Timely Initiation Of Breastfeeding Research Articles

Factors Associated with Prelacteal Feeding and Timely Initiation of Breastfeeding in Hospital-Delivered Infants in India

Early initiation of breastfeeding continues to remain uncommon in India, and the practice of giving prelacteal feeding is still prevalent. We determined the rates of timely initiation of breastfeeeding and prelacteal feeding, factors associated with these practices, and the association between the 2. Five hundred women who delivered live infants at a tertiary care hospital in India were included. The study outcomes were timely initiation of breastfeeding and prelacteal feeding. Multiple logistic regression was used to estimate the odds ratios (OR) of both timely initiation and prelacteal feeding. Timely initiation and prelacteal feeding rates were 36.4% and 16.9%, respectively. Factors associated with timely initiation were higher maternal education (adjusted OR 2.00, 95% confidence interval [CI] 1.10, 3.60), counseling on breastfeeding during antenatal visits (adjusted OR 3.60, 95% CI 2.00, 6.20); absence of obstetric problems (adjusted OR 3.48, 95% CI 1.68, 7.23); vaginal deliveries (adjusted OR 37.57, 95% CI 17.40, 81.11); and increasing gestational age of newborn (adjusted OR 1.20, 95% CI 1.00, 1.40). Factors significantly associated with higher rates of prelacteal feeding were lower maternal education (adjusted OR 2.13, 95% CI 1.06, 4.35), Muslim religion (adjusted OR 2.27, 95% CI 1.18, 4.36), and delivery by cesarean section (adjusted OR 2.56, 95% CI 1.56, 4.19). There was a significant association between delayed initiation and prelacteal feeding (P < .001). The rates of timely initiation of breastfeeding were undesirably low, and the practice of prelacteal feeding existed even in tertiary care hospitals. Identifying factors associated with these practices might be a strategy for optimizing timely initiation and discouraging prelacteal feeding in hospital-delivered babies.

Influencing factors on time of breastfeeding initiation among a national representative sample of women in India

Breastfeeding is seen as vital for mother and child and therefore is of great public health concern. Early initiation of breastfeeding within one hour of delivery is important as it reduces neonatal mortality. Increasing our understanding of barriers and reasons for not commencing early breastfeeding is important to improve strategies and conditions to overcome such barriers. Hence, the present study aimed to investigate factors influencing time of breastfeeding among women in India, focusing on health care utilisation related issues and partner behaviour. Data from the Ministry of Health and Family Welfare of the Government of India’s National Family Health Survey (NFHS) from 2005-2006 (NFHS-3) have been used in this study. Breastfeeding for the latest child was considered in the study. A total of 35,795 female respondents are included in this study. Chi square test and adjusted logistic regression analysis were used. Among all 35,795 women in the study, a total of 31.1% initiated breastfeeding within one hour and 68.6% initiated breastfeeding within the first week. Educational level, economic status and women’s caste or tribe, place of delivery, prenatal visits to health care facilities and assistance during delivery as well as partner’s controlling and violent behavior are important factors influencing time of initiation of breastfeeding. It is evident that policy makers need to ensure that all health professionals support and promote early breastfeeding initiation. It is also important to promote deliveries in hospitals and other healthcare facilities as they may increase early initiation. Furthermore, it is fundamental that efforts are intensified for girls and women to obtain education to increase women’s empowerment and improved gender equality.

MULTILEVEL ORDINAL RESPONSE MODELING OF TREND OF BREASTFEEDING INITIATION

The amount of health benefits derived from breastfeeding is influenced by age of the child at initiation of the first breast milk, the duration and intensity of breastfeeding and age at which the child is introduced to supplementary foods and other liquids. In this study, the general trend of timing of breastfeeding initiation among nursing mothers in Nigeria between 1990 and 2003 is examined. The timing of initiation of the first breast milk to a child by her mother is measured in a three-level ordinal scale (immediately, within 24 h and days after birth) and the impacts of some socio-economic and maternal factors on this are determined. Results from this study revealed a significant improvement in the trend of early initiation of breast milk among Nigeria mothers between 1990 and 2003 (p

Sub-optimal breastfeeding of infants during the first six months and associated factors in rural communities of Jimma Arjo Woreda, Southwest Ethiopia

BackgroundStudies have shown that sub-optimal breastfeeding is major contributor to infant and young child mortality in Ethiopia. To address this problem, infant and young child feeding guideline was developed in 2004 and interventions have been going on based on the guidelines. There is no study that assessed whether the infant and child feeding practices are according the guideline or not. This study was carried out to assess sub-optimal breastfeeding practices and associated factors among infants from birth to six months in rural communities of Jimma Arjo Woreda in the Southwest Ethiopia.MethodsA cross-sectional study was carried out from December to January 2009. Quantitative data were collected from a sample of 382 respondents supplemented by qualitative data generated using in-depth interviews of 15 index mothers. Multivariable logistic regression model was used to identify predictors of timely initiation of breast feeding and non-exclusive breast feeding among mother-infant pairs.ResultsMore than three fourth of mothers breastfeed their infants sub-optimally. Thirty-seven percent of mothers initiated breastfeeding later than one hour after delivery, which was significantly associated with not attending formal education (AOR = 1.05[95%CI: 1.03, 1.94]) and painful breastfeeding experiences (AOR = 5.02[95%CI: 1.01, 10.08]). The majority (67.02%) of mothers had no knowledge about exclusive breastfeeding. Non-exclusive breastfeeding was negatively associated with child’s age of 0-2 months (AOR: 0.27[95%CI: 0.16, 0.47) and 3-4 months (AOR = 0.43 [95%CI: 0.25, 0.73) and ownership of radio (AOR = 0.56[95%CI: 0.37, 0.88]), but positively associated with the practice of discarding colostrums (AOR = 1.78[95%CI: 1.09, 4.94]).ConclusionThe findings showed that the majority of mothers sub-optimally breastfeed their children in the study area. As most of the mothers do not have knowledge on the exclusive breast feeding. Enhancing community based behavior change communications using multiple channels including radio and folk media is recommended to reduce sub-optimal breast feeding practices and associated consequences among children in the study area.

Evaluation of the Supportive Needs of Adolescents during Childbirth Intrapartum Nursing Intervention on Adolescents’ Childbirth Satisfaction and Breastfeeding Rates

To evaluate the effect of the Supportive Needs of Adolescents during Childbirth (SNAC) intrapartum nursing intervention on adolescents' childbirth satisfaction and breastfeeding rates. Separate sample posttest quasi-experimental. A tertiary hospital intrapartum unit. A convenience sample of 106 parturient adolescents. During Phase 1 the control group received current standard of intrapartum care. During Phase 2, the interventionist nurses provided the SNAC intervention and standard of care to the intervention group. The t test indicated higher childbirth satisfaction in the intervention group. Chi-square analysis indicated that the intervention group was more likely to breastfeed within the first hour after birth. There was no significant relationship between childbirth satisfaction and breastfeeding at three months and no differences between the groups in breastfeeding rates at hospital discharge and three months. These results suggest that learning the SNAC intervention may help nurses positively influence adolescents' childbirth experience and timing of breastfeeding initiation. Replication of the study is needed to further explore whether the intervention can significantly influence breastfeeding duration.

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region. Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h. Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 1 h after birth. Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.

Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study

BackgroundBreastfeeding within the first hour of life is a potential mechanism for health promotion. The purpose of this study was to evaluate the prevalence of breastfeeding initiation within the first hour of life in Feira de Santana, Bahia, Brazil, between 2004 and 2005, and investigate the influence of maternal, child and prenatal factors on this practice.MethodsThis is a cross-sectional study extracted from the results of a contemporary cohort conducted in 10 maternity hospitals in the city of Feira de Santana, Bahia, Brazil. A group of 1,309 mother-child pairs was included in the study. Information about mother's and baby's characteristics, pregnancy, birth, and time of breastfeeding initiation was collected in the first 72 hours after delivery, through interview with mothers and hospital records. The data gathered were stored and analyzed using the SPSS 16.0 and R 8.0. The chi-square test and binary logistic regression analysis were used to examine the relationship between breastfeeding within the first hour and different variables.Results47.1% of the mothers initiated breastfeeding within the first hour after birth. Early initiation of breastfeeding was associated with birth at full term pregnancy (adjusted Prevalence Ratio 1.43; 95% confidence interval 1.10 to 2.00), mothers who received prenatal guidance regarding the advantages of breastfeeding (aPR1.23; 95% CI 1.11 to 1.41) and vaginal delivery (aPR 2.78; 95% CI 2.38 to 3.23).ConclusionsIn order to improve the rates of breastfeeding within the first hour of life, health care professionals must promote the factors favoring this practice such as prenatal guidance regarding the advantages of breastfeeding, vaginal delivery and full term birth, and stimulate this practice in vulnerable situations such as mothers with cesarean section and preterm birth.

Relationship between breastfeeding practices and nutritional status of children aged 0-24 months in Nairobi, Kenya.

Breast milk has a major impact on child health, growth and development. Infants should exclusively breastfeed (EBF) for six months, then, nutritionally adequate and safe complementary foods should be introduced. This study’s aim was to determine the breast feeding practices (initiating breastfeeding within one hour of child birth, exclusive breastfeeding for six months, no bottle feeding, and breastfeeding until or beyond two years and on demand breastfeeding) of mothers in Nairobi, and nutritional status of their children aged zero to twenty four months. A descriptive cross-sectional survey was used in the maternal child health (MCH) clinics in four selected Nairobi City Council health centres. A dyad (pair) of mother and her 0-24 month old child were targeted. The dyads were systematically selected based on the nth mother (where n was a fraction of desired sample size per actual number of mothers present in the clinic that day). A structured questionnaire was administered, which focused on maternal socio-demographic profiles and breastfeeding practices. Anthropometric assessments were conducted on the children. A total of 418 dyads were analysed, 99.0% of the mothers had breast fed, but only 12.6% children had been exclusively breastfed for the first six months. Only 34.0% of children aged less than six months were still exclusively breastfeeding, the rest were on complementary feeds. More than three quarters of the mothers had initiated breastfeeding within one hour of child birth, were not using bottles to feed their child, were breastfeeding on demand and had not weaned their child. On nutritional status assessment of children, 10.6 % were stunted, 6.2% underweight and 2.1% wasted. There was a significant association between delay in time of breastfeeding initiation after childbirth and stunting P≤.05(odds ratio 2), discontinuation of breastfeeding and underweight P≤.05 (odds ratio 4.5), as well as weaning less than six months and underweight P≤.05 (odds ratio 2.5). There was no significant association between breastfeeding practices and wasting. Children on bottle feeding and those who had discontinued breastfeeding were likely to be wasted (odds ratio 1.6).However, these associations do not control for age, and both underweight and wasting are related to age. A majority of mothers werecompliant with the recommended breastfeeding practices. Complementary feeding was introduced too early in life in several cases. Health care workers should emphasise the importance of exclusive breastfeeding for the first six months and the dangers of early complementary feeding.Key words: Exclusive Breast feeding, Nutritional status

Factors associated with breastfeeding cessation in nursing mothers in a peer support programme in Eastern Lancashire

BackgroundThe UK has one of the lowest breastfeeding rates worldwide and in recent years the Government has made breastfeeding promotion one of its priorities. The UNICEF UK Baby Friendly Initiative is likely to increase breastfeeding initiation but not duration. Other strategies which involve provision of support for breastfeeding mothers in the early weeks after birth are therefore required to encourage UK mothers to breastfeed for the recommended duration. This paper examines the effects of maternal socio-demographic factors, maternal obstetric factors, and in-hospital infant feeding practices on breastfeeding cessation in a peer support setting.MethodsData on mothers from Blackburn with Darwen (BwD) and Hyndburn in Eastern Lancashire who gave birth at the Royal Blackburn Hospital and initiated breastfeeding while in hospital were linked to the Index of Multiple Deprivation (IMD). The data were analysed to describe infant feeding methods up to 6 months and the association between breastfeeding cessation, and maternal factors and in-hospital infant feeding practices.ResultsThe mean breastfeeding duration was 21.6 weeks (95% CI 20.86 to 22.37 weeks) and the median duration was 27 weeks (95% CI 25.6 to 28.30 weeks). White mothers were 69% more likely to stop breastfeeding compared with non-White mothers (HR: 0.59; 95% CI, 0.52 to 0.67 [White mothers were the reference group]). Breastfeeding cessation was also independently associated with parity and infant feeding practices in hospital. There were no significant associations between breastfeeding cessation and marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation.ConclusionIn this study ethnicity, parity and in-hospital infant feeding practices remained independent predictors of breastfeeding cessation in this peer support setting. However other recognised predictors such as marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation were not found to be associated with breastfeeding cessation.

Assessment of the effect of psychosocial support during childbirth in Ibadan, south‐west Nigeria: A randomised controlled trial

To assess the effect of psychosocial support on labour outcomes. A randomised control trial conducted at the University College Hospital Ibadan, Nigeria, from November 2006 to 30 March 2007. Women with anticipated vaginal delivery were recruited and randomised at the antenatal clinic. The experimental group had companionship in addition to routine care throughout labour until two hours after delivery, while the controls had only routine care. The primary outcome measure was caesarean section rate. Others included duration of active phase, pain score, time of breast-feeding initiation and description of labour experience. Multivariable analyses were used to adjust for potential confounders. The level of statistical significance was set at 5%. Of the 632 recruited, 585 were eventually studied: 293 and 292 were in experimental and control groups, respectively. Husbands constituted about two-thirds of the companions. Women in the control group were about five times more likely to deliver by caesarean section (95% confidence interval (CI) 1.98-12.05), had significantly longer duration of active phase (P < 0.001), higher pain scores (P = 0.011) and longer interval between delivery and initiation of breast-feeding (P < 0.001). However, those in experimental group had a more satisfying labour experience (odds ratio 3.3 95% CI 2.15-5.04). Women with companionship had better labour outcomes compared to those without. It is desirable to adopt this practice in our health-care settings as an alternative strategy to provide comparable quality services to would-be mothers in labour.

Spatial Modelling of Initiation and Duration of Breastfeeding: Analysis of Breastfeeding Behaviour in Malawi - I

The benefits of breastfeeding for child health are well recognized. Appropriate health promotion strategies must recognize the interplay between neighbourhood factors and breastfeeding patterns that may lead to spatial clustering in the health outcome. We developed spatial models to study factors associated with breastfeeding behaviour in Malawi by introducing random effects that allowed for unobserved influences on breastfeeding behaviour. Using the 2000 Malawi Demographic and Health Survey, we studied two breastfeeding behaviours: initiation of breastfeeding and duration of breastfeeding. We fitted an ordinal model to estimate the initiation of breastfeeding, and a discrete-time duration model to analyze the duration of breastfeeding. Each model incorporated two spatial random effects at the subdistrict level, one component to capture spatial similarities across neighbouring areas and the other to permit spatial heterogeneity. Findings indicate a breastfeeding initiation rate of 60% immediately after birth, and a further 37% within 1 hour of birth. Timing of breastfeeding initiation within 1 hour was associated with maternal education; ethnicity; wealth ranking; access to media such as newspapers, radio or TV; and health-sector variables such as place of birth, prenatal care assistance and support at delivery. The mean duration time for breastfeeding was 17.6 months. Again, a range of socio-economic, demographic and health sector factors were identified as influential on breastfeeding duration. The mapped subdistrict-specific effects showed delayed initiation of breastfeeding in the north of the country, while early initiation was displayed in the south-eastern region. Shorter duration of breastfeeding was found in the southern region, whereas protracted breastfeeding was observed in the northern region. This study offers important insight on the relative importance of both spatial effects and individual characteristics on breastfeeding behaviour in Malawi. This has potential implications for health policy planning and further research.

Breast-Feeding Patterns, Time to Initiation, and Mortality Risk among Newborns in Southern Nepal

Initiation of breast-feeding within 1 h after birth has been associated with reduced neonatal mortality in a rural Ghanaian population. In South Asia, however, breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified. Data were collected during a community-based randomized trial of the impact of topical chlorhexidine antisepsis interventions on neonatal mortality and morbidity in southern Nepal. In-home visits were conducted on d 1–4, 6, 8, 10, 12, 14, 21, and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding. Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time. Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth, 3.4% of infants were breast-fed and 56.6% were breast-fed within 24 h of birth. Partially breast-fed infants (72.6%) were at higher mortality risk [relative risk (RR) = 1.77; 95% CI = 1.32–2.39] than those exclusively breast-fed. There was a trend (P = 0.03) toward higher mortality with increasing delay in breast-feeding initiation. Mortality was higher among late (≥24 h) compared with early (<24 h) initiators (RR = 1.41; 95% CI = 1.08–1.86) after adjustment for low birth weight, preterm birth, and other covariates. Improvements in breast-feeding practices in this setting may reduce neonatal mortality substantially. Approximately 7.7 and 19.1% of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life, respectively. Community-based breast-feeding promotion programs should remain a priority, with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding.

Effect of Delivery Method and Timing of Breastfeeding Initiation on Breastfeeding Outcomes in Taiwan

Few studies have examined the independent effect of delivery method and timing of breastfeeding initiation on the prevalence of breastfeeding. The objectives of this study were to examine the effect of method of delivery and timing of breastfeeding initiation on the prevalence of breastfeeding at 1 and 3 months after delivery using a national sample from Taiwan. The study population of 2,064 women who gave birth to infants without congenital anomalies at hospitals in Taiwan from June through October 2003, inclusively, participated in a postal questionnaire survey. Multivariate ordinal logistic regression analysis showed that women with cesarean delivery had a lower odds of breastfeeding at 1 and 3 months after delivery. Women with assisted vaginal delivery had lower odds of breastfeeding at 3 months after delivery compared with women with unassisted vaginal delivery. Initiation of breastfeeding within 30 minutes of delivery was associated with higher odds of breastfeeding at 1 and 3 months after delivery. Women who did not initiate breastfeeding during hospital stay but breastfed at 1 month after delivery had lower odds of breastfeeding at 3 months after delivery. The findings suggest the importance of conservative use of operative obstetrical intervention due to its negative impact on breastfeeding. Health professionals need to support mothers who have experienced cesarean and assisted vaginal delivery to increase their breastfeeding. Hospital staff should improve practice with respect to early initiation of breastfeeding.

Early initiation of and exclusive breastfeeding in large-scale community-based programmes in Bolivia and Madagascar.

About one-fourth to one-half of all infant deaths in developing countries occur in the first week of life. Immediate breastfeeding within the first hour, followed by early exclusive breastfeeding, improves the health and survival status of newborns. The aim of this study was to demonstrate that breastfeeding practices, crucial to infant health, can be improved at scale in developing countries. During 1999-2003, the LINKAGES Project, funded by the United States Agency for International Development, implemented its community-based model to bring about rapid change in individual behaviours and community norms regarding early and exclusive breastfeeding, at a scale [LINKAGES' definition of 'scale' was adapted from a CORE Group background paper on 'Scaling-up' maternal, newborn, and child health services, 11 July 2005] that could achieve significant public-health impact. 'Scale' was defined as bringing improved infant-feeding practices to more people over a wider geographic area, more quickly, more equitably, and with sustainability as a goal. During this time, country-specific programmes were designed and implemented in Bolivia and Madagascar, with catchment populations of one million and six million respectively. These country programmes were implemented with multiple local government, private voluntary organizations, and partners of non-governmental organizations (NGOs) through existing health and nutrition activities. Breastfeeding was an entry point to work at all levels of the healthcare system and, within communities, using policy/advocacy and training for healthcare workers, with a particular emphasis on front-line health workers and community members. Harmonized messages and materials, including mass media, were developed and used by partners. Timely initiation of breastfeeding was one indicator measured. Data collected through rapid assessment surveys showed statistically significant increases (p<0.001) in timely initiation of breastfeeding in both the countries. In Bolivia, timely initiation of breastfeeding went from 56% in 2000 to 69% in 2001 and reached 74% by the end of 2003. In Madagascar, the initiation rate went from 34% at baseline in 2000 to 69% in 2001, 76% in 2002, and rose to 78% in 2004. Exclusive breastfeeding during the first month of life was also measured. At baseline in Bolivia, the rate of exclusive breastfeeding for the first month of life was 81% (2000), decreased slightly in 2001, and then increased to 88% by the end of the Project in 2003. In Madagascar, it started high at 86% in 2000, increased during the implementation of the programme, and by 2004, was 91%. These results were achieved quickly and sustained over the course of the intervention.

Barriers to timely initiation of breastfeeding among mothers of healthy full-term babies who deliver at the University of Port Harcourt Teaching Hospital.

(I) To determine the barriers to timely initiation of breastfeeding in mothers who Hospital. (2). To determine if there is any statistical association between the time of initiation of breastfeeding and certain socio-demographic, obstetric, psychosocial and environmental factors in the mother-baby pairs. METHODOLOGICAL: A prospective, hospital-based study of 500 consecutive health mother-infant pairs delivered at UPTH (both vaginally and by Caesarian section). Information was obtained using a structured questionnaire, medical record review and direct observation. Early initiation, i.e. mothers who initiated breastfeeding within 30 minutes of delivery (in the case of the vaginally delivered (VD) mothers) or within 30 minutes of recovery of post-operative consciousness (in the case of those delivered by Caesarian section) were compared with those who initiated breastfeeding after 30 minutes (Late initiator) in the VD and C/S groups. The association between time of breastfeeding initiation and factors under consideration were determine using the chi-squared test. Approximately 34% of the VD mother initiated breastfeeding early while no mother with Caesarean section had early initiation of breastfeeding. The mean time of breastfeeding initiation was 3.35 -/+ 2.6 hours in mother who had vaginal delivery, 6.50 +/- 3.4 hours and 5.9 +/- 1.9 hours in those who had Caesarean section with general or spinal anaesthesia respectively. Among those with vaginal delivery, mothers younger than 25 years and of high socioeconomic class were found to practice early breastfeeding initiation. Delay in the time of repair of episiotomy and labour duration less than 12 hours were associated with early breastfeeding initiation. Early contact between baby and mother, help received on the delivery table and the presence of more than one delivery assistant also positively influenced breastfeeding initiation. Similarly, the presence of a breastfeeding-trained delivery assistant enhanced the mother' practice of early initiation of breastfeeding. Observation of routine labour ward practices such as cleaning of the newborn and weight/length measurement had negative impact on the practice of early initiation of breastfeeding. Early contact between the mother and her newborn on the delivery table with assistance to initate breastfeeding was the most important predictor of early breastfeeding initiation. Parity, attendance at the antenatal clinic, receipt of breastfeeding information and use of analgesics during labour did not show any statistical association with time of initiation of breastfeeding. There was a low prevalence of early initiation of breastfeeding in mothers delivered at the University of Port Harcourt Teaching Hospital. This low prevalence was due to delay in helping the newly delivered mother, especially those with Caesarean delivery. Routine labour ward practices interfere with the time of breastfeeding initiation. Routine labour ward and delivery table, specific assignment to the staff in the delivery/labour rooms help newly delivered mothers initiate breastfeeding early, and empowering the to request for babies are recommended.

Specifying the antecedents of breast-feeding duration in Peru through a structural equation model.

To examine the effects of socioeconomic status and biocultural variables (planned pregnancy, prenatal care, timing of initiation of breast-feeding and caesarean section delivery) on breast-feeding duration in Peru using structural equation models. Structural equation models were analysed with LISREL using data from the 1991-92 Peruvian Demographic and Health Survey. Models were tested among 6,020 women whose last child was born within 5 years of the survey and among 2,711 women whose last child was born 2-5 years preceding the survey. Unplanned pregnancy and socioeconomic status had a negative influence on breast-feeding duration. Prenatal care was positively associated with the timing of breast-feeding initiation in both samples and with breast-feeding duration in the whole sample. The timing of breast-feeding initiation was inversely associated with breast-feeding duration only in the sample of older children. These results imply that an unplanned pregnancy, a delayed breast-feeding initiation, and higher socioeconomic status are risk factors for an earlier discontinuation of breast-feeding through complex mechanisms involving direct and indirect effects.

The Timing of Breastfeeding Initiation and its Correlates in a Cohort of Rural Egyptian Infants

Recent data on the patterns and correlates of the timing of breastfeeding initiation in newborns are scanty for many countries including Egypt. To obtain such data in four villages in rural Bilbeis, we recruited apparently healthy, single neonates and their apparently healthy mothers within 4 days of child birth, and followed them prospectively during 1987 through 1989. All 150 neonates included in the analyses were breastfed for some duration. At the time of the first breastfeed, 36, 37, and 27 per cent of the neonates were aged < 2, 2-5, and > or = 6 hours, respectively. All neonates had received the first breastfeed by age 72 hours. In a multivariate, polytomous logistic regression model, modern birth attendants and longer ( > 8 hours) duration of labour were significantly associated with deferment of breastfeeding initiation till the neonate was aged > or = 6 hours. Breastfeeding initiation appeared to be unduly delayed in our study mothers and infants given that they were apparently healthy during the early post-partum period. Later initiation of breastfeeding was associated with indiscriminate prelacteal feeding, earlier termination of breastfeeding, and unwelcome supplementation practices. Our findings emphasize the need to initiate and/or strengthen programmes to promote appropriate breastfeeding practices in Bilbeis and other comparable areas.

The Maturation Index of Colostrum and Milk (MICAM): A Measurement of Breast Milk Maturation

A biological marker, the Maturation Index of Colostrum and Milk (MICAM), was developed using filter paper chromatography. The MICAM consists of five patterns used to measure the individual rate of breast milk maturation among mothers. This article documents the biological basis of MICAM patterns as a gradual breakdown of an emulsion of breast milk that is dependent on the ratio of sterols plus phospholipids to fat content of the milk. Frequencies of MICAM patterns by day, timing of the milk collection, and inter-rater reliability are addressed and the construct validity is explored. This was a partial replication of the original tool development reported by Humenick in 1987. In both studies, the variables of timing of breast-feeding initiation, frequency, and cumulative length of breast-feeding episodes were significantly correlated as predictors of early milk maturation as measured by the MICAM. Milk maturation rate was also significantly correlated as a predictor of infant weight gain, weeks of sustained breast-feeding, and maternal-infant breast-feeding satisfaction. The MICAM can be used as a clinical screening tool to assess the progress of milk maturation in cases where breast-feeding has had a difficult or delayed initiation, and to evaluate interventions designed to support lactation.

The Impact of the Healthcom Mass Media Campaign on Timely Initiation of Breastfeeding in Jordan

Initiation of breastfeeding within several hours after a child's birth increases the likelihood of exclusive breastfeeding and longer duration of breastfeeding. However, common beliefs among mothers and health-care providers and routine hospital practices can constrain timely breastfeeding initiation. This article examines the impact of a mass media breastfeeding campaign in Jordan within the context of other activities occurring during and after the child's birth. The campaign had a positive impact on all mothers' knowledge, and on timely initiation of breastfeeding for home and public hospital deliveries, but not for those in private hospitals. The findings indicate that a communication campaign can bring about change in breastfeeding initiation behavior, but that providing mothers with information should be but one part of an integrated program to ensure that hospital and midwife policies and practices support timely initiation.