Suboptimal Breastfeeding Practices Research Articles

Imaging Enigma in Mastitis: A Comprehensive study of Multifaceted Causes, Clinical and Radiological Presentations

Mastitis is an inflammatory condition of the breast which represents an array of underlying etiologies encompassing both infectious and non-infectious causes. Exacerbating factors include endemic infections, lack of awareness and suboptimal breastfeeding practices. Neglected cases lead to prolonged morbidity, recurrent episodes, and complications such as abscess or sinus formation, resulting in permanent breast disfigurement. Its overlapping clinical presentation with breast cancer necessitates an integrated multidisciplinary approach for diagnosis and treatment. The primary aim was to investigate demographic, radiological, and histopathological characteristics of mastitis. Objectives included correlating radiological and histopathological findings, classifying mastitis by etiology, identifying the clinical and imaging patterns across diverse clinical settings to enhance the understanding of mastitis. This is a retrospective observational study, analysing the clinical, radiological, and histopathological data from 65 patients with mastitis between February 2023 and February 2024. The study included 65 patients, aged 18 to 65 years, with breast pain as the most prevalent clinical presentation. Cases were classified as infectious (47.6%) and non-infectious (52%). Acute puerperal mastitis (26.15%) and granulomatous mastitis (30%) were the most common subtypes. The commonest mammographic finding was focal asymmetry. On ultrasound, infectious mastitis showed oedema with other inflammatory changes, including diffuse skin thickening and collections; while non-infectious mastitis typically presented as solitary or multiple breast masses (p < 0.001). Surprisingly, idiopathic granulomatous mastitis constituted the largest percentage amongst various histopathological causes of mastitis in our study. An integrated multidisciplinary approach with understanding of the pathogenesis is imperative for prompt diagnosis and optimizing treatment strategies, thereby improving patient outcome. Radiological imaging is critical for diagnosis, evaluating disease extent, conducting guided interventions, and monitoring treatment response.

Prevalence and determinants of continued breastfeeding beyond 6 months among Algerian women. Evidence for Multiple Indicators Cluster Surveys

Breastfeeding is considered the best nutrition for infants and plays a significant role in a child's growth and development. In this regard, the World Health Organization (WHO) strongly recommends exclusive breastfeeding for the first 6 months of life, as well as continued breastfeeding when safe and appropriate complementary foods are introduced, up to 2 years of age or beyond. Nonetheless, breastfeeding practices remain sub-optimal in many parts of the world. In this respect, many children have shown not to be breastfed up to 6 months of age or are not breastfed during their first hours of life or are weaned too early. This allows for the use of infant formula, which can be life threatening due to poor hygiene, storage conditions or inappropriate foods. Likewise, breastfeeding rates in the Middle East and North Africa (MENA) region are lower than the global average. In Algeria, the breastfeeding rate up to 6 months of age is among the lowest in the world according to previous Multiple Indicators Cluster Surveys (MICS) reports. In addition, by the end of the sixth month, the percentage of children exclusively breastfed is less than 3% and only 23% of children receive breast milk at 22-23 months. The median duration of breast-feeding is 12 weeks. However, the socio-demographic factors associated with this sub-optimal breastfeeding practice are not explored in these reports, as studies and research conducted in this context using other data are few and mostly conducted in limited geographical areas. This stands for a descriptive cross-sectional study of all children who were breastfed in the MICS database, carried out in 2019, 8 709 children, including 4 471 boys and 4 238 girls, registered in the database. To explore factors associated with the duration of breastfeeding, we only included weaned children to minimize bias related to children who were still breastfeeding. This allowed to analyze data from 3 761 children, including 1 930 boys (5.4%) and 1,831 girls (48.6%). Through using a logistic regression model, we could attain the assessment of the role of different socio-demographic, economic and geographical factors in the maintenance of breastfeeding beyond 6 months. The prevalence of breastfeeding is 81.1%; the rate of exclusive breastfeeding of children aged 0-6 months is 28.7%. The factors associated with breastfeeding beyond six months are area of residence, mother's occupational status and wealth quintile. In fact, rural area appears to be a factor favoring the continuation of breastfeeding beyond six months, compared with urban area (OR = 1.29; CI [1.032-1.369]). Mothers living in the Eastern Highlands geographic region appear to be 1.56 times more likely to maintain breastfeeding for more than six months compared to those living in the Southern region (OR = 1.56; CI [1.123 - 1.677]). Children of non-working mothers are almost 1.5 times more likely to be breastfed after 6 months than those of working mothers (OR = 1.489; CI [1.107 - 1.947]). Parents belonging to the "richest" wealth quintiles appear to increase the chance of continued breastfeeding after 6 months with a 1.24-fold increase compared to those belonging to the "poorest" quintile (OR = 1.24; CI [1.086 - 1.812]). Factors such as the child's gender, maternal education level, and functional difficulties do not appear to be determining factors for the continuation of breastfeeding after six months. The prevalence and factors associated with the initiation and continuation of breastfeeding vary from one country to another. Notwithstanding the numerous studies to better comprehend mothers' breastfeeding behaviour and various initiatives for promotion thereof, many countries have low rates. In consequence, the downward trend in breastfeeding is directly linked to advances in the production and marketing of industrial milks, the lack of information and awareness among mothers and the lack of training of health professionals. In this respect, it is highly recommended to encourage behavioural changes, to improve communication about the duration of breastfeeding, to increase the use of postnatal counselling and training of paramedical staff according to the recommendations with support for mothers.This study is of great interest in developing countries like Algeria, in order to adopt preventive interventions, and to organise communication and pre- and post-natal counselling in the breastfeeding project. Clearly, this study should be enhanced with supplementary qualitative studies concerning the factors contributing to early discontinuation of breastfeeding.

Linkages between maternal experience of intimate partner violence and child nutrition outcomes: A rapid evidence assessment.

A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs]. We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs. We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children. Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.

Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum.

Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions. We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics. Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98). HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.

Patterns of Breastfeeding Practices among Mothers in Two Urban Cities in Vietnam

INTRODUCTION: Breastfeeding is associated with lower risk of child morbidity and mortality and foster overall child development. However, suboptimal breastfeeding practices have been reported in many countries. This study aims to describe patterns of breastfeeding from birth to 24 months in Vietnam and examine factors associated with the maintenance of breastfeeding at 12 months. MATERIALS AND METHODS: 573 mothers whose infants aged from 12 to 24 months in a multi-centre cross-sectional study were recruited. RESULTS: The prevalence of initiation of breastfeeding within the first hour post-partum was 52.9%, between 1 to 24 hours was 21.9%, after the 24 hours was 25.2% and none not initiated by the 7th day after birth. The prevalence of delayed initiation of breastfeeding was significantly higher in caesarean section than in vaginal births (p=0.0001). Prevalence of infants ever breastfed was 100%; exclusively breastfed at 6 months was 19.7%, continued breastfeeding at 12 months was 92.5%, and continued breastfeeding at 20-24 months was 43.5%. There were 16.4% of mothers had breastfeeding problems. Correctly describing the recommended duration of exclusive breastfeeding and not using a bottle to give expressed milk to the infants were factors associated with the higher prevalence of breastfeeding maintenance for 12 months. CONCLUSION: Early initiation of breastfeeding and exclusive breastfeeding prevalence at 6 months in our study earn rating of “good” and “fair” respectively according to World Health Organization (WHO) recommendation. Improving mothers’ knowledge of exclusive breastfeeding recommendations and educating about breast milk expression may improve the prevalence of breastfeeding maintenance at 12 months.

Breastfeeding among South Sudanese refugees in protracted settlements in Adjumani district, Uganda: facilitators and barriers

BackgroundEvidence suggests that forced migration and refugee status may adversely impact mothers’ breastfeeding choices. Furthermore, suboptimal breastfeeding practices have been reported among vulnerable populations including those living in refugee settlements. Therefore, this study investigated the barriers and facilitators of breastfeeding in protracted settlements in Adjumani district, in the West Nile region in Uganda.MethodsThis study was conducted among refugees living in protracted settlements located in Uganda in July 2019. Participants, originally from South Sudan, included mothers (n = 63) and fathers (n = 32) of children less than 24 months of age. Agojo, Ayilo-I, and Nyumanzi were randomly selected among the 17 refugee settlements in Adjumani. Participants formed a total of six focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. Each FGD consisted of 15–16 participants. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo, v. 12.ResultsFacilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers noted that breastfeeding protected children from diseases and breastfed children grew well. Fathers, the community, and organizations provided material support for breastfeeding mothers. Four themes were identified as barriers to breastfeeding: physical, socioeconomic, knowledge, and psychosocial. Mothers and fathers described physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers reported that working or educated mothers may use other milk to feed their infant. Some mothers and fathers believed infants under six months needed more than breastmilk. Fathers described psychosocial barriers such as mothers’ fear of pain during breastfeeding and maternal mental health issues.ConclusionInterventions and policies that aim to improve breastfeeding in protracted settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations.

Inpatient and outpatient treatment by specialist infant nutrition centres in Argentina effectively reduced child malnourishment.

We evaluated the impact of inpatient and outpatient treatment provided by an infant nutrition foundation in Las Heras, Mendoza, Argentina and identified the factors that influenced nutritional recovery. This 2010-2018 retrospective study was based on 300 children up to 5 years of age with primary malnutrition, who were treated by an inpatient recovery centre, then an outpatient prevention centre. We analysed the children's height, weight, psychomotor development and living conditions when they were admitted, discharged and had received 1 year of outpatient treatment. There were full data on 241 children and just admission and discharge data for 59. The children's mean age on admission and weight were 14.8 ± 12.4 months and 6.9 ± 2.3kg and they stayed in hospital for a mean of 59.5 ± 49.7 days. We observed a significant increase in the weight-for-age, height-for-age and weight-for-height z-scores when all three time points were compared (p < 0.001). Psychomotor development improved considerably in all patients after treatment. The factors that negatively influenced nutritional recovery were higher age at admission, suboptimal breastfeeding practices, low birth weight, longer hospital stays, younger maternal age and overcrowded housing. Combining inpatient recovery and outpatient preventive treatment was effective for undernourished children in Argentina.

Barriers of exclusive breastfeeding among mothers attending primary health-care centers in Jazan, Saudi Arabia.

Exclusive breastfeeding (EBF) describes infants who were only breastfed for 6 months. Many Saudi mothers have suboptimal breastfeeding practices. Therefore, this study aims to assess breastfeeding knowledge and determine barriers to EBF among mothers attending primary health care centers in Jazan City. A descriptive cross-sectional study was done that included all mothers attending the PHC centers. Data were collected through a self-administered questionnaire. Most study participants understand breastfeeding's health benefits for babies and mothers, but most believe that synthetic milk is the best alternative for working mothers to feed their babies. A percentage of 66.7 of mothers practiced breastfeeding during the first 6 months of the child's life. EBF shows a significant relationship with knowledge and barriers. Sixty percent of mothers have never had any information about breastfeeding; the primary source was from their mothers and only 31.4% from hospital staff. Most respondents disagreed with statements of barriers to EBF, which elicits an unexpected response. Most participants have good knowledge concerning breastfeeding benefits for both mother and infant and disagreed on the mentioned barriers for EBF that include lack of breastmilk, deficiency of information, and working conditions.

The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies.

In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I2 . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I2 = 0.00%, PQ < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated alow-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.

The Impact of Antenatal Obesity on Offspring Breast Feeding - A Review

ObjectivesThe double burden of malnutrition has been a vicious cycle of which culmination is really challenging. The larger proportion of malnutrition is taken over by obesity worldwide. Over and under nutrition are interrelated at deeper levels although seem like simply two different entities to address. Maternal obesity causes poor breast feeding which will lead to infant undernutrition and subsequent risk of obesity in later life(1–3). This review aims discovering the best available evidence on antenatal obesity resulting in delayed establishment, non-exclusive and early cessation of breast feeding.MethodsSystematic reviews published between 2000 and December 2021 were searched for stronger evidence in PubMed and Google scholar with key words.ResultsFive systematic reviews(4–8) with evidence on obesity and breast feeding association were analyzed. There were statistically significant associations (at 5% significance level) reported with delayed establishment, less intention and early cessation of breast feeding of their offspring in women with antenatal obesity in all five reviews. Delayed lactogenesis and reduced lactation were evident among obese(5–7). Obese women breast fed shorter duration than normal weight women even after correcting for possible confounders(8). And non-exclusive breast feeding was also identified as comparatively higher among obese (4). Results were in consistent with a dose-response meta-analysis (6). The reasons identified varies i.e., physiological, behavioral, socio-cultural, psychological and medical (8). Obesity physiologically reduces lactogenesis (7,9). Large breasts may make latching on difficult (poor positioning and attachment) (8,10). Poor mental health, feeling uncomfortable at feeding in public or lack of confidence on body image can be the causes. And obese mothers are more prone to get delivery complications whose babies may end up in delayed initiation and non-exclusive breast feeding(10).ConclusionsIt is evident that the antenatal obesity is associated with sub-optimal breast-feeding practices which needs both medical and behavioral change interventions. The need of more qualitative studies for deeper understanding of maternal perceptions is underscored before planning interventions.Funding SourcesNone.

Violência física contra a mulher pelo parceiro durante a gravidez e sua relação com o aleitamento materno

Abstract Objectives: to estimate the association between physical violence against women by their intimate partner during pregnancy and breastfeeding. Methods: the data source is the 2010 National Demographic and Health Survey (DHS) conducted in Colombia, and 11,416 mother-child dyads were analysed. The relationship between physical violence against women by their partner during pregnancy and breastfeeding indicators was carried out using the weighted propensity score from the Inverse Probability of Treatment Weighting (IPTW). Variables for adjustment were selected through the Directed Acyclic Diagram (DAG) and performed a sensitivity analysis to identify the strength of hidden bias. Results: according to the data, 6.4% (730) of the women suffered physical violence by their partner during their pregnancy. The median time of exclusive breastfeeding was 1.0 month. No statistically significant relationship was observed with any of the breastfeeding indicators analysed: exclusive breastfeeding (OR=1.17; CI95%=0.82-1.67); breastfeeding at any time (OR=1.61; CI95%=0.58-2.60); and initiation of breastfeeding (OR=1.07; CI95%=0.74-1.2) Conclusion: although the association between violence against women committed during pregnancy and breastfeeding indicators was not found, the suboptimal breastfeeding practices and high prevalence of violence against women by the partner are two major public health issues in Colombia. Prenatal care professionals can change this scenario by identifying women exposed to intimate partner violence and offering tailored support for breastfeeding practices.

Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia.

Background:The world is now suffering from malnutrition and remains one of the leading causes of death for under 5 children. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Therefore, the aim of this study was to assess the EIBF practices and determinants among children aged less than 24 months in West Belessa district, Northwest Ethiopia, 2019.Methods:A community-based cross-sectional study was conducted from January 2 to February 28, 2019 in the West Belessa district. A total of 569 mother-children pairs were participated in the study. Study particnapants were selected by using simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable and Multivariable logistic regression analysis were done. Odds ratio with 95% confidence was done to determine the level of significance value less than .05 considered as significant with the outcome variable.Result:The prevalence of early initiation of breastfeeding (EIBF) was found to be 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR = 2.76, 95%CI [1.21, 6.27]), antenatal care (ANC) (AOR = 3.79, 95%CI [2.58, 9.94]), and number of antenatal care visit (AOR = 1.85, 95%CI [1.03, 3.85]) were significantly associated with early initiation of breastfeeding.Conclusion and Recommendation:In this study, more than three fourth of children were received early initiation of breastfeeding within 1 hour after delivery. Age of the mother, antenatal, and number of antenatal care were associated with EIBF. Therefore, during this contact period, improve antenatal services by increasing accessibility and providing counseling is important to improve EIBF utilization.

Maternal experience of intimate partner violence is associated with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia: insights from a DHS analysis

BackgroundDespite widespread suboptimal breastfeeding practices and maternal experiences of intimate partner violence (IPV), the association of IPV and breastfeeding practices remains unclear. This study investigated the associations between maternal experience of physical, sexual, emotional violence, and controlling behaviors with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia.MethodsData included mother-infant dyads from the most recent Demographic and Health Surveys for Malawi (n = 1878), Tanzania (n = 3184), and Zambia (n = 3879). Intimate partner violence (physical, sexual, and emotional) was measured using the Revised Conflict Tactics Scale. Breastfeeding practices were early initiation of breastfeeding (within 1 h of birth), exclusive breastfeeding (in previous 24 h), and continued breastfeeding. Associations between experience of physical, sexual, or emotional violence or controlling behaviors and breastfeeding practices, as well as associations between the frequency of IPV and breastfeeding practices were assessed.ResultsMany Malawian (77.6%) and Zambian (67.7%) and just over half (53.6%) of Tanzanian mothers, initiated breastfeeding within 1 h of birth. Exclusive breastfeeding was 70.6% in Zambia and 60.1% in Malawi, while 55.0% of Tanzanian mothers breastfed exclusively. Continued breastfeeding to at least 1 year was high in Malawi 92.2%, Tanzania 93.4%, and Zambia 95.0%. Most mothers reported experiences of IPV in Tanzania 79.1%, Zambia 78.9%, and Malawi 73.9%. Mothers who experienced sexual IPV were significantly more likely to delay breastfeeding (Malawi [AOR 1.55 (1.14, 2.10)]; Tanzania [AOR 1.30 (1.04, 1.62)]; and Zambia [AOR 1.28 (1.06, 1.54)]). Sexual IPV in Malawi and Zambia was associated with greater odds of not exclusively breastfeeding (Malawi [AOR 1.90 (1.05, 3.45)]; Zambia [AOR 1.75 (1.15, 2.67)]). Tanzanian mothers who experienced IPV often or sometimes were two times more likely not to breastfeed at one-year post-delivery [AOR 2.23 (1.09,4.57)].ConclusionsIn the three countries investigated maternal experience of IPV was associated with suboptimal breastfeeding practices. Policies and programs targeting improved breastfeeding practices should consider screening during antenatal and postnatal care for experience of violence and support initiatives to reduce IPV.

Determinants of Early Days of Newborn Feeding Malpractice Among Mothers of Children Less Than One Year of Age in Mizan-Aman Town, Southwestern Ethiopia, 2020.

BackgroundSuboptimal breastfeeding practices have remained a global public health issue, particularly in Ethiopia due to early days of newborn breastfeeding practices. Although several measures have been taken to comply with the WHO guidelines, newborn feeding malpractices are widely seen in Ethiopia.ObjectiveTo assess the prevalence and determinant of early days of newborn feeding malpractices among recently delivered women in Mizan-Aman Town, southwestern Ethiopia, 2020.MethodsA community-based cross-sectional study of recently delivered women was conducted between March 5/2020 and April 8/2020. A total of 487 mother-to-child (<12month) pairs were selected using a multi-stage randomized sampling technique and the data were collected through a face-to-face interview using a structured questionnaire. The result was analyzed via SPSS version 26. Multivariate logistic regression analysis was used to assess the determinant of newborn feeding malpractices and a p<0.05 was deemed to be significant.ResultsPrevalence of prelacteal feeding, delayed initiation of breastfeeding and colostrum avoidance was approximately 21.9%, 35.5% and 15.5%, respectively. The most common prelacteal food was Rue/“Tenadam”/49 (10.1%). The key reasons for this were: 49 (10.1%) Cultural activity followed by 45 (9.3%) intestinal/ghost/birth clean-ups. Determinants of prelacteal feeding were found to be: mothers who recognize the risks of prelactate feeding, multipara mothers, had ≥4 children and infants birth order between 4 and 6. Likewise, exposure to infant formula advertising, absence of home-to-home health education, multipara mothers and spontaneous vaginal birth were the determinants of colostrum avoidance.ConclusionThe study found that one in four and one-third of newborns had experience with prelacteal and delayed breastfeeding, respectively. This makes the newborn feeding practice suboptimal in the city. As a result, behavioral modification programs on the prevention of prelacteal feeding and enhancement of early initiation of colostrum feeding practices are recommended.

Autism spectrum disorder in the United Arab Emirates: potential environmental links.

Autism spectrum disorder (ASD) has been experiencing an increase in global prevalence in recent decades. While many factors could account for this reality, certain environmental links have been shown to contribute to ASD development and etiology. The Middle East has had relatively little published research on ASD etiology although statistics indicate that ASD affects 1 in 146 births in the United Arab Emirates (UAE). This review therefore aims to examine potential causes of ASD within the UAE specifically, focusing on environmental links that may contribute to the rise in ASD cases in this population. Significantly, suboptimal breastfeeding practices, high levels of vitamin D deficiency, increased exposure to pollution, pesticides and heavy metals within the UAE may all be potentially important contributing factors to ASD in this population. Our findings support the notion that there are key links between various environmental factors and ASD prevalence in the UAE. The lack of knowledge and much research on ASD within the UAE deeply necessitates further studies on its etiology as it poses a serious public health challenge in the region and globally.

Delayed Lactogenesis Is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study

Breastfeeding has many established health benefits to both babies and mothers. There is limited evidence on the association between delayed lactogenesis and breastfeeding practices. We assessed the association between delayed lactogenesis and breastfeeding practices in women initiating breastfeeding. We used data from a prospective cohort study in Wuhan, China, which enrolled pregnant women at 8-16 weeks of gestation and followed up to postpartum. Women were included who had a singleton live birth, initiated breastfeeding, and provided information on infant feeding. Maternal lactogenesis status was assessed by face-to-face interview at day 4 postpartum. Breastfeeding practices (full breastfeeding and/or any breastfeeding) were queried by telephone interview at 3, 6, and 12 mo postpartum. Poisson regression and Cox regression were used to identify the association between delayed lactogenesis and breastfeeding practices. Delayed lactogenesis was reported by 17.9% of the 2877 participants. After adjusting for potential confounders, when compared with timely lactogenesis, delayed lactogenesis was significantly associated with higher risk of inability to sustain full breastfeeding at 3 mo postpartum (RR: 1.24, 95% CI: 1.10, 1.39) and 6 mo postpartum (RR: 1.14, 95% CI: 1.04, 1.24). Delayed lactogenesis was also significantly associated with early termination of any breastfeeding (HR: 1.15, 95% CI: 1.01, 1.30) in the adjusted model. In a combined analysis, women with higher gestational weight gain (GWG, ≥16kg for underweight and normal weight, 15kg for overweight/obesity) and who subsequently experienced delayed lactogenesis had the highest risk of ending any breastfeeding earlier (adjusted HR: 1.32, 95% CI: 1.11, 1.55) compared with those who gained less GWG and experienced timely lactogenesis. This study shows that delayed lactogenesis was associated with low rate of full breastfeeding and shorter duration of any breastfeeding. Greater efforts to promote breastfeeding should be targeted towards women with delayed lactogenesis.

Exploring the challenges and opportunities towards optimal breastfeeding in Ethiopia: a formative qualitative study

BackgroundBreastfeeding, particularly exclusive breastfeeding, is essential to ensure the short- and long-term health of infants and mothers. Sub-optimal breastfeeding practices currently take place in low income countries contributing to morbidity and mortality. This research explored the challenges and opportunities around exclusive breastfeeding in a large city in Ethiopia to inform a larger breastfeeding intervention.MethodsFathers and mothers who had children less than 2 years of age, and who could speak, and understand Tigrigna were recruited from two health centres located in Mekelle, Ethiopia. Two focus group discussions (FGDs) with fathers and two FGDs with mothers (n = 42) were conducted using a semi-structured interview guide to explore the challenges and opportunities related to breastfeeding. Discussions were audio-recorded and transcribed in Tigrigna and translated to English. The data were manually analysed using thematic analysis, generating open codes which were grouped to form themes.ResultsFour themes with 11 sub-themes emerged. The themes identifies were: conflicted emotions on the birth of baby (feeling happy and feeling worried); perspectives on intergenerational approaches (old-fashioned beliefs of grandparents and the power of science, breastfeeding in public, breastfeeding knowledge); gender roles as barriers and enablers (the burden on women, changes in men’s roles and the financial status of the household); the role of healthcare (delivery of health information to parents, the role of health care providers and perceptions of inadequate milk supply).ConclusionParents reported a range of opportunities with respect to breastfeeding, including the power of a scientific approach, the positive role of healthcare, and shifts within gender roles that maximized the potential support from fathers. However, there remains a tension between the beliefs of older generations and current best-practice. Parents continue to need ongoing support in order to practice optimal breastfeeding.

Breastfeeding practices within the first six months of age in mid-western and eastern regions of Nepal: a health facility-based cross-sectional study

BackgroundThe World Health Organization recommends initiation of breastfeeding within 1 hour of birth and exclusive breastfeeding up to 6 months of age. Infant feeding practices, including suboptimal breastfeeding practices, are associated with stunting. Rate of stunting was highest in the Mid-western region and lowest in the Eastern region of Nepal. This study aimed to assess the breastfeeding practices in these two regions, as well as to identify factors associated with partial breastfeeding.MethodsWe conducted a health facility-based cross-sectional study in the Mid-western and Eastern regions of Nepal from December 2017 to May 2018. Investigators administered a pre-tested questionnaire among consecutive 574 mother-infant dyads at different levels of health facilities. We dichotomized the breastfeeding pattern to partial breastfeeding and full (exclusive or predominant) breastfeeding. We conducted multivariable logistic regression to identify factors associated with partial breastfeeding within 6 months of age.ResultsThere were 574 infants included in the study, all of which received at least some breastfeeding. Only 23.2% of infants were exclusively breastfed until 6 months, with 28.2% predominantly breastfed and 48.6% partially breastfed. Partial breastfeeding rate was 52.3% in the Mid-western region and 44.4% in the Eastern region. Breastfeeding was initiated within an hour from birth in 67.2% of infants. One-quarter of infants were given pre-lacteal feed, honey being the commonest. Knowledge of the recommended duration of exclusive breastfeeding was inadequate in 16, and 65% of mothers reported breastfeeding problems in the first 6 months. Firstborn and low birth weight infants had a significantly higher rate of partial breastfeeding. Partial breastfeeding was also higher when infants were not breastfed within 1 hour from birth, mothers reported having breastfeeding-related problems or had inadequate knowledge of the duration of exclusive breastfeeding.ConclusionNearly half of the infants were fully breastfed at 6 months of age in Nepal. The rate of partial breastfeeding was higher with inadequate knowledge on duration of exclusive breastfeeding or late initiation of breastfeeding or perceived breastfeeding problems. Hence, programs should address knowledge and practice gaps in breastfeeding practices, particularly among mothers of low birth weight and firstborn infants.

Determinants of early breastfeeding initiation and exclusive breastfeeding in Colombia.

To identify modifiable risk factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Colombia. Cross-sectional study from the 2010 Colombia nationally representative Demographic Health Survey (DHS). Studied exposures were categorized into five hierarchical blocks of increasing proximity to the outcomes: household, maternal, health systems, child, and early feeding characteristics. The two outcomes examined were delayed breastfeeding initiation among infants <24 months and interruption of EBF among infants <6 months. Prevalence ratios were computed using Poisson regression analysis with robust error variance, adjusted for sampling weights, following a hierarchical modelling approach. Nationally representative cross-sectional survey from Colombia. The EIBF analytical sample included 6592 and the EBF sample 1512 women with young children. EIBF prevalence was 65·6 % in children under 24 months and EBF was 43 % in infants under 6 months. Modifiable risk factors associated with delayed breastfeeding initiation were: C-section (PR = 2·08, CI 95 % = 1·92, 2·25), maternal overweight/obesity (PR = 1·09, CI 95 % = 1·01, 1·17), lack of skilled attendant at birth (PR = 1·09, CI 95 % = 1·01, 1·18). Modifiable risk factors for EBF interruption were C-section (PR = 1·12, CI 95 % = 1·02, 1·23) and prelacteal feeding (PR = 1·51, CI 95 % = 1·37, 1·68). Non-pregnancy intention was a protective factor for EBF interruption (PR = 0·82, CI 95 % = 0·72, 0·93). C-section, lack of skilled attendant at birth, prelacteal feeding, maternal nutritional status, and pregnancy intention were modifiable factors associated with suboptimal breastfeeding practices in Colombia.

Maternal Experience of Intimate Partner Violence Is Associated with Suboptimal Breastfeeding in Malawi, Tanzania, and Zambia: Insights from DHS Analyses (P10-059-19)

ObjectivesMaternal experience of intimate partner violence (IPV) remains an overlooked variable in the context of breastfeeding in East Africa. Therefore, this study investigated the association between maternal experience of different forms of intimate partner violence (IPV) and frequency of IPV and suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia. MethodsData were obtained from the most recent Demographic and Health Surveys for Malawi (n = 1878), Tanzania (n = 3184), and Zambia (n = 3879) and included mother-infant dyads. Outcomes were early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding. IPV was maternal reported experience of physical, sexual, or emotional violence or controlling behaviors and frequency of IPV. Significant bivariate results (P < 0.05) were included in the adjusted models in multivariate logistic regression. ResultsMost (80.4%) Malawian mothers initiated early breastfeeding, compared to mothers in Tanzania (53.4%) and Zambia (67.7%). Just over half (55.0%) of Tanzanian infants were exclusively breastfed while 60.1% and 70.6% of Malawian and Zambia infants were. Continued breastfeeding at 1 year was high in all countries; Malawi (91.0%), Tanzania (92.4%), Zambia (95.0%). In Zambia, 78.8% of mothers reported experiencing any form of IPV compared to 76.6% and 73.4% of Tanzanian and Malawian mothers who reported experiencing IPV. In all three countries, mothers who experienced emotional IPV were more likely not to initiate breastfeeding in the first hour after birth (Malawi [AOR = 1.37(1.05–1.79)]; Tanzania [AOR = 1.43(1.22–1.68)]; Zambia [AOR = 1.28(1.06–1.54)]). In Malawi and Zambia, women who frequently experienced any form of IPV were more likely not to have exclusively breastfed (Malawi [AOR = 1.88(1.17–3.04)]; Zambia [AOR = 1.96(1.35–2.85)]). Tanzanian mothers who experienced emotional IPV were nearly two times more likely not to continue breastfeeding until the child’s first birthday [AOR = 1.94(1.03–3.66)]. ConclusionsIn all three countries, maternal experience of IPV was associated with suboptimal breastfeeding practices. The potential effects of maternal experience of IPV on breastfeeding should be considered when planning interventions and designing policies to improve breastfeeding in Malawi, Tanzania, and Zambia. Funding SourcesNone.