Andy Lee

Curtin University Australia, Bentley, Western Australia, Australia

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Publications (9)11.78 Total impact

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    ABSTRACT: In the aftermath of many disasters the silence is punctuated by the crying of infants, hungry infants. The aim of this paper is to discuss ethical issues in feeding infants after disasters. The Asia Pacific region generates 25% of the world's GDP, but experiences 45% of natural disasters and 42% of the economic losses due to disasters. The region has 61% of the world's population, but 86% of the population affected by disasters. Breastfeeding, exclusive to six months and continuing thereafter, is important for growth and the health of the infant in the short term and later in life. In most natural disasters, mothers and infants will both suffer, but in some disasters, such as earthquakes and building collapses, infants can survive in small spaces. Infants separated from mothers require a wet nurse (rarely available) or feeding with infant formula and sterile water. Formula companies often donate supplies of infant formula but distribution should follow ethical principles. Mothers who are injured or short of food can still continue breastfeeding and don't need formula. Where formula must be used, health workers need to follow the highest ethical standards to avoid promoting infant formula to vulnerable communities in the post recovery phase.
    Asia-Pacific Journal of Public Health 07/2012; 24(4):672-80. · 1.06 Impact Factor
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    ABSTRACT: maternal mortality remains a major public health problem in many countries. The aim of this paper is to describe the progress made in maternal health care in Zhejiang Province, China over 20 years in reducing the maternal mortality ratio (MMR). Zhejiang Province is located on the mid-east coast of China, approximately 180km south of Shanghai, and has a population of 49 million. Almost all mothers give birth in hospitals or maternal and infant health institutes. the annual maternal death audit reports from 1988 to 2008 were analysed. These reports were prepared annually by the Zhejiang Prenatal Health Committee after auditing each individual case. China has made considerable progress in reducing the MMR. Zhejiang has one of fastest developing economies in China, and since the 86 economic reforms of 1978, health care has improved rapidly and the MMR has declined. During the 1988-2008 period, 2258 maternal deaths were reported from 8,880,457 live births. During these two decades, the MMR decreased dramatically from 48.50 in 1988 to 6.57 per 100,000 in 2008. The MMR in migrant women dropped from 66.87 in 2003 to 21.67 per 100,000 in 2008. The rate of decline was more rapid in rural areas than in the city. There has been a decline in the proportion of deaths with direct obstetric causes and a corresponding increase in the proportion of indirect causes. The proportion of deaths classified as preventable has declined in the past two decades. Social factors are important in maternal safety, and on average 26.8% of maternal deaths were influenced by these factors. as the economy was developing, maternal safety was made a priority health issue by the Government and health workers. The provincial MMR has dropped rapidly and is now similar to the rates in developed countries and lower than that in the USA. However, more work is still needed to ensure that all mothers, including migrant workers, continue to have these low rates.
    Midwifery 10/2010; 26(5):544-8. · 1.12 Impact Factor
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    ABSTRACT: This paper describes the influence of caesarean section on breastfeeding rates in Zhejiang Province, People's Republic of China. A longitudinal cohort study of infant feeding was conducted in Zhejiang Province, in city, suburban and rural areas. Mothers were recruited and interviewed while in hospital and then followed for six months. The sample size was 638 in the city, 347 in the suburban area and 532 in the remote mountainous rural area. In this study the highest caesarean section rate was in the city (76%), a similar rate in the suburbs (74%) and the lowest in the rural area (53%). The overall the breastfeeding initiation rate was 94%. Mothers who had a caesarean section were less likely to be exclusively breastfeeding on discharge (35.8% in city, 59.6% in the suburbs) compared to vaginal delivery where the rates were 45% and 74.4% respectively. The adjusted odds ratio for exclusive breastfeeding in caesarean section deliveries in the city and suburban mothers was 0.64 (95% CI 0.46, 0.88). Caesarean section is increasingly being used for routine deliveries in China and other countries in the region. Mothers who have an operative delivery have lower rates of exclusive breastfeeding on hospital discharge. These mothers will need extra support and encouragement to commence and maintain breastfeeding.
    Asia-Pacific Journal of Public Health 11/2008; 20 Suppl:220-7. · 1.06 Impact Factor
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    ABSTRACT: To document infant feeding methods in the first six months of life in Xinjiang Uygur Autonomous Region, People's Republic of China, 2003-2004. Some problems with breast-feeding in the area are explained. A longitudinal study of infant feeding practices was undertaken. A total of 1219 mothers who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes, and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices. Multivariate logistic regression analysis was used to explore factors associated with breast-feeding initiation. 'Any breast-feeding' rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 92.2, 91.3, 89.9, 88.8, 87.7, 86.0 and 73.0%, respectively. 'Exclusive breast-feeding' rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 66.2, 47.6, 30.1, 25.8, 22.1, 13.0 and 6.2%, respectively. The main problem of breast-feeding in Xinjiang was the early introduction of formula or water. The average duration of 'exclusive breast-feeding' was 1.8 months (95% confidence interval (CI) 1.7-2.0), of 'full breast-feeding' 2.8 months (95% CI 2.7-2.9) and of 'any breast-feeding' 5.3 months (95% CI 5.2-5.4). Infant feeding methods in Xinjiang were documented in this study and the main problems with infant feeding in Xinjiang are discussed. Further studies are needed to identify factors associated with 'exclusive breast-feeding' and duration.
    Public Health Nutrition 03/2007; 10(2):198-202. · 2.25 Impact Factor
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    ABSTRACT: To document 'exclusive breastfeeding' duration and factors associated with duration in Xinjiang, PR China. A cohort of 1219 mothers in Xinjiang, PR China was recruited to study their infant feeding practices. The mothers who delivered babies during 2003 and 2004 were contacted in hospital and again at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months postpartum, or until they ceased to breastfeed. Interviews were conducted using a structured questionnaire. Survival analysis was used to calculate the mean of 'exclusive breastfeeding' and explore factors affecting 'exclusive breastfeeding' duration. The average 'exclusive breastfeeding' duration in Xinjiang was 1.8 months. Factors negatively associated with 'exclusive breastfeeding' duration were mother's going to work and using pacifier. Factors positively associated with 'exclusive breastfeeding' duration were 'whether the maternal mother breastfed her children' and deciding 'exclusive breastfeeding' before delivery. 'Exclusive breastfeeding' duration in Xinjiang, PR China was short. The study identified some factors associated with 'exclusive breastfeeding' duration. The results suggested an education program aimed to correct traditional inappropriate breastfeeding perceptions and promote 'exclusive breastfeeding' in Xinjiang.
    Asia Pacific Journal of Clinical Nutrition 02/2007; 16(2):316-21. · 1.06 Impact Factor
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    ABSTRACT: Breastfeeding is the foundation of good nutrition and provides the basis for health throughout the life span. The WHO and the Chinese Ministry of Public Health recommend exclusive breastfeeding to six months of age. The practice of giving prelacteal feeds may interfere with the establishment of good breastfeeding practices and is contrary to the principles of Baby Friendly Hospital accreditation. The objective of this study was to investigate the prevalence of prelacteal feeds in a hospital in Hangzhou and the influence of this practice on breastfeeding at discharge. A longitudinal study of infant feeding was conducted in Hangzhou, China and a total of 638 mothers were recruited and interviewed while in hospital. The questionnaire included full details of infant feeding methods and factors likely to influence the initiation and duration of breastfeeding. Binary logistic regression was used to analyse factors influencing breastfeeding on discharge. In Hangzhou almost all babies are born in hospital, the median length of stay was 5.6 days and 77% of births were by caesarian section. In 26% of births the infants were given formula, water or milk as their first feed. At the time of discharge from hospital 91% of infants were receiving some breastmilk, but only 36% of mothers were exclusively breastfeeding. Breastfeeding on discharge from hospital was inversely related to giving prelacteal feeds (OR 0.115, 95% CI 0.055-0.238). While in hospital just over one quarter of infants received prelacteal feeds and these infants had a lower rate of breastfeeding on discharge.
    Asia Pacific Journal of Clinical Nutrition 01/2007; 16 Suppl 1:458-61. · 1.06 Impact Factor
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    ABSTRACT: The aim of this study was to document the introduction rates of complementary foods to infants in the Han, Uygur and other ethnic groups living in the Xinjiang Uygur Autonomous Region, PR China. A longitudinal study of infant feeding practices was undertaken using a random sample that included all of the ethnic groups in the region. Mothers were randomly recruited and interviewed in hospitals and maternal and child health institutes in the region. A total of 1219 mothers (578 Han, 360 Uygur and 281 from "other minority" groups), who delivered babies during 2003 and 2004, were recruited. After discharge they were contacted at approximately monthly intervals during the first six months of their infant's life to obtain details of feeding practices. The overall introduction rates of water, cow's milk and solid food in Xinjiang were, respectively, 23%, 2% and 6% before discharge and 76%, 39% and 78% at six months. The rates were different between ethnic groups. Uygur mothers were most likely to feed water to their babies, with introduction rates of 57% before discharge and 95% at six months, while the corresponding rates were 6% and 77% for Han and 12% and 52% for other minority groups. Mothers from Uygur and other minorities introduced cow's milk earlier than Han mothers. Uygur mothers also introduce solid foods earlier (10% pre discharge and 91% by six months) when compared to Han (3% pre discharge and 85% by six months) and other minorities (4% pre discharge and 48% by six months). The pattern of introduction of complementary foods in this region does not follow internationally recognized practices, suggesting the need for further education of health professionals and parents.
    Asia Pacific Journal of Clinical Nutrition 01/2007; 16 Suppl 1:462-6. · 1.06 Impact Factor
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    ABSTRACT: Breastfeeding is an important factor in infant health and there have been no previous studies of breastfeeding practices in the different ethnic groups of this region of China. We aimed to compare breastfeeding rates and duration between Han, Uygur and other ethnic groups living in Xinjiang, PR China. A longitudinal study of infant feeding practices was undertaken using a sample that included different ethnic groups. Mothers were randomly recruited and interviewed in hospitals and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices. Setting: Xinjiang Uygur Autonomous Region, PR China. Subjects: A total of 1219 mothers (578 Han, 360 Uygur and 281 'other minority' mothers) who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes located in both urban and rural areas. 'Any breastfeeding' rates in Han, Uygur and 'other minority' groups at discharge were 88.5 %, 94.3 % and 97.1 % respectively, and at six months 76.7 %, 54.7 % and 87.6 % respectively. While 'exclusive breastfeeding' rates in the Han, Uygur and 'other minority' groups at discharge were 78.0 %, 34.5 % and 83.1 % respectively, at six months they had fallen to 4.8 %, 0.4 % and 16.8 % respectively. The median duration of 'Exclusive breastfeeding' of Han, Uygur and 'other minority' babies were 1.5, 0.1 and 2.5 months respectively. The Uygur babies were least likely to be 'exclusive breastfed'. Uygur babies were least likely to be 'exclusive breastfed' and continued to 'any breastfeed' at six month. The 'any breastfeeding' rates in the Han group were lower in the first four months. An education program focused on breastfeeding continuation and exclusive breastfeeding is necessary in Xinjiang, especially for Uygur and Han ethnic groups.
    BMC Public Health 02/2006; 6:196. · 2.08 Impact Factor
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    ABSTRACT: This study documented the prevalence (proportion) of mothers taking folic as supplements or as fortified foods and explored the factors that determined whether folic acid was taken. A cross sectional analysis of the baseline data of mothers who participated in the Perth Infant Feeding Study was performed. A total of 587 mothers who delivered at the two hospitals in the study completed baseline questionnaires. The factors associated with the decision to take folic acid supplements or fortified foods were investigated using multivariate logistic regression. Main outcome measures were the percentage of mothers taking folic acid or folic acid fortified foods. A total of 455 (78%) mothers stated that they took folic acid supplements before or during the first three months of their pregnancy. Of the 132 who did not take folate supplements only 35 (6% of all participating mothers) claimed to have taken folate fortified food or beverages. In the highest income group, 87% of mothers took folic acid supplements compared to 64% in the poorest group. The significant factors independently associated with not taking folic acid supplements or fortified food were " years of education " (OR ' 10 years or less' 0.45 (0.23-0.88)), " family income " (OR < $ 25000 0.40(0.20-0.80)), and for taking folic acid "the timing of the pregnancy. "(OR'actively trying'2.01 (0.1.04-0.3.87)). There was a significant proportion of mothers who did not take folic acid periconceptually. The mothers who were not taking folic were less educated, from lower socio-economic groups and were not actively trying to fall pregnant at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory fortification of foods with folic acid should be required.
    Asia Pacific Journal of Clinical Nutrition 01/2006; 15(3):335-40. · 1.06 Impact Factor