique was used to recruit mothers with children between the ages of 6 months and 24 months attending the Child Welfare Clinic. Mothers were interviewed with the aid of a structured questionnaire.ResultsOut of the 222 of mothers interviewed, 68.8% of them exclusively breastfed their infants up to 6 months. Mothers who have good knowledge were more than 3 times (AOR = 3.484, 95% CI 1.200, 10.122, P = 0.022) likely to breastfeed their children exclusively. Those who had positive attitudes towards EBF were about 4 times (COR: 4.018, 95% = 1.444, 11.181, P = 0.008) more likely to exclusively breastfeed than those who had poor attitudes towards EBF. Also, mothers whose spouses complained about EBF were about 3 times (AOR: 2.655, 95% CI 0.620, 11.365, P = 0.018) at increased odds of not exclusively breastfeeding their babies.ConclusionsHigh rate of EBF among mothers who visited the child welfare clinic was found. The mothers' level of knowledge and attitude towards EBF significantly influenced the 6 months of EBF. Spouses also showed a high influence on whether or not mothers should exclusively breastfeed their babies.

The Current Status of Prolonged Breastfeeding and Its Related Factors in Korean Infants and Their Mothers: A Nationwide Cross-Sectional Study.

International authorities recommend prolonged breastfeeding (PBF) for 12-24 months or more with 6 months of exclusive breastfeeding (EBF). Based on the Korean National Health and Nutrition Examination Survey (KNHANES) data, this study attempted to help encourage and educate breastfeeding (BF) over 1 year by investigating long-term BF trends and related factors in Korean infants and their mothers. This cross-sectional study was based on data on children aged 12-23 months and their mothers from 2010 to 2020. BF rates were compared between KNHANES V (2010-2012), KNHANES VI (2013-2015), KNHANES VII (2016-2018), and part of KNHANES VIII (2019-2020). In addition, data related to mothers and infants, including demographics, socioeconomic, educational, and health status, were collected, and their association with BF status was analyzed. Of the 933 infants included in the study, the proportions achieving full BF at 6 months of age and PBF at 12 and 18 months were 34.8%, 33.7%, and 7.1%, respectively. Over the past 10 years, the trends of all three BF practices have significantly decreased since 2016 (P < 0.001). Of the 849 infants whose maternal data were available, multiple logistic regression analysis showed that EBF for 6 months (defined as full BF at 1, 3, and 6 months of age) positively correlated with maternal and infants' factors such as unemployed status, past BF experience, no history of drinking, and infants' birth weight of ≥ 2.5 kg. The mother's education level, particularly the nutrition label impact, current employment status, and smoking and drinking status, were significantly associated with PBF for ≥ 12 months but were not related to PBF for ≥ 18 months, except for drinking status. In Korea, the long-term BF rate of ≥ 12 months has declined in the past 10 years, and BF becomes rare after 18 months. Higher maternal interest in nutrition information appears to be driving access to PBF over 12 months than EBF for 6 months or PBF over 18 months. To promote PBF over 12 months in Korea, it may be helpful to strengthen nutrition education that specifically emphasizes the benefits of PBF along with EBF, especially during infant health examinations.

Perceived Hindering Factors of Exclusive Breastfeeding among Lactating Mothers of Itahari

Introduction: World Health Organization recommends first 6 months of exclusive breastfeeding after birth. It helps in proper growth and development of child. At the same time, it reduces infant mortality by preventing common childhood illnesses and helps for a quicker recovery during illness. So, the study aimed to identify the perceived hindering factors of exclusive breastfeeding among lactating mothers. Methods: A community-based, descriptive cross-sectional study was conducted in Itahari Sub-Metropolitan City. Convenience sampling technique was used to select a total of 123 lactating mothers having infants 0-6 months. A pretested questionnaire was used to interview mothers. Collected data were analyzed using descriptive and inferential statistics. Results: Although nearly all mothers (97.6%) had knowledge about exclusive breastfeeding and 93.5% of them had correct knowledge of recommended duration of EBF, the prevalence of exclusive breastfeeding was only 17.6%. Breastfeeding was initiated within 1 hour by 68.3% of mothers. Half of the mothers perceived that only mother’s milk is not sufficient to their child and about 22% of the mother’s perceived that their child is thirsty and should give water to the infant. Ethnicity and EBF duration to first child in multiparous mother was significantly associated with exclusive breastfeeding practice. Conclusions: Majority of the mothers do not practice EBF although they had known the recommended duration. The major hindering factor of EBF was the perception of the mother that the mother’s breastmilk only is not sufficient to the infant.