Exclusive breastfeeding practices in the Coast region, Tanzania.

Background: Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare. Objective: To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania. Methods: A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses. Results: The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding. Conclusion: The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

Infant breastfeeding patterns by sex: Do males feed more?

Background: Most studies have looked at breastfeeding practices from the point of view of the maternal behavior only, however in counseling women who choose to breastfeed it is important to be aware of general infant feeding patterns in order to adequately provide information about what to expect. Available literature on the differences in infant breastfeeding behavior by sex is minimal and therefore requires further investigation. Objectives: This study determined if at the age of 2 months there were differences in the amount of breast milk consumed, duration of breastfeeding, and infant satiety by infant sex. It also assessed whether infant sex is an independent predictor of initiation of breastfeeding. Methods: This is a secondary analysis of data obtained from the Infant Feeding Practices Survey II (IFPS II) which was a longitudinal study carried out from May 2005 through June 2007 by the Food and Drug Administration and the Centers for Disease Control and Prevention. The questionnaires asked about demography, prenatal care, mode of delivery, birth weight, infant sex, and breastfeeding patterns. A total of 3,033 and 2,552 mothers completed the neonatal and post-neonatal questionnaires respectively. ^ Results: There was no significant difference in the initiation of breastfeeding by infant sex. About 85% of the male infants initiated breastfeeding compared with 84% of female infants. The odds ratio of ever initiating breastfeeding by male infants was 0.93 but the difference was not significant with a p-value of 0.49. None of the other infant feeding patterns differed by infant gender. ^ Conclusion: This study found no evidence that male infants feed more or that their mothers are more likely to initiate breastfeeding. Each baby is an individual and therefore will have a unique feeding pattern. Based on these findings, the major determining factors for breastfeeding continue to be maternal factors therefore more effort should be invested in promoting breastfeeding among mothers of all ethnic groups and social classes.^

Socioeconomic inequities in the health and nutrition of children in low/middle income countries

OBJECTIVE: To describe the effects of social inequities on the health and nutrition of children in low and middle income countries. METHODS: We reviewed existing data on socioeconomic disparities within-countries relative to the use of services, nutritional status, morbidity, and mortality. A conceptual framework including five major hierarchical categories affecting inequities was adopted: socioeconomic context and position, differential exposure, differential vulnerability, differential health outcomes, and differential consequences. The search of the PubMed database since 1990 identified 244 articles related to the theme. Results were also analyzed from almost 100 recent national surveys, including Demographic Health Surveys and the UNICEF Multiple Indicator Cluster Surveys. RESULTS: Children from poor families are more likely, relative to those from better-off families, to be exposed to pathogenic agents; once they are exposed, they are more likely to become ill because of their lower resistance and lower coverage with preventive interventions. Once they become ill, they are less likely to have access to health services and the quality of these services is likely to be lower, with less access to life-saving treatments. As a consequence, children from poor family have higher mortality rates and are more likely to be undernourished. CONCLUSIONS: Except for child obesity and inadequate breastfeeding practices, all the other adverse conditions analyzed were more prevalent in children from less well-off families. Careful documentation of the multiple levels of determination of socioeconomic inequities in child health is essential for understanding the nature of this problem and for establishing interventions that can reduce these differences.

Modélisation de facteurs associés à une perception d'insuffisance lactée

Peu de femmes atteignent la recommandation internationale d’un allaitement exclusif d’une durée minimale de 6 mois malgré ses nombreux bienfaits pour l’enfant et pour la mère. Une raison fréquemment mentionnée pour la cessation précoce de l’allaitement ou l’introduction de préparations commerciales pour nourrissons est l’insuffisance de lait. L’origine de cette perception maternelle demeure toujours inexpliquée bien que sa prévalence dans les écrits soit bien documentée. L’insuffisance lactée relève-t-elle de pratiques d’allaitement qui contreviennent au processus physiologique de la lactation ou relève-t-elle d’un manque de confiance maternelle dans sa capacité d’allaiter? Une meilleure compréhension des déterminants de la perception d’insuffisance lactée (PIL) s’avère primordiale, un manque d’interventions infirmières permettant de prévenir, dépister et soutenir les femmes allaitant percevant une insuffisance lactée ayant été identifié. Cette étude visait à déterminer l’apport explicatif de variables biologiques et psychosociales de 252 femmes primipares allaitant sur une PIL. Une modélisation de facteurs associés à la PIL a été développée à l’aide de l’approche synthèse théorique comportant les variables suivantes: les événements entourant la naissance, les capacités infantiles et maternelles, la supplémentation, le sentiment maternel d’efficacité en allaitement, la PIL et les pratiques d’allaitement. Afin de mieux comprendre comment se développe et évolue la PIL, un devis prédictif confirmatif longitudinal a été privilégié de la naissance à la 6e semaine postnatale. Au T1, soit le premier 24 heures suivant la naissance, les participantes ont complété un questionnaire concernant leur intention d’initier et de maintenir un allaitement exclusif pour une durée de 6 mois. Au T2, soit la 3e journée postpartum, les femmes complétaient un 2e questionnaire regroupant les différentes mesures utilisées pour l’étude des variables de la modélisation PIL, incluant le prélèvement d’un échantillon de lait maternel. À la 2e semaine, soit le T3, les femmes complétaient un questionnaire similaire à celui du T2, lequel était envoyé par la poste. Finalement, au T4, soit à la 6e semaine, une entrevue téléphonique semi-dirigée concernant les pratiques d’allaitement a été réalisée. La vérification des hypothèses s’est faite principalement à l’aide de tests de corrélations de Pearson, d’analyses de régressions et d’équations structurelles. Les résultats indiquent une influence simultanée des capacités infantiles et du sentiment maternel d’efficacité en allaitement sur la PIL au T2 et au T3; le sentiment maternel d’efficacité en allaitement exerçant de surcroit un effet médiateur entre les capacités infantiles et la perception d’insuffisance lactée au T2 et au T3. Au T2, la fréquence des tétées est associée à une diminution du taux de Na+ du lait maternel, marqueur biologique de l’établissement de la lactogenèse II. Des interventions ciblant le développement d’un sentiment maternel élevé d’efficacité en allaitement devraient être privilégiées.

Tendência do aleitamento materno em município da região centro-sul do estado de São Paulo: 1995-1999-2004

OBJETIVO: Avaliar a situação do aleitamento materno em 2004 no município de Botucatu, SP, e identificar sua tendência nos últimos 10 anos. MÉTODOS: Trata-se de um estudo epidemiológico, no qual foram comparados os resultados de 3 inquéritos populacionais transversais (1995-1999-2004), metodologicamente semelhantes, sobre a situação do aleitamento materno em crianças menores de 12 meses. Os dados foram obtidos em Campanhas de Multivacinação, a partir de questionário contendo um recordatório da alimentação das crianças no dia anterior à pesquisa. Para identificar a tendência dos diferentes tipos de aleitamento (aleitamento materno exclusivo, aleitamento materno predominante e aleitamento materno), foram comparadas as prevalências, segundo faixas etárias selecionadas (0-1 mês, 0-4 meses, 0-6 meses e 0-12 meses), nos 3 inquéritos. Os resultados foram submetidos a teste estatístico (teste z) para verificação das diferenças entre proporções. RESULTADOS: Para as crianças menores de 4 meses, houve aumento progressivo e de grande magnitude (19,1% em 1995 e 36,9% em 2004) do aleitamento materno exclusivo e diminuição do aleitamento materno predominante - diferenças estatisticamente significantes. O mesmo ocorreu para as crianças menores de 6 meses: 13,0% em aleitamento materno exclusivo em 1995, 29,6% em 2004, representando 128,0% de aumento. Com relação ao aleitamento materno, tanto para as crianças menores de 4 meses, quanto para as menores de 6 meses e de 1 ano, houve pequeno aumento de prevalência, mas as diferenças não foram estatisticamente significantes. A duração mediana do aleitamento materno exclusivo aumentou 14 dias (82,0%) e do aleitamento materno 85 dias (50,9%) no período de 10 anos. CONCLUSÃO: Com a elevação expressiva da prevalência de crianças menores de 6 meses em aleitamento materno exclusivo e o aumento da mediana da amamentação exclusiva e da amamentação, pode-se afirmar que a evolução do aleitamento no município foi favorável. Entretanto, a situação em 2004 ainda está distante das recomendações atuais sobre alimentação infantil.

Empoderamento da puérpera para o sucesso no aleitamento materno

São muitas as vantagens do aleitamento materno para a mãe e recém-nascido, havendo consenso de que a sua prática exclusiva deve ser até aos seis meses de vida. A intervenção teve como objetivo empoderar a puérpera para o sucesso no aleitamento materno. Foram aplicados três questionários a duas populações-alvo: um aos enfermeiros do Serviço de Obstetrícia do Centro Hospitalar Barreiro-Montijo, Entidade Pública Empresarial e outros dois às puérperas, que permitiram a recolha de informações sobre os conhecimentos dos enfermeiros acerca das práticas no aleitamento materno e da perceção das puérperas, quanto aos cuidados recebidos durante o internamento. Os resultados apontaram para a necessidade de formação dos enfermeiros sobre o aleitamento materno e a necessidade de empoderamento/acompanhamento no pós-parto. Desenvolveram-se atividades formativas e educacionais, quer para os profissionais, quer para as puérperas. A intervenção profissional revelou-se benéfica para a melhoria contínua dos cuidados de enfermagem na promoção do aleitamento materno exclusivo; EMPOWERMENT OF POSTPARTUM WOMEN FOR SUCCESSFUL BREASTFEEDING ABSTRACT: Breastfeeding presents several advantages to the mother and child, being generally agreed that its practice should be exclusive until six months of age. The goal of this intervention was to empower the puerpera towards breastfeeding success. Three questionnaires were applied to two populations: one to the nurses from the Obstetric Department of the Centro Hospitalar Barreiro-Montijo, Entidade Pública Empresarial and other two to puerperas, which allowed collection of information on the nurses’ knowledge about breastfeeding practices and the puerperas’ perception on received care during hospitalization. The results demonstrated the nurses’ need of training on breastfeeding and the need of empowerment/follow-up during the post-partum period. Educational and training activities, directed to professionals and puerperas, were developed. The professional intervention demonstrated benefits to the improvement of the nursing care in the promotion of exclusive breastfeeding.

Exclusive Breastfeeding in Southern Brazil: Prevalence and Associated Factors

Background: Worldwide strategies have been conducted in order to guarantee longer periods of exclusive breastfeeding for most children, especially those from developing countries. The evaluation of infant feeding practices and the identification of weaning risk factors are essential for public health policy planning. Methods: This cross-sectional study was carried out in Joinville, the biggest city of Santa Catarina State in the southern Brazilian region. The caregivers of children under 1 year of age were systematically selected for interview in previously drawn immunization units during the 2005 National Vaccination Campaign. A structured questionnaire was applied for collection of infant, maternal, and healthcare variables. A 24-hour food recall survey was included in order to evaluate infant feeding practices. Descriptive statistic analysis on breastfeeding prevalence and Poisson regression analysis of risk factors for discontinuing exclusive breastfeeding for infants up to 6 months of age were performed. Results: Caregivers of 1,470 infants were interviewed. The feeding inquiry showed an overall rate of breastfeeding of 72.5% and a frequency of exclusive breastfeeding of 43.7% and 53.9% among infants younger than 6 and 4 months of age, respectively. The findings associated with the interruption of exclusive breastfeeding for infants up to 6 months were: higher infant age (P < 0.001), pacifier use (P < 0.001), and lower maternal educational level (P = 0.013). Conclusions: In developing countries, specific strategies must be created for the delivery of information about breastfeeding and the effect of pacifier use, especially for less educated women.

Initiating breastfeeding in postwar Queensland

The aim of this article, part of a larger study (Thorley 2000), was to determine and examine the practices which surrounded the initiation of breastfeeding in Queensland maternity hospitals in the postwar period, 1945-1965. Although it was assumed that mothers would breastfeed, and sound advice was available on how to achieve a good latch, the often arbitary delay of the first breastfeed, and consistently restrictive practices surrounding the frequency and duration of the feeds, were not conducive to an optimal start for breastfeeding. Staff shortages compounded the situation. Mothers felt powerless and were commonly not informed about whether their babies were being complemented with pooled breastmilk or artificial infant milk in the central nursery, nor were they asked permission for these to be given to their babies. Pooled breastmilk from the postnatal wards was available throughout this period, though in the latter part of this period there appears to have been an increase in the use of artificial milks.

Factors associated with infant feeding practices after hospital discharge

OBJECTIVE: To assess factors associated with infant feeding practices on the first day at home after hospital discharge. METHODS: A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. RESULTS: Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. CONCLUSIONS: On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.

IPH response to DHSSPS Consultation on a ten year breastfeeding strategy for Northern Ireland 2012-2022

The Department of Health, Social Services and Public Safety invited submissions on the development of a new ten-year Breastfeeding Strategy for Northern Ireland 2012-2022 between May and September 2012. The draft Breastfeeding Strategy 2012 – 2022 proposes further action in relation to breastfeeding and aims to protect, promote, support and normalise breastfeeding within the population of Northern Ireland. Key points from IPH response IPH welcomes the commitment by the Department of Health, Social Services and Public Safety to develop a comprehensive long-term strategy to support women in Northern Ireland to breastfeed. The timeframe provides scope for developing clear long-term targets and actions and the embedding of breastfeeding culture into allied services, policies and programmes throughout Northern Ireland. The draft strategy’s recognition of the potential of breastfeeding as a means for tackling health inequalities forms a central theme of the IPH submission IPH welcomes the success achieved to date in improving breastfeeding. However, it is clear that the overall breastfeeding rate in Northern Ireland still lags behind the rest of the UK. Inequalities in breastfeeding rates remain an ongoing concern. IPH emphasises the importance of integrating the actions of the breastfeeding strategy with the strategic direction of overall public health policy in particular the forthcoming Fit and Well policy framework and early years strategies. IPH welcomes the inclusion of stipulations regarding weaning practices as an important component of the vision and one which, if achieved, will maximize the benefits from improving breastfeeding rates and duration.

Breastfeeding preterm infant from the delivery ward via nicu to home

The aim of this study was to examine how to support breastfeeding of preterm infants immediately after birth in the delivery ward, during their hospital stay in a neonatal intensive care unit (NICU), and at home after hospital discharge. Specifically, the role of early physical contact, maternal breastfeeding attitude, and an internet-based peer support group were investigated. The delivery ward practices concerning the implementation of early physical contact between a mother and her infant admitted to a NICU were examined by a structured survey in two hospitals. An Internet-based, breastfeeding peer-support intervention for the mothers of preterm infants was developed and tested in a randomized controlled design with one year follow-up. The main outcomes were the duration of exclusive and overall breastfeeding, expressing milk, and maternal attitude. In addition, the perceptions of mothers of preterm infants were investigated by analyzing the peer-support group discussions with a qualitative approach. The implementation of early physical contact was different between the two hospitals studied and was based more on hospital routines than the physiological condition of the infant. Preterm infants, who were born before a gestational age (GA) of 32 weeks, were hardly ever allowed to have early contact with their mothers. Both, a higher GA and early physical contact predicted earlier initiation and increased frequency of breastfeeding in the NICU. A maternal breastfeeding-favorable attitude predicted increased frequency of breastfeeding in the NICU and also a longer duration of overall breastfeeding. The actual duration of breastfeeding was, however, shorter than the mothers intended in advance. The internet-based, peer-support intervention had no effect on the duration of breastfeeding, expressing milk, or maternal attitude. The participating mothers enjoyed the possibility of sharing their experiences of preterm infants with other mothers in similar situations. Some of the mothers also experienced being given useful advice for breastfeeding. Based on the mothers’ discussions, a process of breastfeeding preterm infants was created. This included some paradoxical elements in the NICU where, for example, breast milk was emphasized over breastfeeding and support in the hospital varied. Hospital discharge was a critical point, when the mothers faced breastfeeding in reality. Over time, the mothers assimilated their breastfeeding experience into part of being a mother. The care practices related to early physical contact in delivery wards need to be re-evaluated to allow more infants to have a moment with the mother. Maternal attitude could be screened prenatally and attitude-focused interventions developed. Breastfeeding support in the NICU should be standardized. Internet-based breastfeeding peer-support intervention was feasible but additional research is needed.

Association between breast-feeding practices and sucking habits: A cross-sectional study of children in their first year of life

In addition to providing nutrition and immunological protection, breast-feeding has positive effects on the development of the infant's oral cavity. The aim of the present study is to assess breast-feeding patterns and to analyze the influence of breast-feeding practices and maternal sociodemographic variables on the prevalence of non-nutritive sucking habits in a sample of Brazilian infants. This cross-sectional study was carried out in Southern Brazil. A random sample of 100 mothers of infants up to 12 months of age was interviewed during the National Vaccination Campaign Day. The prevalence and median duration of breast-feeding were assessed. Breast-feeding practice, the exposure factor, was categorized as exclusive breast-feeding, predominant breast-feeding, complementary breast-feeding, or weaning. Maternal sociodemographic variables included age, race, marital status, educational level, profession, and family income. The outcome investigated was the prevalence of sucking habits (pacifier use and thumb sucking). We used two-sample tests, the chi-square test and Fisher exact test0 for statistical analyses of the data. The study revealed that 75% of infants were being breast-fed. Pacifier use and thumb sucking were common in 55%. Bottle-feeding was prevalent in 74% of infants. Breast-feeding was negatively correlated with pacifier use and thumb sucking (OR = 0.11; 95% CI: 0.03 to 0.4). Bottle-feeding was strongly associated with weaning (p = 0.0003). Among the sociodemographic variables, only marital status showed a statistical association with sucking habits (p = 0.04). These findings suggest that breast-feeding can prevent the occurrence of sucking habits. Although we could not evaluate causality assessment, malocclusion prevention seems to be yet one more reason for promoting breast-feeding practices.

Breastfeeding: knowledge and practice

The objective of this study was to characterize the practices of breastfeeding promotion developed by nursing professionals of the Family Health Strategy and analyze the correlation between their knowledge of breastfeeding and how often they provided teaching regarding this topic. This cross-sectional, descriptive study was performed at the Family Health Strategy units of Uberaba, Minas Gerais with 85 nursing professionals, using two questionnaires. Data analysis was performed using frequency distribution and Spearman's correlation analysis. Most professionals said that they often addressed breastfeeding in the investigated practices. However, a poor correlation was observed between the frequency of this approach and the mean score on knowledge test. The nursing professionals' statements indicate that breastfeeding recommendations were provided regardless of their knowledge on the topic.

A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa--the International epidemiologic Databases to Evaluate AIDS (IeDEA)

INTRODUCTION There are limited data on paediatric HIV care and treatment programmes in low-resource settings. METHODS A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). RESULTS A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult-paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4-6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. CONCLUSIONS In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.