Perceived Breast Milk Insufficiency Research Articles

Factors influencing breastfeeding continuation and formula feeding beyond six months in rural and urban households in Indonesia: a qualitative investigation

BackgroundGlobal and Indonesian guidelines suggest that breastfeeding should continue for at least the first two years of life. While many studies have focused on six-month exclusive breastfeeding practices, little is known about why mothers do not sustain breastfeeding beyond this period. This qualitative study aimed to explore factors influencing breastfeeding continuation and formula feeding beyond six months, regardless of any additional food consumed, focusing on Indonesia’s rural and urban areas.MethodsWe collected the data through 46 in-depth interviews in Pati District and Surakarta City, Central Java, Indonesia. Participants were mothers, grandmothers, health care practitioners, and village kader (frontline female health workers). We used thematic analysis combining deductive and inductive techniques for analysing the data.ResultsRural mothers practised breastfeeding and intended to breastfeed for a longer duration than urban mothers. Maternal attitude towards breastfeeding, breastfeeding knowledge, previous experiences, and other breastfeeding strategies (e.g., enhancing maternal dietary quality) positively influenced breastfeeding sustainability. In the urban setting, mothers encountered several breastfeeding barriers, such as perceived breast milk insufficiency and child hunger and satiety, child biting, and breastfeeding refusal, causing them to provide formula milk as a breast milk substitute or supplement. In addition, families, communities, health practitioners, and employment influenced maternal decisions in breastfeeding continuation and formula-feeding practices.ConclusionsOptimal breastfeeding practices up to two years of age are determined by the individual and setting (i.e., community, healthcare, employment) factors. Providing breastfeeding education covering practical breastfeeding guidance will encourage mothers to breastfeed for longer. Such interventions should involve families, communities, health workers, and the work environment as a breastfeeding support system. Policymakers should develop, enforce, and monitor the implementation of breastfeeding policies to protect, promote, and support breastfeeding in households, communities, health systems, and work settings.

Perceived breast milk insufficiency: Prevalence and associated factors among women attending a young child clinic in Uganda

BackgroundThe most cited reason for early cessation or reduced exclusivity of breastfeeding is perceived breastmilk insufficiency. However, minimal work has been reported on perceived breast milk insufficiency, especially in Africa, where the practice of EBF remains low, hence the need to conduct the study. ObjectiveThis study aimed at identifying the prevalence and factors associated with perceived breast milk insufficiency. MethodsThis cross-sectional study was conducted among 180 mother-baby dyads with infants less than six months of age. The mothers attended an infant and young child clinic (IYCC) at an urban facility in Kampala. Data were collected using a structured interviewer-administered questionnaire using a systematic sampling procedure. Descriptive statistics and logistic regression were the major analysis techniques. ResultsThe prevalence of perceived breast milk insufficiency was (26 %). The reported indicators for PMI were; infant not gaining enough weight (38 %) and infant crying even after breastfeeding (38 %). Mothers who were unmarried (aOR = 0.18; 95 % CI = 0.05–0.61), and mothers who consumed less than two liters of fluid daily (aOR = 0.045; 95 % CI = 0.005–0.37) were more likely to experience perceived breast milk insufficiency. There is a need for continued reassurance and professional support for women to breastfeed their babies successfully.

Barriers and Facilitators to Optimal Infant and Young Child Feeding Practices in the Central Region of Ghana: Perceptions of Heath Care Providers

ObjectivesThis qualitative study sought to describe provider’s perspectives on barriers and facilitators to optimal infant and young child feeding (IYCF) practices (primarily exclusive breastfeeding (EBF), meal frequency, and diet diversity) among caregivers in Central Region of Ghana. MethodsQualitative data were collected through audiotaped in-depth interviews with care providers from three districts within the Central Region of Ghana: Gomoa East, KEEA, and Assin South (N = 18). Interviews were conducted in English, were audio taped, and transcribed. Transcripts were read and coded independently by two authors, consensus was reached about emerging domains and themes, and a final codebook was developed. The socioecological model was used to map barriers and facilitators for EBF and complementary feeding (CF) practices. ResultsPreliminary findings showed that several barriers and facilitators were similar for EBF and CF within each level. Individual level barriers included returning to work, poor maternal hygiene and ill health, limited maternal IYCF knowledge. Additional EBF barriers included not recognizing early hunger signs, breast problems, perceived breastmilk insufficiency while additional CF barriers were related to food access, time for preparation, and food safety. Interpersonal barriers/facilitators included family/provider support, family cultural beliefs/practices, family influence on practices, provider IYCF knowledge/education delivery, role modeling. Community level barriers/facilitators were related to the built environment including access to health facility and sanitation as well as community-level characteristics such as illiteracy and traditional beliefs. Societal barriers/facilitators included industry advertising, and IYCF policies/guidelines. Poverty was identified as a cross-cutting barrier. Providers recommended intensifying IYCF counseling, home visits to address barriers and training IYCF counseling. ConclusionsProviders were aware of challenges caregivers face when trying to practice optimal IYCF. Multi-level interventions are needed, including IYCF counseling to address identified barriers. Funding SourcesThis study was funded by UNICEF-Ghana.

Determinants of non-exclusive breastfeeding practice during the first 6 months after an elective caesarean birth: a prospective cohort study

BackgroundCaesarean birth is associated with higher rate of non-exclusive breastfeeding (non-EBF) than vaginal birth. Non-EBF refers to providing food or fluid besides breast milk, excluding drugs and vitamins, to infants before six months of age. This study determined the prevalence and factors associated with non-EBF during the first six months after an elective Caesarean birth.MethodsThis prospective cohort study recruited 171 mothers who underwent an elective caesarean birth at two tertiary hospitals in Kelantan, Malaysia. Face-to-face interviews were conducted two days after the birth to obtain information on the variables of interest. Follow-up phone calls were made at one, three and six months after birth to determine the prevalence of non-EBF. Simple and multiple logistic regressions were used for data analysis.ResultsThe prevalence of non-EBF was 19.9%, 40.4% and 57.9% at one, three and six months, respectively. Women who perceived that they had no breast milk, or their breast milk was inadequate were more likely to practise non-EBF at one month [Adjusted Odds Ratio (AOR) 4.83; 95% CI 1.06, 21.96], three months (AOR 4.97; 95% CI 1.67, 14.85) and six months (very often / often AOR 10.06; 95% CI 2.41, 41.99; sometimes / seldom AOR 3.27; 95% CI 1.46, 7.32). Women with at least one child were less likely to practise non-EBF at one month (age of last child ≤ 2 years old AOR 0.10; 95% CI 0.02, 0.66; 3–5 years old AOR 0.10; 95% CI 0.02, 0.53; and > 5 years AOR 0.15; 95% CI 0.02, 0.92).ConclusionPerceived breast milk insufficiency was the only factor associated with non-EBF at all time points. The issue of perceived breast milk insufficiency therefore needs to be explored further and addressed by lactation consultants and other maternal and child health professionals. Strategies may include breastfeeding education prior to the surgery and provision of a helpline to provide information and emotional support to the mothers following delivery. The important roles of lactation support groups in early detection and intervention of the problem cannot be emphasised enough.

Effectiveness of structured education and follow-up in the management of perceived breastmilk insufficiency: A randomized control trial

In this study, we examine the effectiveness of structured education and follow-up in the management of perceived milk insufficiency and in increasing the baby’s amount of milk intake in breastfeeding mothers. We conducted a randomized controlled trial over the period December 2018-June 2019 at Family Health Centers in Turkey with 64 mothers (intervention group: 33 and control group: 31). We provided the intervention group with education using structured educational material. A Descriptive Information Form, a Breastfeeding Follow-up Form, and the Scoring System for Measuring a Baby’s Intake of Breast Milk were the instruments we used in the data collection. Mothers in the intervention group started breastfeeding their babies in the first one hour after birth. We observed at each monitoring that a significantly greater percentage of the mothers in the intervention group believed their milk to be sufficient and that they fed their babies exclusively with breast milk in the three follow-ups. We found from the data we obtained that all three tracking times indicated that the baby’s amount of milk intake in the intervention group was better than in the control group; the differences were statistically significant. We concluded that structured education and follow-ups increased the exclusive breastfeeding of 0-2-month-old babies, improved perceptions of sufficient milk intake, diminishing the perception of breast milk deficiency. Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.2007249

Evaluation of perceived breast milk insufficiency in mothers of infants with infantile colic: a case-control study.

Mothers' lack of information about crying spells in infantile colic and feeling of insufficiency create anxiety in mothers, a decrease in satisfaction with being a mother and make them feel insufficient and tired. Fatigue in breastfeeding mothers can also lead to changes in milk biology and cause insufficient milk secretion. This study aims to determine the perceived breast milk insufficiency of mothers of infants with infantile colic and mothers of healthy infants. Mothers of infants aged three weeks to six months who were diagnosed with infantile colic (N.=162) and were healthy (N.=162), were admitted to the Pediatric Polyclinic of a hospital, comprised the target population of the case-controlled study. The Infant Colic Scale (ICS) and Perception of Insufficient Milk Supply (PIM) were used as data collection tools. The PIM score averages of the case and control group mothers were compared and the case group mothers had a significantly higher perception of insufficient milk (P<0.05). However, as a result of a correlation analysis between the ICS total and the subscale score average of the case group infants and the PIM Scale total score average of the mothers, no significant correlation was found (P>0.05). As a result of the study, there was a significant difference between the milk insufficiency perceptions of the case and control group mothers. However, no significant correlation was found between the infantile colic score of the case group infants and insufficient milk perception of the mothers.

Barriers and facilitators of exclusive breastfeeding: Findings from a Barrier Analysis Conducted in Mwenezi and Chiredzi Districts, Zimbabwe

A barrier analysis study was carried out in Mwenezi and Chiredzi Districts of Zimbabwe, to guide the development of a community-based behaviour change program. The aim of the barrier analysis was to identify factors that influenced a woman’s infant feeding and care practices. This paper reports the findings for one behaviour, exclusive breastfeeding. The study was based on the methodology from “A Practical Guide to Conducting a Barrier Analysis” (Kittle 2013). Structured in-depth interviews were administered to 91 women who were mothers of infants under the age of six months, 46 of whom who were exclusively breastfeeding and 45 who were not. Issues pertaining to self-efficacy, social support and perceived risks and benefits, as well as cultural and community norms and rules were identified. The qualitative analysis included sorting and identifying themes. Common barriers for exclusive breastfeeding were influence from the mother-in-law, high maternal workload, and perceived breast milk insufficiency. The main enablers were breastfeeding knowledge, the presence of a spouse/partner who assisted with chores and nurses who provided breastfeeding information. The insights gained from this study were used by Nutrition Action Zimbabwe to develop a behaviour change programme that was implemented from 2018-2020.

Profile and pattern of infants with mothers having lactation failure

Background: Breastfeeding mothers face various kinds of problems to breastfeeding. Literature on the frequency and outcome of perceived breast milk insufficiency in mothers of hospitalized neonates in India is patchy and scanty.Methods: Neonates weighing 1000 grams or more, and their mothers willing to breastfeed formed the study population. Relevant history was taken and clinical examination was performed along with anthropometry of the baby at the time of enrolment in the study. Mothers of neonates were also interviewed. Breast milk was also analyzed for sodium level by ion selective electrophoresis. Weight, head circumference and height were measured at each visit.Results: Of total 285 mothers, 188 mothers (65.9%) said that their milk formation was not sufficient and remaining 97 mothers said that their milk formation was sufficient to fulfil the needs of newborn. Breast milk sodium level was &gt;16 mmol/L in 142 (75.5%) mothers in the crisis group as compared to 21 (21.6%) in the non crisis group. Babies in the crisis group weighed significantly less at admission as well as discharge. The proportion of sick babies, use of bottles/pacifiers and pre lacteal feeds was significantly higher in the crisis group. The velocity of growth of neonates after discharge in both the groups was comparable.Conclusions: Lactation failure was more common among those mothers who were involved in delayed initiation of breastfeeding. Structured counselling sessions with reinforcement on lactation support were proved to be useful to mitigate the situation.

Prenatal infant feeding intentions and actual feeding practices during the first six months postpartum in rural Rwanda: a qualitative, longitudinal cohort study

BackgroundExclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0–1 month to 81% among those aged 4–5 months. Little is known about what influences mothers’ breastfeeding practices. This study aimed to gain insights into expectant mothers’ prenatal feeding intentions, the underlying reasons, actual practices after birth, and factors facilitating or impeding EBF for the first 6 months of a child’s life in Muhanga District, Rwanda.MethodsThis qualitative longitudinal study, conducted between December 2016 and October 2017 as part of a larger study, recruited a purposive sample of 39 pregnant women attending prenatal consultations during their last trimester in two rural health centers. Women were interviewed during pregnancy, within the first week after birth and at 4 and 6 months postpartum to explore intentions, actual practices, critical transition points, and facilitating or impeding factors. Interviews were recorded, transcribed verbatim, and analyzed thematically.ResultsOf the 39 participants, 38 intended to breastfeed within the first hour after birth, and 32 intended to breastfeed exclusively for the first 6 months. In practice, 34 initiated breastfeeding within the first hour, and 12 breastfed exclusively for 6 months. Impeding factors include perceived breastmilk insufficiency, pressure from family members, past experiences, mothers’ concerns over their infants’ health, mothers’ heavy workload, poverty and food insecurity. Factors facilitating early initiation and EBF include mothers’ awareness of EBF’s advantages, confidence in their breastfeeding ability, and support from health professionals and family members.ConclusionDespite participants’ intentions about breastfeeding, there was a gap between intentions and actual practices. An interplay of barriers at individual, group and societal levels impeded women from EBF for the first 6 months. EBF promotion interventions should consider supporting and equipping breastfeeding mothers with skills to deal with perceived breastmilk insufficiency and to recognize the true signs of baby hunger cues. Furthermore, important influential family and community members should be targeted to support mothers to breastfeed. Interventions that consider addressing the issue of poverty-driven food insecurity should not be overlooked either.

Formula Feeding and Associated Factors among a Group of Egyptian Mothers.

BACKGROUND:Breastfeeding provides an unequalled way of infant nutrition, despite that, the rate of exclusive breastfeeding for the first 6 months in Egypt is only 13%, and the rates of artificial feeding are rising.AIM:The current study aimed to explore the reasons for the use of artificial feeding among mothers receiving subsidised milk from formula dispensing centres in Egypt, and to detect the reasons behind the use of a formula only for infant feeding rather than mixed breastfeeding and artificial feeding.METHODS:This exploratory cross-sectional study involved 197 mothers; who attended centres for dispensing subsidised artificial formula at primary health care facilities (PHC) in El-Fayom and Ismailia governorates via a purposive sampling technique. The study spanned over 6-months duration from June till December 2018.RESULTS:A statistically significant higher percentage of artificial feeding only was noticed in male infants (47.5% in the AF group only versus 28.7% in the mixed feeding group (p = 0.018), and infants aged 6-12 months (47.5% in the AF group only versus 28.7% in the mixed feeding group, p = 0.032). A statistically significant higher percentage of artificial feeding only was noticed among infants born to mothers who have general anaesthesia during labour (67.2% in the AF group only versus 41.9% in the mixed feeding group, p = 0.004), and among infants born to mothers who think that formula feeding is better (13.1% in the AF group only versus 0.7% in the mixed feeding group, or that formula has a similar quality to breast milk (6.6%% in the AF group only versus 4.4% in the mixed feeding group, p = 0.0004. The most common reasons for formula feeding reported by both groups were perceived breast milk insufficiency (60.9%), weak babies (50.3%), and doctors’ advice (37%). Previous negative breastfeeding experience and the need for own body privacy were the two reasons which differed statistically in both groups p = 0.004 and 0.008, respectively.CONCLUSION:Antenatal care education is essential to improve mothers’ knowledge and practice of breastfeeding. Baby-friendly hospital initiative implementation is essential to ensure early initiation and continuation of breastfeeding.

A survey on difficulties and desires of breast-feeding women in Wuhan, China

Objectivesexclusive breast feeding in China is relatively low and no research has been conducted to explore the difficulties and desires of Chinese lactating mothers. Currently, Chinese women turn to massage therapists to increase breastmilk volume, implying that many breast-feeding women faced problems but had few support mechanisms.This study aimed to explore the difficulties and desires of Chinese breast-feeding women and to propose strategies for increasing the rate of exclusive breast feeding. Methodsthree hundred and seventy-five primiparous women were recruited from two randomized cluster communities in Wuhan following ethical approval. Face-to-face semistructured interviews were conducted with 76 of the participants to collect data on their infants' feeding status, duration of exclusive breast feeding, reasons for stopping, difficulties encountered, and sources of support for lactation. Resultsthe breast feeding initiation rate was 93.6%, but exclusive breast feeding was only 6.2% at six months. The most frequently cited reason for giving up exclusive breast feeding was perceived breastmilk insufficiency. Women cited a desire for professional and individualised instruction from following resources: (1) lactation consultants in hospital and communities; (2) Qualified cuirushi; (3) breast feeding website;(4) Relatives, friends and peers;(5) Telephone hotline. Conclusionsto improve the rate and duration of exclusive breast feeding in China, effective and available resources must be available. Timely,professional and face-to-face lactation counselling such as lactation consultant, qualified cuirushin is needed.

Perceived Breastmilk Insufficiency and HIV are Associated with Exclusive Breastfeeding at 1 and 3 Months among Mothers in Northern Uganda

Exclusive breastfeeding (EBF) contributes to the health and survival of HIV‐exposed and HIV‐unexposed infants and is recommended for 6 months. However, infant feeding practices are typically suboptimal in areas with high HIV‐prevalence, such as East Africa. Understanding the determinants of EBF is essential for designing comprehensive programs to support HIV‐infected and HIV‐uninfected mothers to EBF for 6 months, but these are not well understood. Therefore, our objective was to evaluate factors associated with EBF at 1 and 3 months among HIV‐infected and HIV‐uninfected mothers in Uganda.A sample of postpartum women, purposively selected to achieve a 2:1 proportion of HIV‐uninfected to HIV‐infected (n=238, 36.2% HIV), were recruited into a longitudinal cohort study at Gulu Regional Referral Hospital in northern Uganda. Demographics, psychosocial factors, individual food insecurity, HIV status, depression (using the Center for Epidemiologic Studies Depression Scale), breastmilk sufficiency, EBF intention, EBF knowledge, EBF‐specific social support (using an adaptation of the Hughes Breastfeeding Support Scale), and EBF self‐efficacy (using an adaptation of the Breastfeeding Self‐Efficacy Scale‐Short Form) were assessed at 1 and 3 months. These characteristics were compared between women who reported practicing EBF and those who did not at both 1 and 3 months postpartum, using chi‐square and t‐tests. We then built multivariate logistic models to explore factors associated with EBF at 1 and 3 months.Breastfeeding initiation was nearly universal in this sample (98%), with 64% reporting EBF at 1 month and 61% at 3 months. In multivariate logistic models of EBF at 1 month, perceived breastmilk insufficiency was negatively associated with EBF (OR 0.34, p=0.001) and HIV‐infected status was positively associated with EBF (OR 1.97, p=0.04). At 3 months, perceived breastmilk insufficiency was negatively associated with EBF (OR 0.24, p&lt;0.001) and HIV‐infected status (OR 2.24, p= 0.02) and EBF self‐efficacy (OR 1.16, p=0.05) were positively associated with EBF.In conclusion, perceived breastmilk insufficiency was associated with a substantially decreased likelihood of EBF at both 1 and 3 months, and low EBF self‐efficacy was associated with a decreased likelihood of EBF at 3 months. In addition, HIV‐infected women were much more likely to EBF at 1 and 3 months, compared to HIV‐uninfected women. These findings have important implications for programs, suggesting the need to address women's concerns about breastmilk insufficiency and better support women to feel confident in their ability to breastfeed in the early postpartum period in order to achieve EBF for 6 months. Because breastmilk insufficiency has been identified as a barrier to EBF globally, future research might also explore if breastmilk is objectively insufficient, or “only” perceived as such. The positive association between EBF and HIV‐infected status suggests infant feeding counseling to prevent mother‐to‐child transmission of HIV has likely been successful at increasing EBF. These lessons may be leveraged to increase EBF among HIV‐unexposed infants as well.Support or Funding InformationFunding: K01 MH098902, USAID Coop. Agreement AID‐OAA‐L‐10‐00006, and Cornell University‐Weill Medical College Inter‐campus Seed Funds

Traditional Oral Remedies and Perceived Breast Milk Insufficiency Are Major Barriers to Exclusive Breastfeeding in Rural Zimbabwe

Only 5.8% of Zimbabwean infants are exclusively breastfed for the first 6 mo of life despite substantial investment in exclusive breastfeeding (EBF) promotion throughout the country. We conducted a survey of 295 mothers of infants <6 mo of age who were recruited from rural immunization clinics and outreach sites in the Midlands Province of Zimbabwe. We explored infant feeding knowledge, beliefs and attitudes, and details regarding facilitators for EBF mothers and first foods fed by non-EBF mothers to identify and understand barriers to EBF. Among mothers of infants <1 mo, 1 to <2 mo, and 2–6 mo of age, 54%, 30%, and 12%, respectively, were practicing EBF. In adjusted multivariate analyses, EBF practice was positively associated with belief in the sufficiency of EBF (P = 0.05), belief in the avoidance of cooking oil feeding (a common traditional practice) in the first 6 mo (P = 0.001), and perceived pressure from others regarding infant feeding and traditional medicine use (P = 0.03). Psychosocial support and viewing breast milk as sufficient were reported as primary facilitators of EBF practice. Maternal responses to open-ended questions identified protection, nutrition, and crying as the main reasons for EBF interruption. During the first 2 mo of life, “protection feedings” using traditional oral remedies (such as cooking oil and water) to prevent or treat perceived illness, specifically colic and sunken/depressed fontanel, made up 78.5% of the non-breast milk feeds. From the second month of life, “nutrition feedings,” mainly of water and porridge, were given when mothers believed their breast milk was insufficient in quantity or quality to meet the hunger or thirst needs of their infants. Our findings underscore the importance of exploring cultural beliefs and practices as they pertain to infant feeding and care and present insights for designing and targeting EBF promotion interventions.

Decline of exclusive breastfeeding: Practical advice and stronger policy compliance are needed in government health services in Lima, Peru

In Peru, exclusive breastfeeding (EBF) in urban areas decreased from 64.5% in 2007 to 59.9% in 2010 despite a national infant feeding policy to protect, promote and support breastfeeding (BF). Health care providers (HCPs) play an essential role in influencing mothers’ feeding decisions. This study examined infant feeding advice provided by HCPs in government health services (N=3) in a peri‐urban area of Lima using a case‐study methodology. Semi‐structured interviews were conducted with 16 HCPs and 11 mothers of infants &lt; 6 months of age. Seven mothers participated in two focus group discussions. The health service environment and educational activities were observed. Advice was provided via growth monitoring and medical visits, nutrition counseling sessions, home visits and talks. HCPs recommended EBF for 6 months but did not provide practical advice to address common problems. Barriers to providing adequate BF counseling by HCPs included heavy client load, inadequate in‐service training, poor counseling skills, and formula industry influence. Barriers to EBF among mothers included employment, perceived breast milk insufficiency, and infant formula promotion. Improved training of HCPs, stronger monitoring of compliance and implementation of national policy are needed in government health services to protect BF behaviors. Funding: CIHR GBH‐87063; McGill University

Japan–France–US comparison of infant weaning from mother’s viewpoint

Background: Breastfeeding and weaning are strongly connected with infant–mother mutual autonomy, and hence are good touchstones to examine the characteristics of the mother–child relationship. Comparison of the weaning practice gives a framework to understand characteristics of the mother–infant relationship. Objective: The purpose of this study was to compare three industrialised countries concerning the relationship between feeding and weaning practices and its reasons, mother’s perception of child care, and of breast milk and formula. Methods: A questionnaire study on weaning practice was conducted for 310 Japanese, 756 French, and 222 American mothers with 4- to 20-month-old infants. Results: French mothers expected and had accomplished weaning at an earlier age of the infant, compared to Japanese and American mothers. Perceived insufficiency of breast milk was the leading reason for the termination of breastfeeding for Japanese mothers at the earlier stages, whereas back to work was the more important reason for French mothers. Japanese mothers were more negative in their image of themselves as mothers, whereas French mothers felt more burdened by child-care. Japanese mothers who terminated breastfeeding because of perceived breast milk insufficiency were also those who were less motivated to breastfeed. Conclusion: Weaning is a significant framework to interpret cultural differences in mother–infant relationship. The perceived insufficiency is interpreted as a solution of conflict between the social pressure to breastfeed and its burden.

Knowledge and practices of women in Monastir, Tunisia regarding breastfeeding

We assessed the prevalence of breastfeeding and its determinants and mothers' knowledge and practices towards this issue among 354 women attending primary health centres for their child's 6- month vaccination in the region of Monastir in 2008. The mean age of the women was 30 (SD 5.5) years. Most (90.8%) knew that breastfeeding helped prevent infections in babies but only 38.5% knew that breast milk supplies all infant feeding needs until 6 months of age. While was 94.4% breastfed their babies to start, only 1.9% continued exclusive breastfeeding until 6 months. Main reasons for stopping breastfeeding were perceived breast milk insufficiency followed by return to work. Exclusive breastfeeding over 3 months was associated with skin-to-skin contact (OR = 1.93; 95% CI: 1.016-3.69) and mothers' knowledge about breast milk benefits (OR = 2.8; 95% CI: 1.2-6.6). Early weaning was related to using pacifiers and breast-milk substitutes (OR = 0.17; 95% CI: 0.08-0.36 and OR = 0.14; 95% CI: 0.05-0.38 respectively).

Perceived breast milk insufficiency in mothers of neonates hospitalized in neonatal intensive care unit

A) To study the frequency of perceived breast milk insufficiency in mothers of hospitalized neonates. b) To assess subsequent duration of exclusive breast feeding and growth (upto three months) in neonates whose mothers perceived breast milk insufficiency. Neonates whose mothers were willing to breastfeed their babies were included in the study. Their breastfeeding status was assessed and the mother's perception of breastfeeding was elicited as per WHO guidelines. In mothers who perceived breast milk insufficiency (crisis group), causes for such a perception were looked into. Mothers were regularly counseled to breastfeed the infant After discharge the mother infant dyad were followed up for three months and babies evaluated for weight, length and head circumference. Three hundred and seven neonates and their mothers fulfilling the inclusion criteria were enrolled in the study. Perceived breast milk insufficiency was present in 208 (68%) mothers. Common reasons for such a perception were irrational. In the crisis group, 35% mothers had preterm babies as compared to 16% in the non crisis group (p =0.001). One hundred and fifty three mothers (73.33%) in the crisis group had breast milk sodium levels>16 mmol/L as compared to 12 mothers (12.12%) in the non crisis group (p 0.001). Micturition <6 times/24 hours was reported in 166 (83%) mothers in crisis group as compared to 18 (18.1%) mothers in non crisis group. All mothers who perceived breast milk insufficiency could be helped by lactation management and exclusively breastfed their babies. All infants were exclusively breastfed at discharge and at three month follow up. The growth of the infants was satisfactory in the crisis group at 3 months follow up. The Present study suggests that lactation failure following delayed initiation of breastfeeding can be countered by subsequent intensive counselling. Emphasis is required on counselling for breastfeeding in primary neonatal care.

Breastfeeding in China: a review

This review aims to describe changes in breastfeeding and summarise the breastfeeding rates, duration and reasons of discontinuing 'any breastfeeding' or 'exclusive breastfeeding' in P.R. China. Breastfeeding rates in China fell during the 1970s when the use of breast milk substitutes became widespread, and reached the lowest point in the 1980s. As a result many efforts were introduced to promote breastfeeding. The breastfeeding rate in China started to increase in the 1990s, and since the mid-1990s 'any breastfeeding' rates in the majority of cities and provinces, including minority areas, have been above 80% at four months. But most cities and provinces did not reach the national target of 'exclusive breastfeeding' of 80%. The 'exclusive breastfeeding' rates in minority areas were relatively lower than comparable inland provinces. The mean duration of 'any breastfeeding' in the majority of cities or provinces was between seven and nine months. The common reasons for ceasing breastfeeding, or introducing water or other infant food before four months, were perceived breast milk insufficiency, mother going to work, maternal and child illness and breast problems. Incorrect traditional perceptions have a strong adverse influence on 'exclusive breastfeeding' in less developed areas or rural areas. China is a huge country, geographically and in population size, and there is considerable ethnic diversity. Therefore breastfeeding rates in different parts of China can vary considerably.

Why healthcare workers give prelacteal feeds.

Because prelacteal feeds can adversely affect breastfeeding, UNICEF/WHO discourage their use unless medically indicated. The study was carried out to determine the proportion of healthcare workers who routinely give prelacteal feeds, and their reasons for doing so; further, to determine whether any differences exist between medically and non-medically trained healthcare workers in their administration of prelacteal feeds. Survey. Primary, secondary and tertiary health facilities in Kaduna township Nigeria. Of 1100 healthcare workers sampled, 747 (68%) responded. Of these 80% had received medical training, 20% had not. Use of a pretested validated questionnaire. Large proportions of both medical and non-medically trained healthcare workers stated they routinely give prelacteal feeds (doctors, 68.2%; nurses, 70.2%; and non-medical, 73.6%). However their reasons for doing so differed significantly (P=0.00001). Nurses gave mainly for perceived breast milk insufficiency, doctors for prevention of dehydration, hypoglycaemia and neonatal jaundice and non-medical staff to prepare the gastrointestinal tract for digestion and to quench thirst. Most healthcare workers (medical and non-medical) routinely and unnecessarily give prelacteal feeds. Therefore training and retraining programmes in lactation management are necessary and must include non-medical staff. These programmes, while emphasizing the danger of giving prelacteal feeds, must deal with the misconceptions of each group. Deliberate efforts have to be made to incorporate clinical training in breastfeeding in curricula of Schools of Medicine and Nursing.

Studies on perceived breast milk insufficiency—relationship to the weaning process

In order to study the weaning process in relation to transient lactation crises, 51 mother‐infant pairs were followed prospectively during the period from 3 days to 18 months after delivery. In total, 55% of the mothers experienced transient lactation crises, emanating mostly from a perception of breast milk insufficiency. It was found that those in the crisis group introduced taste portions and started the weaning process significantly earlier than those in the non‐crisis group although most mothers in both groups initiated weaning in accordance with general recommendations. A wide variation in the length of the weaning period was also found. In 25% of the infants in the crisis group and 35% in the non‐crisis group the weaning period lasted for more than 5 months. It was also revealed that most mothers in both groups started the transition from breast milk feeds to supplements at single feeds with the noon feed and ended the weaning with the evening or night feed. This transition at single feeds, however, was carried out at very different speeds, ranging from 0 to 46 weeks in the crisis group and from 0 to 28 weeks in the non‐crisis group. It is concluded that each individual mother seemed to have her own way of weaning her infant. A greater awareness of this variation in weaning behaviour is of importance when guiding the mother.