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The Need for Culture Sensitive Participatory Health Promotion Activities to Promote Breastfeeding
Abstract and Figures
Breastfeeding practices are no longer a norm nowadays. Exclusive breastfeeding is an even bigger challenge, and although it is recommended by the World Health Organisation (WHO) that mothers should exclusively breastfeed for the first six months of a baby's life, not many mothers actually practice it. Health promotion activities to promote exclusive breastfeeding are necessary to improve the practices within communities. There is a need to be culturally sensitive when addressing communities as there are already values and beliefs in place that can either promote or hinder the process of health promotion. Community participation is also an important aspect to incorporate during implementation of breastfeeding-promotion activities, because it encourages active participation and is more likely to be accepted than an approach where the community is given information in a directive manner.
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Background: The feeding method of neonates and babies and, especially, the issue of breastfeeding is one of the most important for public health. Despite the sensitization, the intention and recommendations of the world scientific community, only 39% of babies, on an international level, are fed during the first six months of their lives exclusively with mother's milk. Aim: The present study attempted a bibliographic review of the studies about cultural practices and beliefs for breastfeeding. The research question focused on whether cultural and social standards lead up to what degree a process as breastfeeding is accepted by the mothers in a society. Method: We studied all articles at the period 1988-2008 in the Pubmed which associated the initiation and duration of breastfeeding with the cultural status of a certain society. The key-words were society, breastfeeding, initiation, duration, cultural status. Results: The process of breastfeeding is often not determined by biological factors, but it is mainly based on the habits, standards and behaviors existing in each society. Views on the function of female breasts, the quality of mother's milk as well as traditional practices related to breastfeeding are often the reasons that lead to how much this process is accepted by the mothers. Conclusion: Public health policies worldwide must take into account and study the cultural status of a society in order to create favorable conditions for the initiation and duration of breastfeeding.
There are several strategies to promote health in individuals and populations. Two general approaches to health
promotion are behavior change and empowerment. The aim of this article is to present those two kinds of
strategies, and show that the behavior-change approach has some moral problems, problems that the
empowerment approach (on the whole) is better at handling. Two distinct ‘ideal types’ of these practices are
presented and scrutinized. Behavior change interventions use various kinds of theories to target people’s
behavior, which they do through information, persuasion, coercion and manipulation. Empowerment is a collaborative
method where those ‘facilitated’ participate in the change process. Some ethical problems with the
behavior-change model are that it does not sufficiently respect the right to autonomy of the individuals involved
and risks reducing their ability for autonomy, and that it risks increasing health inequalities. Empowerment, on
the other hand, respects the participant’s right to autonomy, tends to increase the ability for autonomy, as well
as increasing other coping skills, and is likely to reduce inequalities. A drawback with this approach is that it often
takes longer to realize.
Background
The debate on breastfeeding in areas of high HIV prevalence has led to the development of simulation models that attempt to assess the risks and benefits associated with breastfeeding. An essential element of these simulations is the extent to which breastfeeding protects against infant and child mortality; however, few studies are available on this topic. We did a pooled analysis of studies that assessed the effect of not breastfeeding on the risk of death due to infectious diseases.
Methods
Studies were identified through consultations with experts in international health, and from a MEDLINE search for 1980–98. Using meta-analytical techniques, we assessed the protective effect of breastfeeding according to the age and sex of the infant, the cause of death, and the educational status of the mother.
Findings
We identified eight studies, data from six of which were available (from Brazil, The Gambia, Ghana, Pakistan, the Philippines, and Senegal). These studies provided information on 1223 deaths of children under two years of age. In the African studies, virtually all babies were breastfed well into the second year of life, making it impossible to include them in the analyses of infant mortality. On the basis of the other three studies, protection provided by breastmilk declined steadily with age during infancy (pooled odds ratios: 5·8 [95% Cl 3·4–9·8] for infants <2 months of age, 4·1 [2·7–6·4] for 2–3-month-olds, 2·6 [1·6–3·9] for 4–5-month-olds, 1·8 [1·2–2·8] for 6–8-month-olds, and 1·4 [0·8–2·6] for 9–11-month-olds). In the first 6 months of life, protection against diarrhoea was substantially greater (odds ratio 6·1 [4·1–9·0]) than against deaths due to acute respiratory infections (2·4 [1·6–3·5]). However, for infants aged 6–11 months, similar levels of protection were observed (1·9 [1·2–3·1] and 2·5 [1·4–4·6], respectively). For second-year deaths, the pooled odds ratios from five studies ranged between 1·6 and 2·1. Protection was highest when maternal education was low.
Interpretation
These results may help shape policy decisions about feeding choices in the face of the HIV epidemic. Of particular relevance is the need to account for declining levels of protection with age in infancy, the continued protection afforded during the second year of life, and the question of the safety of breastmilk substitutes in families of low socioeconomic status.
Immunisation has contributed greatly to the control of vaccine-preventable diseases and therefore to improvements in health and survival, especially among young children, and remains one of the most successful and cost-effective public health interventions. This remains true for many of the newer, more expensive vaccines. Vaccines against invasive pneumococcal disease and rotavirus infection were introduced into the South African Expanded Programme on Immunization in April 2009. This article describes the rationale for and process of the introduction of these two vaccines, pneumococcal conjugate vaccine and rotavirus vaccine. It also aims to evaluate the success of and challenges related to their introduction, in terms of both achieving universal coverage and improving survival and health in South African children.
BACKGROUND: Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described. OBJECTIVES: To document pre-hospital home and primary care management of diarrhoea, and certain risk factors and complications of diarrhoea. METHODS: We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital, Parow, Cape Town, between 1 February 2007 and 31 May 2008. Caregivers were interviewed, and demographic, clinical and laboratory variables were collected. RESULTS: We recruited 142 children, median age 8.9 months. A third had moderate malnutrition. Twenty-four (16.9%) were HIV-exposed, with 9 (6.3%) HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed, uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2% stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. CONCLUSIONS: Most caregivers do give ORT, but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition, and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies, prehospital management and nutritional rehabilitation.
Breastfeeding is viewed as the optimal method of infant feeding that provides many benefits to both the infant and the mother. The monitoring and reporting of breastfeeding indicators are essential for any country to plan and implement effective promotion programs for sustainable breastfeeding. The aim of this review is to examine the available studies and data on breastfeeding in Saudi Arabia, and determine the potential factors that affect breastfeeding practices and duration in this country.
The databases of Web of Knowledge, Science Direct and PubMed were searched using the relevant key words. Only studies that reported breastfeeding practices, rates and indicators in Saudi Arabia were included. Standard WHO definitions for breastfeeding categories were used in this review.
Seventeen cross-sectional studies were identified and reviewed and five stated they used standard definitions. The self-administered questionnaire as a measurement tool was the predominant method of data collection. Infants' ages range from less than six months up to five years. Initiation rates were high (mostly above 90%), but a few studies reported low rates of timely initiation (within the first hour). The exclusive breastfeeding rate could not be accurately determined as rates range from 0.8% to 43.9% among studies due to the lack of clear definitions and the nature of study design. The partial (mixed) feeding method was common and the category of 'any breastfeeding' has generally high rates. The mean duration of breastfeeding has showed a progressive decline over time from 13.4 months in 1987 to 8.5 months in 2010. Factors associated with a high prevalence of breastfeeding and longer duration include increased maternal age, low educational levels, rural residence, low income, multiparity and avoiding contraceptives. The most common reason for breastfeeding cessation was insufficient breast milk. Other reasons include sickness, new pregnancy and breastfeeding problems.
Breastfeeding indicators in Saudi Arabia could not be monitored or compared relying on the available data because no longitudinal studies have been conducted in this country. A cohort study design would be the most appropriate procedure to rigorously assess and report valid results on breastfeeding practices and patterns in the Saudi society.
Health Promotion in sub-Saharan Africa (SSA) is currently facing many difficult challenges. Health status is worse than in any other region, with the midpoint data indicating that that SSA is not on track to achieve any of the Millenium Development Goals. This paper explores the history of health promotion in Africa, from before Alma Ata, through the 1970s, 1980s and 1990s, and up to the present. Using examples from Mozambique, Zimbabwe and South Africa during their transitional periods, and health promotion approaches adopted to tackle HIV/AIDS, diarrhoea and non-communicable diseases, the paper shows how the focus has shifted away from the ideals of the Ottawa Charter to an individualistic behaviour change approach. The reasons for the shift reflect political choices of governments that have favoured technocratic approaches over harnessing the popular mobilisations that have accompanied national struggles. The experiences of global movements, such as the Global Equity Gauge Alliance are considered as a way of enhancing local health promotion initiatives which, as presently conceived, are limited in their ability to address equity and the broader determinants of ill health.
The primary purpose of this mixed-methods study was two-fold: first, to assess diabetes knowledge, attitudes, disease management and self efficacy among a sample of Mexican American (MA) and Mexican-Native (MN) adults living in North Texas; and second, to determine factors which promote or deter diabetes prevention and management using Airihenbuwa's PEN-3 Model. Data was collected by way of quantitative surveys and focus groups. A volunteer sample of 100 MA and MN men and women who were living in North Texas and diagnosed with T2DM agreed to participate in the research. Data was analyzed using Pearson product correlations, t-tests, and MANOVA as well as qualitative analysis. Results showed that knowledge and perceived psychosocial impact scores for participants were significantly lower than those from national samples. No significant effects for gender were found. Barriers identified from focus group data included fatalistic views, language challenges, fear of deportation, mistrust of U.S. medical personnel, lack of financial resources, transportation, and guilt relating to the perceived burden of management and prevention of the disease. By using mixed methodologies and culturally inclusive planning models such as PEN-3, health educators and other personnel can develop more relative and empowering diabetes education programs and services for this population. (Contains 8 tables and 1 figure.)
This article develops a conceptual model of cultural competency’s potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.
AIM: Low level of knowledge and practice of exclusive breast feeding have been reported in Nigeria especially in rural communities. The purpose of this study is to identify factors contributing to low knowledge and practice of exclusive breast feeding (E B F) in rural communities of Abia State, Nigeria and apply health promotion intervention (H P I) to address these factors in order to increase knowledge and practice of E B F. METHOD: A quasi-experimental study design was used. Four communities formed the unit of allocation to experimental and control groups for the purpose of introducing health promotion intervention. A multi-stage sampling procedure was used in selecting the study sample. A sample size of 400 households out of 1978 enumerated from the four communities was used for the survey, two as experimental and two as control. Data were collected using a pretested structured questionnaire that was interviewer administered. Data were analyzed quantitatively and qualitatively. Chi-square and Mc Nemar statistic were used in determining statistical significance. Analysis of knowledge and practice of EBF was taken before and after H P I and compared in both experimental and control groups. RESULTS: The results indicated increase in knowledge of E B F from 28(14%) to 200(98.5%). Correspondingly, practice of E B F increased from 21 (10%) to 162(80%) in the experimental group. No significant increase was made in the control group both in knowledge and practice of EBF. Factors contributing to low level of practice of EBF in the study area included low level of knowledge about ten steps to successful breast feeding, illusory fears about EBF, ignorance, resistance to change, cultural imperatives and medical reasons. Health promotion intervention directed at the rural women helped to scale up the practice of EBF to 70% within nine months. CONCLUSION: The study recommends health promotion intervention as a proven method for scaling up knowledge and practice of EBF in rural communities.