ArticleLiterature Review

Support for breastfeeding mothers: A systematic review

November 2003
Paediatric and Perinatal Epidemiology 17(4):407-17

November 2003
17(4):407-17

DOI:10.1046/j.1365-3016.2003.00512.x

Source
PubMed

Authors:

Jim Sikorski

King's College London

Mary Josephine Renfrew

University of Dundee

Angie Wade

University College London

Although the benefits of breastfeeding are widely accepted, the effectiveness of different strategies to promote the continuation of breastfeeding once initiated are less clear. The objective of this systematic review was to describe studies comparing standard care with the provision of extra breastfeeding support and to measure its effectiveness. Outcome measures used were rates of cessation of any breastfeeding or exclusive breastfeeding at chosen points in time. Measures of child morbidity and maternal satisfaction were also used when these were reported. Twenty eligible randomised or quasi‐randomised controlled trials were identified, involving 23 712 mother–infant pairs. Extra support had a beneficial effect on the duration of any breastfeeding (RR [95% confidence intervals] for stopping any breastfeeding before the last study assessment up to 6 months 0.88 [0.81, 0.95]; 15 trials, 21 910 women). The effect was greater for exclusive breastfeeding (RR for stopping exclusive breastfeeding before the last study assessment 0.78 [0.69, 0.89]; 11 trials, 20 788 women). Although the point estimates of relative risk were very similar, benefit derived from professional support achieved statistical significance for any breastfeeding (RR 0.89 [0.81, 0.97]; 10 trials, 19 696 women) but not for exclusive breastfeeding (RR 0.90 [0.81, 1.01]; six trials, 18 258 women). Lay support was effective in reducing the cessation of exclusive breastfeeding (RR 0.66 [0.49, 0.89]; five trials, 2530 women) while the strength of its effect on any breastfeeding was less clear (RR 0.84 [0.69, 1.02]; five trials, 2224 women). Professional support in the largest trial to assess health outcomes produced a significant reduction in the risk of gastrointestinal infections and atopic eczema. In two trials with children suffering from diarrhoeal illness, extra support was highly effective in increasing short‐term exclusive breastfeeding rates and reducing recurrence of diarrhoea. This review supports the conclusion that supplementary breastfeeding support should be provided as part of routine health service provision. There is clear evidence for the effectiveness of professional support on the duration of any breastfeeding although the strength of its effect on the rate of exclusive breastfeeding is uncertain. Lay support is effective in promoting exclusive breastfeeding although the strength of its effect on the duration of any breastfeeding is uncertain. Evidence supports the promotion of exclusive breastfeeding as central to the management of diarrhoeal illness in partially breast‐fed infants.

Breastfeeding: Common Questions and Answers

Article

Sep 2018

All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of life. After six months, complementary foods may be introduced. Most organizations recommend breastfeeding for at least one year, and the World Health Organization recommends a minimum of two years. Maternal benefits of breastfeeding include decreased risk of breast cancer, ovarian cancer, postpartum depression, hypertension, cardiovascular disease, and type 2 diabetes mellitus. Infants who are breastfed have a decreased risk of atopic dermatitis and gastroenteritis, and have a higher IQ later in life. Additional benefits in infants have been noted in observational studies. Clinicians can support postdischarge breastfeeding by assessing milk production and milk transfer; evaluating an infant's latch to the breast; identifying maternal and infant anatomic variations that can lead to pain and poor infant weight gain; knowing the indications for frenotomy; and treating common breastfeeding-related infections, dermatologic conditions, engorgement, and vasospasm. The best way to assess milk supply is by monitoring infant weight and stool output during wellness visits. Proper positioning improves latch and reduces nipple pain. Frenotomy is controversial but may reduce pain in the short term. The U.S. Preventive Services Task Force recommends primary care interventions to support breastfeeding and improve breastfeeding rates and duration.

Comparing the effect of breastfeeding promotion interventions on exclusive breastfeeding: an experimental study

Article

Full-text available

Nov 2016

Introduction: Despite the proven risks associated with not breastfeeding, few mothers exclusively breastfeed their babies for six months as recommended by the World Health Organization. This study was conducted to compare the effect of breastfeeding promotion interventions on exclusive BMF among primiparous women. Methods: This quasi-experimental study was conducted on a sample of 93 primiparous women who were referred to health care centres, Mashhad, Iran, in 2010. Health care centres were selected by multistage sampling method, and then randomly allocated into two intervention groups (peer support group and health care provider’s education group) and one control group. Primigravidae aged 18-35 years old, with singleton pregnancy, with gestational age of 35-36 weeks, and intending to breastfeed their children were randomly selected out of health care centres. The peer support group participants received supports from their peers four times and education group’s participants received 4 training sessions by health care providers. The control group received only routine cares. Exclusive BMF duration and rate assessed at 4 and 8 weeks postpartum and collected data were analysed using SPSS (ver.11.5) software. Results: There were no significant differences in exclusive BMF duration at 4 and 8 weeks among the 3 groups (P=0.993, P=0.904). Exclusive BMF rate at 4 and 8 weeks after birth was significantly different among the 3 groups (P=0.043, P=0.023). No significant difference was found between peer support and healthcare provider’s education groups with respect to BMF rate at 4 weeks (P=0.111), but the difference was significant at 8 weeks (P=0.027). Conclusion: All women should be offered education and peer support to breastfeed their babies to increase the exclusive breastfeeding rate. But to continue exclusive breastfeeding, and increase its duration, help of family is more important than education and peer support. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing support so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.

Assessed Breastfeeding Knowledge, Attitude, and Practice and Identified Associated Factors

Article

Dec 2022

Understanding Factors Influencing Breastfeeding Outcomes in a Sample of African American Women

Article

Full-text available

Apr 2022
MATERN CHILD HLTH J

Objectives Persistent disparities in breastfeeding rates among African American (AA) women compared to other population groups have motivated researchers to understand factors influencing breastfeeding choices using a variety of methods. Quantitative surveys are more commonly reported, however, qualitative work that amplifies voices of AA women is limited. Methods Participants were recruited from a randomized controlled feasibility trial focused on breastfeeding support for AA women in Detroit, MI. Thirteen women were enrolled in the qualitative portion of the study described here. Using the Socioecological model (SEM) as the theoretical foundation, semi-structured qualitative interviews were conducted to explore perceived facilitators and barriers to breastfeeding. Interviews were digitally recorded, transcribed, and analyzed using Theoretical thematic analysis. Results Women reported factors ranging from micro to macro SEM levels that discouraged or reinforced breastfeeding. Key challenges included breastfeeding-related discouragement issues, including factors that decreased confidence and led women to terminate breastfeeding (e.g., problems with latching, pumping, lack of comfort with breastfeeding in public, and work constraints). Facilitators included perceived mother and infant benefits, perseverance/commitment/self-motivation, pumping ability, and social support. Participant suggestions for expanding breastfeeding promotion and support included: (1) tangible, immediate, and proactive support; (2) positive non-judgmental support; (3) “milk supply” and “use of pump” education; and (4) self-motivation/willpower/perseverance. Conclusions for Practice Despite the identification of common facilitators, findings reveal AA women face many obstacles to meeting breastfeeding recommendations. Collaborative discussions between women and healthcare providers focused on suggestions provided by AA women should be encouraged.

Promoting Sustained Breastfeeding of Infants at Risk for Asthma: Explaining the “Active Ingredients” of an Effective Program Using Intervention Mapping

Article

Full-text available

Mar 2018

Infants whose parents and/or siblings have a history of asthma or allergy may profit from receiving exclusive breastfeeding during the first 6 months of life. This is expected to diminish the chance of developing childhood asthma and/or atopic disease. Ongoing breastfeeding for 6 months seems challenging for many women. An educational program was developed using Intervention Mapping as a logic model to guide development and was found successful in improving breastfeeding rates at 6 months postpartum, improving knowledge and beliefs about breastfeeding for 6 months, after exposure to the program compared to controls. Intervention elements included an evidence- and theory-based booklet addressed during pre- and postnatal home visits by trained assistants. This paper elucidates the inner workings of the program by systematically describing and illustrating the steps for intervention development.

Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: A cluster randomized controlled trial

Article

Full-text available

Dec 2017

Background Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. Methods We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis. ResultsA total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4–59.9) in the intervention group and 54.6% (95% CI 50.0–59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0–2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0–4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0–6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718). ConclusionsEBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions. Trial registrationISRCTN ISRCTN83692672. Registered 11 November 2012. Retrospectively registered.

Breastfeeding Education: Where Are We Going? A Systematic Review Article

Article

Full-text available

Aug 2016

Background UNICEF (United Nations International Children’s Emergency Fund) and WHO estimate that if all babies were breastfed for at least the first six months of their lives, the rate of morbidity and malnutrition would significantly decrease all over the world. In this view, these two organizations promoted a worldwide campaign for breastfeeding, creating the Baby Friendly Hospital Initiative (BFHI) that encourages good practices for the promotion of breastfeeding in hospitals. The aim of our study was to review the available evidence regarding the positive effects of breastfeeding, in order to suggest to most appropriate strategy to support it. Methods The main databases including Scopus, PubMed, MEDLINE, Google scholar and Science Direct were researched to obtain the original papers related to breastfeeding education. The main terms used to literature search were “Breastfeeding education”, Breastfeeding support”, and “Breastfeeding healthcare policy”. The timeframe included the obtained articles was from 1980 to 2015. Results Our analysis confirms that healthcare providers play a pivotal role in education and encouraging mothers to begin and continue breastfeeding. In this view, the adequate training of healthcare providers seems to be mandatory in order to support this practice. Moreover, adequate facilities are needed in order to promote and support breastfeeding. Conclusion Considering the available evidence, breastfeeding should be supported among all the mothers. Based on the positive data emerging from the public awareness campaign in different Countries of the world, we strongly encourage an accurate training for doctors and midwives and the implementation of adequate facilities in order to support breastfeeding.

Mother Support Groups for Raising Awareness in the Community About Kangaroo Mother Care and Breastfeeding in the Era of COVID-19: Experiential Learning

Article

Apr 2024

Introduction: This article explores the establishment and subsequent challenges faced by a Mother Support Group (MSG) initiated in Gujarat, India, focusing on promoting Kangaroo Mother Care (KMC) and exclusive breastfeeding, particularly amid the COVID-19 era. Methods: The methodology involved adapting to COVID-19 restrictions, utilizing online platforms for training and webinars, and collaborating with ASHA workers for community outreach. The MSG members received training on breastfeeding and KMC, followed by practical demonstrations and community visits. Although initial efforts were promising, the group’s sustainability faltered when key stakeholders withdrew, revealing challenges in maintaining community-driven interventions. Results and discussion: The article underscores the importance of sustained efforts in establishing and retaining parent support groups. The lack of comprehensive data collection limits the ability to evaluate specific outcomes, but we highlight the potential benefits of MSG, including improved breastfeeding practices and KMC adherence. We acknowledge the need for robust frameworks and standard operating procedures to enhance the sustainability of such initiatives, emphasizing the importance of community involvement and leadership in supporting disadvantaged newborns. Conclusion: We draw attention to the complexities of sustaining grassroots initiatives and call for further research to develop effective models that address the unique needs of marginalized communities, particularly regarding the care of preterm newborns.

Determination of Effectiveness of Exclusive Breastfeeding Preparing Program on Knowledge of Primipara Mothers in Kirkuk City Hospitals

Article

Sep 2021

Objective: To determine of effectiveness of exclusive breastfeeding preparing program on knowledgeof primipara mothers in kirkuk city hospitalsMethodology: A quasi-experimental design of thirty Primipara women in three hospitals in kirkuk cityfor the period from March 1st to October 1st 2020.The data collected through stages which includepretest, posttest.Results: The finding indicate that among thirty study sample the MS and SD were higher in posttestin compare with pretest, and significant differences were found within study sample before and afterprogram at (P=0.05) which indicated that educational program positively effect on the study sampleregarding exclusive breastfeeding.Conclusions: The study concludes that after assessing the knowledge of the study sample, it found thattheir knowledge was poor and exclusive breastfeeding educational program was effectively improvedtheir knowledge.

Cost-Effectiveness and Equity Trade-Off for Breastfeeding Interventions

Chapter

Full-text available

Jun 2023

Many factors influence mothers’ decisions to begin and continue breastfeeding (BF). These include individual, societal and policy factors. In this chapter, we address these factors including the social differences in BF practice among Irish women and discuss important policy implications (efficiency and equity). It is well-documented that BF practice is different for mothers with different social backgrounds. Traditionally, evaluations of BF support interventions have focused on either the effectiveness or the equity issues, but rarely analysed both in a joint framework. The aim of this chapter is to discuss the cost-effectiveness and equity trade-off for BF interventions. We identify different BF support interventions and focus on social differences and their influence for maintaining BF practices. We illustrate how the “Distributional cost-effectiveness (DCEA) framework” can be applied to these interventions and how some interventions may be more effective in changing behaviour and outcomes for mothers with different social-economic status (SES), which may change the inequality in effectiveness and reduce the health equity.

Postpartum Breastfeeding Practices and Attitudes in Parents: A Randomized Study to Evaluate the Effects of Individual and Group Breastfeeding Education of Mothers and Fathers

Article

Full-text available

Sep 2023

Background Antenatal breastfeeding training is defined as the provision of breastfeeding information during pregnancy, which can be given in various ways, such as individual training and group training. The inclusion of fathers in this educational approach is associated with the initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding. However, studies involving fathers are limited. This randomized controlled study aimed to compare the effects of individual and group training given to parents and those of normal hospital practices on mothers’ breastfeeding self-efficacy and fathers' attitudes toward breastfeeding. Methods The study was conducted randomly in a training and research hospital between March 2014 and September 2014 and included 180 people. Of them, 90 were prospective mothers who were in the third trimester of their pregnancy and were living with their husbands and received service from the obstetrics outpatient clinic of the hospital. The expecting mothers and their husbands were randomly assigned to three groups: individual training, group training and control group. After randomization, prospective mothers and fathers in all groups received training. In the first week, sixth week, and fourth month after delivery, the mothers’ breastfeeding self-efficacy and breastfeeding attitudes as well as the attitudes of the fathers' toward breastfeeding were evaluated. Results There were no differences between the groups in terms of variables such as age, education status, family type, breastfeeding education status, and mode of delivery. There were significant differences between the scores obtained from the Breastfeeding Self-Efficacy Scale and its subscales in all three groups during the postpartum period (p <0.05). The highest scale scores were obtained at the postpartum fourth month in the individual training and control groups and at the postpartum sixth week in the group training group. There were differences between the scores obtained by the mothers and fathers during the postpartum process from the Iowa Infant Feeding Attitude Scale (p<0.05). Conclusion The analysis of all the results indicates that breastfeeding education given to parents in the antenatal period increases their breastfeeding self-efficacy and provides them with a positive attitude toward breastfeeding. However, further research is needed to determine whether individual or group training contributes to the development of breastfeeding self-efficacy and attitudes.

The role of doulas in providing breastfeeding support during the COVID-19 pandemic

Article

Full-text available

Apr 2023

Background Doulas have been instrumental in providing breastfeeding support to nursing mothers before and during the COVID-19 pandemic, as they can significantly impact a mother's ability to initiate and maintain breastfeeding. However, the COVID-19 pandemic, subsequent lockdowns, and social isolation created challenges for nursing mothers to access doulas' services, usually provided in person. In this study, we examined the role of doulas in providing breastfeeding support during the COVID-19 pandemic, exploring adaptation to COVID-19 guidelines and the challenges doulas face in providing breastfeeding support during the pandemic. Methods A systematic review was conducted following the PRISMA guidelines. Thirteen scientific databases and twenty peer-reviewed journals were searched for journal articles published in English between January 2020 and March 2022 using key search terms (e.g., Doula, Breastfeeding, COVID-19). Studies evaluating the role of doulas in providing breastfeeding support during COVID-19, and the impact of COVID-19 Guidelines on doula services, were included. Two reviewers independently performed the risk of bias assessment and data extraction. Summative content analysis was used to analyze the data. Results The majority of studies were conducted in developed nations. This systematic review includes eight articles, four qualitative, one survey, two mixed-methods studies, and one prospective research study. Seven of the eight studies were conducted in the United States, and the eighth was conducted in multiple countries. These studies have three main themes: (1) virtual breastfeeding support provided by doulas during the pandemic; (2) remote social support provided by doulas to breastfeeding mothers during the pandemic; and (3) barriers to doula service delivery due to COVID-19 restrictions, primarily the exclusion of doulas as essential workers. The eight studies showed that doulas found innovative ways to serve the needs of birthing and nursing mothers during the difficulties brought on by the pandemic. Conclusion Doulas provided breastfeeding support during the COVID-19 pandemic by utilizing innovative service delivery methods while navigating changes in COVID-19 guidance. However, system-level integration of doulas' work and the acknowledgment of doulas as essential healthcare providers are needed to enhance doula service delivery capacity, especially during a pandemic, to help improve maternal health outcomes.

Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers

Article

Full-text available

Mar 2023

Objective: To assess the knowledge and practice of breastfeeding and the effects of lactation counseling, as a health promotion intervention, on breastfeeding duration and exclusive breastfeeding (EBF) among Saudi women. Methods: In this quasi-experimental design study, 664 mothers attending a women’s hospital from January 2017 to December 2018 were interviewed. Women were allocated into two groups, control and intervention groups, based on received lactation counseling. Interviews were performed using a structured questionnaire collecting data on the sociodemographic characteristics, knowledge, attitude and practice of breastfeeding mothers. A chi-squared test was used to determine the level of significance on breastfeeding practices among two groups. Propensity score matching was presented to control confounders, as women cannot be randomly assigned to lactation counseling. Results: Of 664 women, 592 were Saudi nationals, and the majority of mothers were literate (96.2%). A significantly higher number of mothers in the consultation group were employed as compared with the non-consultation group (p = 0.015). One third (33.3%) of the women practiced EBF, while 39.8% preferred mixed feeding for the first six months of the infant’s life. The consultation group demonstrated a significantly higher response rate in their knowledge on the benefits of breastfeeding in babies (increased intelligence; p < 0.05) and mothers (breast engorgement; p = 0.004), colostrum and its importance (p = 0.027) and effective breastfeeding practices (initiate breastfeeding within 30 min after birth (p = 0.01), baby needs 10–20 min between each feed (p = 0.009), breastfeeding should last for 6 months (p = 0.01)) compared with the non-consultation group. The age of weaning (5.3 ± 2.8 vs. 5.9 ± 3.2 months) was similar across both the groups. However, “the intended duration of BF” was higher in the non-consultation group, and the difference was statistically significant (p = 0.002). The mean weight and length of the baby at follow-up were similar in both groups, with no statistical significance. The duration of exclusive breastfeeding among two groups was not statistically significantly different (8.7 ± 6.9 vs. 8.1 ± 7.1 weeks). Mothers in the two groups were satisfied with their breastfeeding experience. The mean scores lie within the range of 4.2 to 5.0. Baby age (month), mother LoE, mother job and type of BF were controlled for, and the propensity-score-matched 62.5% sample from both the groups yielded the same results. Conclusions: Breastfeeding women in our study showed a fair knowledge of EBF. However, the duration of actual EBF was very short, and the counseling intervention showed no impact on EBF in our study population. We recommend interventions that are tailored to the needs of this population, while identifying factors that improve breastfeeding practice among mothers.

Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

Article

Full-text available

Sep 2022

Background Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins. Methods A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis. Results All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding. Conclusions Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

Breastfeeding woes: a family physician’s approach

Article

Feb 2022

Effects of Exclusive Breastfeeding Consultation for Mothers on Continuation of Breastfeeding and Weight-gaining of Late Preterm Infants Hospitalized in Fatemieh Hospital in Hamadan, 2016

Preprint

Full-text available

Jan 2016

Weight-gaining refers to providing sufficient calorie, liquids, and nutrients and appropriate growth for the newborn baby, so training the appropriate feeding methods improves weight-gaining. The present research is aimed to investigate the effects of counseling the mothers on weight-gaining of the preterm infants hospitalized in Fatemieh Hospital in Hamadan. The randomized clinical trials on 124 individuals from among the mothers with preterm babies hospitalized in Fatemieh Hospital in Hamadan were investigated and the samples were randomly categorized in two control and experimental groups. A researcher-made checklist was used for examining the breastfeeding performance and five sessions of breastfeeding consultation were held for the intervention group. In order to examine the babies' weight-gaining, a baby-weighting scale of co12000 model, made in Iran, was used. Finally, the information and the significance level P<0/05 were analyzed using the Software SPSS Version-21. Comparison of the preterm babies' weight-gaining in control and experimental groups showed no significant difference before intervention (P=0/86), but this difference was significant during the first to fourth month of follow-up(P<0/001). so that the average weight of the preterm babies in both control and experimental groups in all four months of follow-up had increased compared to the period before the intervention. Findings showed that consultation improves the continuation of exclusive breastfeeding, increases the number of breastfeeding sessions, reduces the use of liquids and dry milk instead of breastfeeding for the preterm babies, and increases the babies' weight-gaining.

Six months of exclusive breastfeeding recommendation: How applicable is the universal exclusive breastfeeding recommendation policy?

Article

Full-text available

Jul 2014
AJFAND

Public health organisations, including the World Health Organisation recommend 6 months of exclusive breastfeeding for optimal growth, cognitive development and health . In addition, the provision of nutritionally adequate and safe complementary foods to the infants while breastfeeding continues up until 2 years of age and beyond is also recommended . Exclusive breastfeeding for the first 6 months of life meets the energy and nutrient needs of the infants. The objective of this review therefore, is to assess the appropriateness of a universal 6 months exclusive breastfeeding recommendation policy in both developed and developing countries. In the last years, recommendations for the optimal duration of exclusive breastfeeding promoted by WHO and UNICEF started to differ. The World Health Organization had recommended exclusive breastfeeding for 4 to 6 months, with the introduction of complementary foods thereafter, whereas UNICEF preferred the wording “for about 6 months”. This led to concerns in larger infant nutrition and public health communities. The American Academy of Pediatrics’ position was also unclear: In two different sections of their Pediatric Nutrition Handbook, recommending human milk “as the exclusive nutrient source for babies during the first 6 months” and “the delayed introduction of solid foods until 4 to 6 months”. Until recently, the only scientific evidence that contributed to the exclusive breastfeeding duration debate was based on observational studies, with well -recognized sources of potential bias. Reverse causality was another potential source of bias, particularly with respect to infectious morbidity and neuro- motor development. Infants who developed a clinically important infection were likely to become anorectic and experienced reduced breast milk intake that led to reduction in milk production and even termination of breastfeeding. The lack of functional and effective food safety standards and policies, safe drinking water, exclusive breastfeeding promoting programs, high infection rates and the broken healthcare systems in the developing countries unlike in the developed countries, are key areas that need further research before the 6 months recommended duration of exclusive breastfeeding can be reduced and/or changed to 4 months, to avoid child morbidity and mortality. It is also important that the 6 months of exclusive breastfeeding are promoted in all developing countries and 4- 6 months in all developed countries.

Online Health Information Seeking Behaviors and Infant Feeding Practices: A Social Cognitive Theory Perspective

Article

Full-text available

Aug 2021

Breastfeeding benefits infants, but support is often needed to meet breastfeeding goals. Social media may help disseminate infant feeding information to caregivers. The relationship between parents’ health information-seeking behaviors (HISB) on social media and infant feeding practices remains understudied. Based on social cognitive theory (SCT), parents’ self-efficacy and outcome expectations are two potential factors for improving online HISB. We aimed to use SCT to describe associations between outcome expectations, self-efficacy (eHealth literacy), and online HISB across infant feeding groups among a nationally representative sample of U.S. parents. Eligible participants (N = 580) completed a cross-sectional online survey assessing infant feeding practices (never breastfed, only pumped, only fed-at-the-breast, and both pumped and fed-at-the-breast), self-efficacy (using eHealth literacy as a proxy), outcome expectations in online HISB, parents’ online HISB on social media, and demographic information. Survey weighted linear and logistic regression models were constructed. No online activities differed by infant feeding practices. Parents who pumped only had significantly lower eHealth literacy than parents who never breastfed (adjusted β = -2.63, 95% CI: -4.73, -0.53). Parents who used both methods had 1.78 times greater odds of considering online tools useful for making health-related decisions (95% CI: 0.96, 3.28) and 1.49 times greater odds of considering online tools important for accessing health information (95% Cl: 0.70, 3.15) than parents who never breastfed, though neither association was statistically significant. Understanding these associations between infant feeding practices and online HISB, as well as the two potential factors of parents’ self-efficacy and outcome expectations, may offer implications for tailoring online social media resources to promote breastfeeding outcomes.

E-cigarettes: an acceptable alternative to smoking for breastfeeding mothers?

Article

Full-text available

Dec 2020

Emily Jade Johnston

Despite many women quitting smoking during pregnancy, the majority will return to smoking by 12 months postpartum. Smoking postpartum carries substantial risks of morbidity and mortality for both mother and baby. Breastfeeding is a protective factor against some of the risks associated with smoking. However, mothers who smoke are less likely to intend to breastfeed, initiate breastfeeding at birth, or continue breastfeeding, than non-smoking mothers. Current explanations for this association include a possible physiological mechanism, a coincidental association due to shared demographics, or a fear of harm. E-cigarettes are an increasingly popular alternative to smoking, helping to prevent relapse in those trying to quit, and Public Health England, in an evidenced based review, estimate cite them to be at least 95% safer than smoking. While research has explored e-cigarette use during pregnancy, thus far, no study has considered how e-cigarettes may be being used in the postpartum period. Crucially, research has not explored if and how e-cigarettes are used by breastfeeding mothers. As e-cigarettes are likely to be far safer than cigarettes, with far fewer toxicants, they may be an appropriate alternative to smoking in the postpartum period. To explore possible future interventions using e-cigarettes to reduce postpartum smoking and increase the likelihood and duration of breastfeeding, research must first explore the acceptability and current use of e-cigarettes in relation to breastfeeding. This thesis includes three studies. The first study aimed to explore whether an association between smoking and breastfeeding currently existed within a sample of UK mothers, independent of demographic factors. This study used data from the Pregnancy Lifestyle Survey, which recruited 750 current and recent ex-smokers, e-cigarette users and dual users (both smoking and e-cigarette users) who self-completed questionnaires in early pregnancy, late pregnancy and at 3 months postpartum. In late pregnancy, 63.5% of women intended to breastfeed, 46.35% initiated breastfeeding, and 17.68% of women were breastfeeding at 3 months. Older mothers were more likely to initiate breastfeeding at birth (p = 0.02), and mothers with higher levels of education were more likely to intend to breastfeed (p<0.001), initiate breastfeeding (p<0.001) and be breastfeeding at three months (p=0.01). Ex-smokers were more likely to intend to breastfeed (p<0.01), initiate breastfeeding (p=0.04) and be breastfeeding at three months (p<0.01) than smoking/vaping mothers. When adjusted for age and education, smokers were less likely to breastfeed at birth (OR 0.48, 95% CI: .26 - .75), and at three months postpartum (OR .19, 95% CI: .09 - .37), compared to ex-smokers. Vapers were similarly less likely to initiate and intend to breastfeed, but this was not significant. A negative association between smoking and breastfeeding exists in the UK, irrespective of demographics. Interventions should consider the association is at least, in part, due to factors other than demographics. Due to only a small sample of vapers recruited, further research should explore the use of e-cigarettes and attitudes to vaping as a breastfeeding mother in more detail. The second study used infodemographic methods to explore the use of e-cigarettes postpartum, and opinions towards e-cigarette use when breastfeeding. This study used data obtained from online parenting forums. The study identified four themes using a template approach to thematic analysis; use; perceived risk; social support; and evidence. Women were using e-cigarettes to prevent returning to smoking postpartum, many having started using them during pregnancy to quit smoking. In regards to breastfeeding, women varied on their opinions as to the acceptability of e-cigarettes. However, overall, women were generally positive about their use. Women viewed the risks of using e-cigarettes using direct comparisons to the risks of smoking; using e-cigarettes was seen as a positive behaviour to avoid smoking. Social support was an important part of the discussion; some women felt judged for using e-cigarettes, which was primarily related to the use of nicotine. Some women thought that the use of nicotine was evidence of bad mothering and a morality issue as well as a safety issue. A key finding was the sources of evidence women used and were looking for. Some women had accessed peer-reviewed scientific sources but had misinterpreted the results of the studies they quoted. Some women used non-scientific sources such as blogs and media articles to form both positive and negative opinions on vaping. Many women felt there was not enough research on the long term use of e-cigarettes; this made them fearful that serious harm would be linked to e-cigarettes use in the future. One thing that united women who were both positive and negative about e-cigarette use were the shared opinion there wasn't enough advice and support for mothers who vaped and wanted to breastfeed. More advice and support needs to be available as part of usual care for women who do vape, to enable them to make informed decisions about breastfeeding their infants. The third study used an online survey to explore further the themes identified in the second study. This study recruited 149 women who either smoked, vaped, or smoked and vaped and had an infant aged 18 months or younger using social media advertisements and links on parenting forums. The survey asked women about their experiences and opinions on smoking/vaping breastfeeding using open-ended questions that were thematically analysed. The survey also included Likert scales following PPI feedback. Three main themes were identified: smoking, vaping and breastfeeding behaviours; barriers and facilitators for breastfeeding as a smoking or vaping mother; and barriers and facilitators for using e-cigarettes (and not smoking) postpartum. Women employed a series of behaviours to reduce perceived harm to their infant from breastfeeding as a smoker or vaper. For vaping mothers, this involved using only low or zero nicotine. Smoking and vaping mothers discussed maintaining a smoke-free home, ensuring the maintenance of proper hygiene, and timing feeds around their smoking/vaping behaviours. Vaping mothers reported being less cautious about vaping around their infants. Dual-use mothers reported vaping in the day and only smoking when they had either expressed enough milk they wouldn't need to feed their infant or when they had their partner home to care for the infant. Barriers and facilitators were not fixed and invariable. They included the mothers' beliefs on what was acceptable, the perceived safety of breastfeeding as a smoker/vaper, and access to social support. Barriers to breastfeeding as a smoker were often due to women's beliefs it was unacceptable and unsafe for them to breastfeed; this barrier was sometimes overcome by switching to vaping. However, a lack of support and advice from health care professionals about vaping and breastfeeding was a barrier. Barriers to using e-cigarettes included previous use resulting in adverse events (such as a cough, or not successfully quitting smoking) and a lack of consistent (if any) advice from health care professionals. Facilitators included wanting to improve health, pregnancy, good social support, saving money and not having the smells associated with smoking. Overall, women view e-cigarettes as acceptable for use when breastfeeding. Interventions should consider the use of e-cigarettes to prevent women from returning to smoking postpartum and improve confidence in breastfeeding. To support and encourage women to switch to vaping, training for health care professionals on the relative safety of e-cigarettes is required.

Breastfeeding following in vitro fertilisation in Switzerland-Does mode of conception affect breastfeeding behaviour?

Article

Full-text available

Aug 2020

Aim Breastfeeding has numerous advantages. Our aim was to investigate whether breastfeeding initiation and duration in women with pregnancies conceived through in vitro fertilisation differ from spontaneously conceived pregnancies. Methods This is a comparative cross‐sectional study about breastfeeding behaviour performed at the Bern university hospital including mothers of singletons conceived by in vitro fertilisation (n = 198) with or without gonadotropin stimulation between 2010 and 2016 (in vitro fertilisation group). They were compared to a population‐based control group (n = 1421) of a randomly selected sample of mothers in Switzerland who delivered in 2014. Results A total of 1619 women were included in this analysis. Breastfeeding initiation rates were high, similar between the in vitro fertilisation group (93.4%) and the control group (94.8%). No increased risk of stopping breastfeeding earlier after in vitro fertilisation treatment compared to the control group could be found over the observational period of 12 months (HR=1.00, 95% CI 0.83‐1.20, p=0.984). There was no difference in breastfeeding initiation or duration after gonadotropin stimulated versus unstimulated in vitro fertilisation. Conclusion In Switzerland, in vitro fertilisation treatments were not associated with earlier breastfeeding cessation. This result is reassuring for mothers undergoing in vitro fertilisation.

Nutri-Epigenetics and Gut Microbiota: How Birth Care, Bonding and Breastfeeding Can Influence and Be Influenced?

Article

Full-text available

Jul 2020
INT J MOL SCI

Maternal lifestyle is an important factor in the programming of an infant's epigenome, in particular when considered alongside the mode of birth and choice of feeding method (i.e., breastfeeding or formula feeding). Beginning in utero, and during the first two years of an infant's life, cells acquire an epigenetic memory of the neonatal exposome which can be influential across the entire lifespan. Parental lifestyle (e.g., malnutrition, alcohol intake, smoke, stress, exposure to xenobiotics and/or drugs) can modify both the maternal and paternal epigenome, leading to epigenetic inheritance in their offspring. This review aims to outline the origin of early life modulation of the epigenome, and to share this fundamental concept with all the health care professionals involved in the development and provision of care during childbirth in order to inform future parents and clinicians of the importance of the this process and the key role it plays in the programming of a child's health.

When Is the Breast Best? Infant Feeding as a Domain of Intrasexual Competition

Article

Full-text available

Jan 2020

Medical science is unanimous in stating the numerous and significant benefits (to child and mother) of breastfeeding. Breastfeeding is free and is biologically plausible for most mothers. Yet a significant percentage of mothers do not breastfeed their infants. Feminist theorists have aligned themselves on both sides of this issue (as well as the fence in between). Some view breastfeeding as an inherently natural and empowering aspect of femininity. Others view it as a means of suppressing women’s choices and belittling their contributions. We suggest that one reason for this controversy is that breastfeeding may be about more than just providing nutrition to one’s infant. Breast-feeding may also represent a domain of female intrasexual competition. We review evidence from modern developed and developing countries, historical countries, and hunter–gatherer cultures and find it consistent with our hypothesis. Specifically, wealthy women in developed countries tend to have fewer children yet flaunt their breastfeeding as a display of their resources whereas wealthy women in developing/historical countries tend to demonstrate their resources by focusing on having more children and avoiding breastfeeding. We therefore find support for breastfeeding as an intrasexual domain for signaling one’s social status and resources. Given this variation in breastfeeding practices, we argue that breastfeeding is an agentic expression of women’s proximate and evolved psychological decisions and advocate for providing supports that allow women to freely make the best decisions for themselves.

Complementary feeding practices in Mexican healthy infants: How close are they to the current guidelines?

Article

Full-text available

Oct 2019

Background: The foundations for the growth and optimal development of every human being are laid in the first 2 years of life. Exclusive breastfeeding (EBF) up to 6 months of age and the introduction of complementary feeding (CF) from this age are considered the preventive interventions with the most significant impact on a child's life. The objective of this study was to determine if pediatricians base their recommendations by following the Guidelines for CF in Healthy Infants (GCFHI) and if mothers have any awareness and knowledge of these recommendations. Methods: Surveys based on the GCFHI were conducted in a group of mothers (n = 377) and pediatricians (n = 104) living in Mexico. Results: Not all pediatricians recommended the EBF, and 76% recommended infant formula before 6 months of age. Regarding mothers, 76.9% practiced the EBF for the first 6 months. Vegetables were the leading starting food of CF suggested by pediatricians and mothers (87% and 91%, respectively), contrasting with food sources of iron (44%), which are the foods of choice according to the GCFHI. The practices performed by the mothers were statistically different from the recommendations of the pediatricians. Conclusions: The results reflect a lack of updating regarding CF. It is imperative to reinforce efforts to maintain the EBF for 6 months and to continue it together with the CF, as well as to promote the beginning of CF based on macro- and micro-nutrients.

ESTADO DE LAS PRÁCTICAS ALIMENTARIAS DE LOS MENORES DE DOS AÑOS EN LA COMUNIDAD ARTEMISEÑA DE SAN CRISTÓBAL

Article

Full-text available

May 2019
Rev Cubana Pediatr

Santa Magaly Jiménez-Acosta

Introducción: La alimentación adecuada de los menores de 2 años de edad es esencial para la supervivencia infantil y el fomento de crecimiento y desarrollo saludables. Una nutrición óptima durante este ciclo vital reduce tanto la morbi-mortalidad como el riesgo de aparición de enfermedades crónicas no transmisibles en edades posteriores. Objetivo: Evaluar las prácticas alimentarias de los menores de dos años de edad que viven sin restricciones en la localidad de San Cristóbal (Artemisa, Cuba). Diseño del estudio: Descriptivo, transversal. Serie de estudio: Ciento cincuenta niños de uno u otro sexo, con edades comprendidas entre 0 y 23 meses y 29 días de edad, dispensarizados en los 13 consultorios atendidos por el Policlínico Docente “Camilo Cienfuegos”(San Cristóbal, Artemisa), entre Noviembre del 2014 y Marzo del 2015. Material y método: Se administró el cuestionario empleado en el “Estudio Nacional sobre Hábitos y Prácticas Alimentarias de los lactantes y niños pequeños” (Cuba, 2008). Se obtuvieron los indicadores definidos globalmente para evaluar las prácticas alimentarias de los menores de dos años. Resultados: La prevalencia de la lactancia materna exclusiva (LME) hasta el sexto mes de vida fue del 27.3%. Esta cifra aumentó hasta ser del 34.5% cuando se consideró el suministro de vitaminas, minerales y sueros de rehidratación oral junto con la LME. El 88% de los niños fueron amamantados durante la primera hora de vida. En el 30.9% de los menores de 5 meses de vida predominó la lactancia materna acompañada de lactancia artificial. La lactancia materna continuada al año y a los dos años de edad fue del 25.0% y el 11.0%, respectivamente. En el 54.6% de los niños menores de 6 meses se introdujo algún alimento de diversa textura (incluyendo leche artificial) antes de la edad óptima para ello. El 71.6% de los niños con edades entre 6 meses – 23 meses y 29 días siempre consumió algún alimento con ayuda del biberón. Los cereales y las frutas (64.2% de los niños incluidos en este grupo etario), las carnes, el huevo y las leguminosas (77.3%), la leche (77.9%), y los aceites y las grasas (81.1%) fueron consumidos entre 6 – 7 veces a la semana por más del 60% de los niños examinados. Por el contrario, las frutas (49.5%), los vegetales (30.5%), y los azúcares y los dulces (53.7%) no fueron consumidos nunca por los niños en estas edades. Conclusiones: Se encontró una baja prevalencia de la LME hasta el sexto mes. La alimentación complementaria de los niños con edades entre 6 y 23 meses y 29 días se conduce inadecuadamente, es poco variada y además (probablemente) nutricionalmente insuficiente.

Attitudes of expectant fathers in the setting of teenage pregnancy towards breastfeeding - a mixed methods study

Article

Full-text available

Jan 2018

Effectiveness of breastfeeding interventions delivered to fathers in low- and middle-income countries: A systematic review

Article

Full-text available

May 2018

Impact of Educational Materials on the Duration of Exclusive Breastfeeding Assured by Women Who Delivered at the Souissi Maternity Hospital in Rabat

Article

Full-text available

Jan 2017

A MIXED METHOD APPROACH TO DEVELOP AND VALIDATE A MULTIDISCIPLINARY FRAMEWORK FOR EVALUATION OF BARRIERS AND FACILITATORS TO AWARENESS, IMPLEMENTATION, INITIATION AND CONTINUITY OF EXCLUSIVE, BREASTFEEDING IN NEWBORN STAGE IN SAUDI ARABIA

Conference Paper

Full-text available

May 2016

Background: Exclusive breastfeeding has been a major international health initiative as regulated and launched by the World Health Organization and UNICEF since 1992. As a vital component of the reproductive process, exclusivity in breastfeeding for at least six months has shown implications for the well-being of the infants as well as the mothers. It has been observed that in Saudi Arabia, few newborn hospital units practice exclusive breastfeeding leading to design a well-structured approach to solving issues and concerns. As such, still, there is no strong and unique multidisciplinary theoretical framework with a family-centred service delivery and sustainable quality health outcome philosophy seen in the hospitals in the country. Aim: This study aims to provide a more efficient multidisciplinary research method for collecting and analyzing both quantitative and qualitative focus group data in developing and validating a framework to evaluate the barriers and facilitators to awareness, implementation, initiation and continuation of exclusive breastfeeding practices in the new born stage in Saudi Arabia. Methods: Quantitative-qualitative research methods were utilized to design and validate a framework for barriers and facilitators to exclusive breastfeeding. For the quantitative methods, previously published multidisciplinary international standards, guidelines and evidence-based research and practice were reviewed, analyzed, tabulated and coded into systems, constructs and themes resulting in 257 comprehensive items. Coding criteria and ranking were used for validating the framework. The developed framework was validated by six session's focus groups of ISBN: 978-605-64453-7-8 251 multidisciplinary experts in the fields of speech pathology, rehabilitation, paediatrics, neonatology, obstetrics and nursing for consensus' verification and re-verification of the classifications and codes of the pre-classified framework. Another team of co-researchers re-read, reviewed and reclassified the focus group re-verification data with > 90% reliability. Results: A focused and quantifiable consensus and validation was obtained from the focus groups discussions. Focus groups consensus revealed a high (> 85%) content validity and reliability. All statements in each category were rated from 9 to 10 as highly important. The literature referenced predetermined framework and coding criteria helped focus group participants and researchers to design and focus a valid standard framework with modification of less than 15% of the original. Conclusion: This study provides a validated mixed methodology in medical research to design and validate frameworks with results informing modification of the framework and identification and organization of appropriate exclusive breastfeeding constructs and themes. Establishing a framework is hoped to lead to the development of tools to evaluate barriers and facilitators to breastfeeding to sustain the nutritional needs of the infant and likewise the health of the mother. Utilization of the mixed method design is recommended as a focused and efficient research tool to elicit process and validate reliable data.

NNF Evidence Based Guidelines - Management of Breastfeeding

Chapter

Full-text available

Jan 2010

Gender and maternal healthcare

Chapter

Jan 2016

This chapter addresses some key issues in maternal healthcare which have resonance in the international arena. In many middle and high-income countries, a key policy focus is on addressing disparities or inequities in healthcare recently highlighted by the revisiting of work on the social determinants of health by the WHO (CSDH, 2008). The report argues that social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are seen as mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries, with ongoing debate about the effective contribution that health services can make to mitigate the impact the these social determinants on health and well-being. © Ellen Kuhlmann and Ellen Annandale 2010. and their respective authors 2010

Gender and maternal healthcare

Chapter

Full-text available

Jan 2012

Brookings supports breastfeeding: using public deliberation as a community-engaged approach to dissemination of research

Article

Mar 2017

Empirical evidence demonstrates myriad benefits of breastfeeding for mother and child, along with benefits to businesses that support breastfeeding. Federal and state legislation requires workplace support for pumping and provides protections for public breastfeeding. Yet, many are unaware of these laws, and thus, support systems remain underdeveloped. We used a community-based approach to spread awareness about the evidence-based benefits of breastfeeding and breastfeeding support. We worked to improve breastfeeding support at the local hospital, among local employers, and throughout the broader community. Our coalition representing the hospital, the chamber of commerce, the university, and local lactation consultants used a public deliberation model for dissemination. We held focus groups, hosted a public conversation, spoke to local organizations, and promoted these efforts through local media. The hospital achieved Baby-Friendly status and opened a Baby Café. Breastfeeding support in the community improved through policies, designated pumping spaces, and signage that supports public breastfeeding at local businesses. Community awareness of the benefits of breastfeeding and breastfeeding support increased; the breastfeeding support coalition remains active. The public deliberation process for dissemination engaged the community with evidence-based promotion of breastfeeding support, increased agency, and produced sustainable results tailored to the community’s unique needs.

Faktor yang Memengaruhi Pemberian ASI Eksklusif pada Bayi Cukup Bulan yang Dilakukan Inisiasi Menyusu Dini (IMD)

Article

Full-text available

Nov 2016

Latar belakang. Air susu ibu merupakan nutrisi ideal untuk bayi. World Health Organization (WHO) menganjurkan pemberian ASI eksklusif hingga 6 bulan. Data Survey Demografi dan Kesehatan Indonesia (SDKI) tahun 2003 dan 2007 menunjukkan angka ASI eksklusif di Indonesia cenderung turun. Beberapa penelitian menunjukkan terdapat beberapa faktor yang memengaruhi pemberian ASI eksklusif. Tujuan. Mengetahui proposi ASI eksklusif pada bayi yang dilakukan IMD, dan mengetahui faktor-faktor yang memengaruhinya. Metode. Penelitian potong lintang analitik dengan pengumpulan data melalui wawancara pada bulan Juni-September 2012. Subjek penelitian adalah ibu yang memiliki anak berusia 0-6 bulan yang datang ke Poliklinik Anak RS St. Carolus Jakarta. Analisis statistik dengan uji Kai kuadrat dan regresi logistik. Hasil. Dilakukan penelitian pada 120 subjek. Proporsi ASI eksklusif 75%, sebagian besar merupakan primipara (56,7%). Kelahiran secara spontan 65,8%. Subjek yang memiliki tingkat pendidikan tinggi 73,3% dan 59,2% merupakan ibu bekerja. Subjek yang termasuk ke dalam status sosial ekonomi tinggi 45%, sisanya berada di sosial ekonomi rendah (4,2%), dan menengah (50,8%). Sebagian besar subjek (73,3%) telah memperoleh konseling ASI. Faktor yang paling bermakna memengaruhi ASI eksklusif berturut-turut, yaitu faktor psikis ibu, dukungan keluarga, pengetahuan tentang ASI eksklusif, dan konseling ASI. Kesimpulan. Proporsi ASI eksklusif pada bayi cukup bulan yang dilakukan IMD di RS St Carolus adalah 75%. Faktor yang terbukti memengaruhi pemberian ASI eksklsusif adalah faktor psikis ibu (keyakinan ibu terhadap produksi ASI), dukungan keluarga, pengetahuan ibu yang benar tentang ASI eksklusif, dan konseling ASI.

Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers

Article

Full-text available

Nov 2016
MATERN CHILD HLTH J

Objectives To explore African American women’s breastfeeding thoughts, attitudes, and experiences with healthcare professionals and subsequent influences on their breastfeeding interest and behavior. Insight was also sought about the most effective practices to provide breastfeeding support to African American women. Methods Thirty-eight pregnant or lactating African American women and racially diverse health professionals were recruited and participated in one of six membership specific focus groups in the metro Detroit area. An experienced focus group facilitator who was African American woman served as the primary group facilitator, using a semi-structured guide to discussions. Focus groups explored perceptions of personal and professional roles and behaviors that support African American women’s breastfeeding behavior. Discussions were digitally recorded and audiotapes were transcribed. Thematic content analysis was conducted in combination with a review of field notes. Results Participants generally agreed that breastfeeding is the healthier feeding method but perceived that healthcare providers were not always fully supportive and sometimes discouraged breastfeeding. Non-breastfeeding mothers often expressed distrust of the information and recommendations given by healthcare providers and relied more on peers and relatives. Health professionals lacked information and skills to successfully engage African American women around breastfeeding. Conclusions for Practice Breastfeeding initiation and duration among African American mothers may increase when postpartum breastfeeding interventions address social and cultural challenges and when hospital breastfeeding support with the right professional lactation support, is void of unconscious bias and bridges hospital, community, peers, and family support. Professional lactation training for healthcare professionals who are in contact with expectant and new mothers and an increase in the number of IBCLC of color could help.

The Factors Affecting the Most Healthy Way of Giving Breast Milk (Breastfeeding) and The Role of Nurse

Article

Full-text available

Jun 2019

Breast milk is the most suitable food for healthy growth and development of babies. The World Health Organization and the United Nations Children's Fund, for the first six months of birth from the birth to baby nutrition, without taking any additional food, including water only breast milk is considered to be the most appropriate way. Although a good level of breastfeeding rates in the world and Turkey, in the first six months only breastfeeding rates are low. There are neonatal, maternal, and environmental-social factors affecting the initiation of breastfeeding and especially the first six months. Training and counseling roles of nurses are of great importance in the initiation and effective implementation of breastfeeding. Therefore nurses who are in close contact with the mother and the baby in the prenatal and postnatal period should be aware of the importance of breastfeeding and the factors affecting the breastfeeding process. In this review, the importance of breastfeeding will be emphasized and then the studies on these factors that affect the initiation and continuation of breastfeeding will be examined. In addition, the roles of nurses who play a key role in increasing breastfeeding during the first six months and supporting the mother's breastfeeding behavior will be examined in line with literature. Keywords: Breastfeeding; breast milk; newborn; nurse's role.

The Effect of Peer Support on the Breastfeeding Continue During the First 2 Years of Infant Life Among Primiparous Women: Randomized Clinical Trial

Article

Full-text available

Feb 2021

Effective interventions for breastfeeding and child feeding

Article

Full-text available

Nov 2022

Objective: To develop a rapid review on effective actions for the promotion of breastfeeding and healthy complementary feeding in primary health care and to summarize a list of actions and their elements for implementation. Data source: The review included systematic reviews on the effectiveness of interventions to promote breastfeeding and/or healthy complementary feeding for mothers and other caregivers, and/or professionals who work with this population, in comparison with any usual approach or none. Data synthesis: A total of 32 systematic reviews were included in the evidence synthesis. Ten types of interventions were evaluated in systematic reviews on promotion of breastfeeding and four types of interventions on promotion of healthy complementary feeding. The synthesis allowed six aspects to be discussed, and these must be considered to increase the chances of interventions' impact: type of intervention, target audience, timing of intervention, actors that can implement it, strategies and methods of intervention, and intensity of intervention. Conclusions: It was possible to assemble a list of actions whose effectiveness has already been demonstrated, providing elements for local adaptations. Evidence is expected to support and Objetivo: Desenvolver uma revisão rápida sobre intervenções efetivas para a promoção do aleitamento materno e da alimentação complementar saudável na Atenção Primária à Saúde e sintetizar um cardápio de ações e seus elementos para implementação. Fontes de dados: Foram incluídas revisões sistemáticas que avaliaram a efetividade de intervenções para promoção do aleitamento materno e/ou alimentação complementar saudável com mães e outros cuidadores e/ou profissionais que atuam com essa população em comparação com qualquer abordagem usual ou nenhuma. Síntese dos dados: Na síntese das evidências, foram incluídas 32 revisões sistemáticas. Nas revisões sistemáticas, foram avaliados dez tipos de intervenções no tema "promoção do aleitamento materno" e quatro tipos de intervenções no tema "promoção da alimentação complementar saudável". A síntese dos resultados permitiu discutir seis aspectos da implementação que devem ser considerados para aumentar as chances de impacto das intervenções: tipo de intervenção, público-alvo, momento da intervenção, atores que podem implementar, estratégias e métodos para conduzir a intervenção, e intensidade da intervenção. Conclusões: Os resultados permitiram apresentar um cardápio de ações cuja efetividade já foi demonstrada, fornecendo ABSTRACT RESUMO Effective interventions for the promotion of breastfeeding and healthy complementary feeding in the context of Primary Health Care Intervenções efetivas para a promoção da amamentação e da alimentação complementar saudável no contexto da Atenção Primária à Saúde

Effective interventions for the promotion of breastfeeding and healthy complementary feeding in the context of Primary Health Care

Article

Full-text available

Nov 2022

Severity of Hyperbilirubinaemia

Article

Jul 2022

Shabih Manzar

Increased prevalence of severe neonatal hyperbilirubinaemia during social distancing

Article

Jan 2022

Aim Social distancing guidelines implemented with the COVID-19 pandemic impacted health-care utilisation and disrupted critical social supports. Resurgence of highly transmissible strains has resulted in revisiting restrictions with potential impacts on newborn health. With concerns for inadequate post-partum support, we sought to determine if social distancing correlated with increased rates of readmission for hyperbilirubinaemia. Methods Retrospective chart review identified all readmissions for hyperbilirubinaemia between 1/18 and 4/20 in Western New York. Infant/maternal demographics and data on hospital course were collected on control (1/1/18–31/1/20) and social distancing (1/2/20-30/4/20) cohorts. Nineteen outpatient clinics were surveyed regarding lactation support. Results Monthly readmissions for hyperbilirubinaemia nearly tripled during social distancing (0.90 ± 0.91 vs. 2.63 ± 2.29 per 1000 births during early COVID, P = 0.015). Comparable severity of disease at readmission was observed with no difference in the need for therapies (phototherapy, intravenous immunoglobulin or exchange transfusion) or length of hospital stay. Mothers were younger (25.8 ± 3.3 vs. 31.3 ± 4.7 years; P = 0.005) with higher rates of primiparity and exclusive breastfeeding than national norms, however not significantly higher than controls in our small cohort (62.5 vs. 37.0% for primiparity; 87.5 vs. 81.5% for breastfeeding). Of 19 clinics surveyed, only six confirmed a telemedicine option for lactation support. Conclusions Rates of readmission for hyperbilirubinaemia increased during social distancing. Younger maternal age with high rates of primiparity and exclusive breastfeeding raise concern for inadequate social and/or lactation support. Proactive identification of mothers at risk and expansion of remote lactation services may be indicated with recurrent waves of the pandemic.

The impact of Baby Friendly Initiative accreditation: An overview of systematic reviews

Article

Full-text available

Jun 2021
MATERN CHILD NUTR

Despite its reported benefits, breastfeeding rates are low globally, and support systems such as the Baby Friendly Initiative (BFI) have been established to support healthy infant feeding practices and infant bonding. Increasingly reviews are being undertaken to assess the overall impact of BFI accreditation. A systematic synthesis of current reviews has therefore been carried out to examine the state of literature on the effects of BFI accreditation. A systematic search of CINAHL, MEDLINE, Maternal and Infant Health, Scopus, the Cochrane Library and PROSPERO was undertaken. Study selection, data extraction and critical appraisal of included reviews using the AMSTAR-2 tool were undertaken by two authors, with disagreements resolved through discussion with the third author. Due to heterogeneity, a narrative synthesis of findings was applied. Fourteen reviews met the inclusion criteria. Overall confidence in the results of the review was rated as high for three reviews, low for two reviews and critically low for nine reviews. Most evidence suggests some increase in breastfeeding initiation, exclusivity and duration of breastfeeding, and one main trial suggests decreased gastrointestinal infection and allergic dermatitis in infants. However, overall certainty in the evidence was rated as very low across all outcomes due to concerns over risk of bias within and heterogeneity between the original studies. More contemporary, good-quality randomised controlled trials or well-controlled prospective comparative cohorts are required to better evaluate the impact of full BFI accreditation, with particular attention paid to the context of the research and to long-term maternal and infant health outcomes.

KEBUTUHAN DAN KENDALA KADER KESEHATAN DALAM MEMBANTU KEBERHASILAN IBU MENYUSUI

Article

Full-text available

Nov 2020

Kader kesehatan masyarakat adalah pihak dari masyarakat desa yang merupakan lini terdepan dalam membantu masyarakat di desa mengatasi permasalahan kesehatan termasuk membantu keberhasilan ibu menyusui memberikan ASI ekslusif selama enam bulan dan melanjutkan sampai dua tahun, namun belum banyak penelitian yang menggali bagaimana kebutuhan serta kendala yang dihadapi kader dalam membantu keberhasilan ibu menyusui. Tujuan penelitian ini yaitu untuk mengetahui kebutuhan kader kesehatan desa dalam menyukseskan menyusui eksklusif dan menyusui sampai dua tahun serta kendala yang dihadapi. Penelitian ini menggunakan pendekatan cross sectional study dengan metode deskriptif eksploratif terhadap 47 orang kader kesehatan dari 6 desa di kecamatan Darussalam Aceh Besar yang diambil secara acak. Hasil penelitian menunjukkan bahwa 63,8% kader sangat setuju bahwa mereka berperan dalam keberhasilan ibu menyusui. Selain itu, 66% kader membutuhkan kelompok diskusi dengan pertugas kesehatan tentang menyusui secara tatap muka. Dalam melaksanakan perannya, juga terdapat kendala yang dihadapi kader kesehatan dalam membantu ibu menyusui yaitu merasa gagal dalam berkomunikasi dan meyakinkan ibu untuk menyusui bayinya (21,3%), belum memiliki pengetahuan yang memadai ketika ibu menyusui mengeluhkan ASI nya sedikit, puting kecil, dan bayi tidak mau menyusu (17%). Oleh karena itu, dibutuhkan pengetahuan yang mumpuni dari kader serta forum diskusi yang dapat memotivasi kader serta berkonsultasi terhadap permasalahan yang belum diketahuinya untuk membantu keberhasilan ibu menyusui. Community health workers are village structures that are at the frontline of helping communities overcome health problems including helping successful mothers to breastfeed exclusively for six months and continue for up to two years. However, very little research has discussed the needs and constraints faced by the community health worker in helping breastfeeding mothers succeed. The purpose of this study was to determine the needs of village community health workers in the success of exclusive breastfeeding and breastfeeding for up to two years and the obstacles faced. This study used a cross-sectional study approach with a descriptive exploratory method on 47 community health workers from 6 villages in the Darussalam Aceh Besar sub-district who were taken randomly. The results showed that 63.8% of the community health worker strongly agreed that they played a role in the success of breastfeeding mothers. Besides, 66% of community health workers need a face-to-face discussion group with health workers about breastfeeding. In carrying out their role, there are also obstacles faced by the community health worker in helping breastfeeding mothers, namely feeling that they fail to communicate and convince mothers to breastfeed their babies (21.3%), do not have adequate knowledge when breastfeeding mothers complain about their low milk, small nipples, and babies do not want to breastfeed (17%). Therefore, it requires qualified knowledge from community health workers as well as discussion peer group with the breastfeeding counselor that can motivate them and consult on unknown problems to help the success of breastfeeding mothers.

Effect of Peer Support on the Incidence of Pregnancy during Breastfeeding in Nulliparous Women

Article

Nov 2018

Effect of Dedicated Lactation Support Services on Breastfeeding Outcomes in Extremely-Low-Birth-Weight Neonates

Article

Nov 2017

Background: Breastfeeding is associated with major benefits for high-risk infants born prematurely, yet this population faces significant challenges to breastfeeding. Lactation services provide successful interventions, yet the impact of lactation services on breastfeeding outcomes in preterm infants is understudied. Research aim: The provision of full-time lactation support in the neonatal intensive care unit (NICU) will improve quantitative breastfeeding measures in premature infants. Methods: A longitudinal retrospective nonexperimental design was used. Data were collected from medical records of breastfeeding outcomes in patients 30 weeks' gestational age and under admitted to a level IV regional NICU over three epochs of varying levels of lactation services, from none to full time. Demographic, medical, and breastfeeding data were collected. Data analysis was performed using standard statistical tests and hierarchical regression analysis. Results: A significant increase in the number of lactation consults was observed across epochs, and the number of infants who received human milk via feeding at the breast, as the first oral feeding, increased across epochs. After controlling for covariates, the odds of infants receiving any human milk compared with exclusive formula feeding increased across epochs. Conclusion: The provision of full-time dedicated NICU lactation support is associated with an increase in breastfeeding outcome measures for high-risk preterm infants.

Facteurs associés à l'allaitement maternel exclusif chez les mères d'enfants de 24 mois à Bamako

Article

Mar 2014

Objectif : notre étude avait pour objet d’étudier les facteurs associés à l’allaitement maternel exclusif dans la ville de Bamako. Méthodes : il s’agissait d’une étude transversale descriptive et analytique qui s’est déroulée du 3 mars au 14 avril 2013 à Bamako. Les mères d’enfants de 24 mois n’ayant pas atteint leur troisième anniversaire constituaient la population de l’étude. Un sondage à deux degrés a été utilisé pour interviewer les cibles à l’aide d’un questionnaire. La régression logistique sur Epi 2000 version 3.5.1 a été utilisée pour analyser les données. Résultats : l’étude a concerné 362 mères. Les moyennes d’âge des mères et la durée de l’allaitement maternel étaient respectivement de 26,86 ± 6,44 ans et de 19,22 ± 3,28 mois. Environ 92 % des mères étaient mariées, 30,7 % avaient pratiqué l’allaitement maternel exclusif (AME), 22,9 % avaient pratiqué l’allaitement maternel (AM) dans les 30 minutes suivant l’accouchement, et 29 % des mères avaient effectué l’AM jusqu’à 24 mois ou plus. Cependant, nous avons observé une association par la régression logistique entre l’allaitement maternel exclusif, la pratique de l’allaitement maternel dans les 30 minutes suivant l’accouchement, et le niveau de scolarisation. Conclusion : nous avons identifié des facteurs modifiables en vue d’améliorer la pratique de l’allaitement maternel exclusif à Bamako.

Breastfeeding and Diabetes

Chapter

Sep 2017

Elizabeth Stenhouse

Effect of educational and support interventions on long-term breastfeeding rates in primiparous women: a systematic review and meta-analysis

Article

Sep 2017

Background: Long-term breastfeeding, including exclusive breastfeeding for six months and continuation of breastfeeding with complementary food until two years of age, has been recommended by the World Health Organization. However, despite the clear benefits of long-term breastfeeding (six months and beyond), the rates of breastfeeding still continue to remain low. Although there are some individual interventional studies that aimed to increase prolonged breastfeeding rates among both multiparous and primiparous women, there is no systematic review or meta-analysis to examine the effectiveness of those interventions among primiparous women who had no previous breastfeeding experience. Objectives: The aim of this review was to identify the effects of professional educational and support interventions on breastfeeding rates at six months and up to two years postpartum compared to the standard care among primiparous women. Inclusion criteria types of participants: Studies that included primiparous women aged 18 and over who intended to breastfeed. Types of intervention(s): Studies that investigated the effect of educational and support interventions provided by health professionals during the antenatal, postnatal period or both. Types of studies: Randomized controlled trials. Outcomes: Studies with reported breastfeeding rates at six months or up to two years postpartum. Search strategy: A three-step search strategy was utilized in this review. The search was conducted in Cochrane, MEDLINE and CINAHL databases. Only trials that met the inclusion criteria and published in English were considered for this review. Databases were searched from their commencement year to May 2016. Methodological quality: Two independent reviewers selected the papers using the standardized critical appraisal tool from the Joanna Briggs Institute. Data extraction and data synthesis: Data was extracted using the standardized Joanna Briggs Institute data extraction instrument. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan v5.3 (Copenhagen: The Nordic Cochrane Centre, Cochrane). In the absence of trials comparing the same outcomes, meta-analysis could not be performed; the findings have therefore been presented in a narrative form, including tables and figures to aid in data presentation where appropriate. Results: Ten randomized controlled trials were included in this review. Interventions with only one antenatal or postnatal component were not effective in increasing breastfeeding rates at six months. However, based on one trial, an intervention that included antenatal education and support in combination with postnatal education and support doubled the rate of breastfeeding at six months among primiparous women randomized to the intervention group compared to the control group (p = 0.28). Conclusion: Despite the good methodological quality of the trials, due to the heterogeneity of the interventions and outcome measures (types of breastfeeding) it was not possible to identify any specific effective intervention. However, based on a single trial, it appears that a combination of antenatal and postnatal education interventions may be useful in increasing breastfeeding rates at six months.

Associations Between Peer Counseling and Breastfeeding Initiation and Duration: An Analysis of Minnesota Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Article

Full-text available

Jan 2018
MATERN CHILD HLTH J

Background Peer counseling (PC) has been associated with increased breastfeeding initiation and duration, but few analyses have examined the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) model for peer counseling or the continuation of breastfeeding from birth through 12 months postpartum. Objectives Identify associations between Minnesota WIC Peer Breastfeeding Support Program services and breastfeeding initiation and continuation. Methods Retrospective analysis of observational data from the Minnesota WIC program’s administrative database of women who gave birth in 2012 and accepted a PC program referral prenatally (n = 2219). Multivariate logistic regression and Cox regression models examined associations between peer services and breastfeeding initiation and continuation of any breastfeeding. Results Among women who accepted referral into a PC program, odds of initiation were significantly higher among those who received peer services (Odds Ratio (OR): 1.66; 95% CI 1.19–2.32), after adjusting for confounders. Women who received peer services had a significantly lower hazard of breastfeeding discontinuation from birth through 12 months postpartum than women who did not receive services. (Hazard Ratio (HR) month one: 0.45; 95% CI 0.33–0.61; months two through twelve: 0.33; 95% CI 0.18–0.60). The effect of peer counseling did not differ significantly by race and ethnicity, taking into account mother’s country of origin. Conclusion for practice Receipt of peer services was positively associated with breastfeeding initiation and continued breastfeeding from birth through 12 months postpartum. Making peer services available to more women, especially in communities with low initiation and duration, could improve maternal and child health in Minnesota.

Effect of educational and support interventions to increase long-term breastfeeding rates in primiparous women: a systematic review protocol

Article

Mar 2017

Review question/objective: The objective of this review is to identify the effects of educational and supportive interventions provided by health professionals on long-term breastfeeding rates at six months and up to two years post partum among primiparous women who intend to breastfeed.

Breastfeeding and Health

Chapter

Dec 2017

Lucía Colodro-Conde

Breastfeeding, either by the mother or other women, has been the main way of feeding infants for most of human history. Only recently has bottle feeding become an option to feed newborns. Further, in the last decades, women's decisions regarding maternity, birth control, and nursing have evolved without precedent. Social norms, including gender norms, have had a key role in these changes and the decision to breastfeed.Breastfeeding not only has a nutritional function but is a fundamental area of socialization. In this chapter we cover what breastfeeding means from a biological and cultural perspective; how breastfeeding, being exclusive to women, is influenced by gender (ie, by the conformity that women have with feminine gender stereotypes); how gender and health are important during pregnancy; and how they relate to decision making on feeding methods. Lastly, we propose some guidelines for the psychological intervention in the health context.

Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant MortalityWHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant MortalityLancet200035545145510841125

Article

Full-text available

Feb 2000

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.

Promotion of breastfeeding intervention trial (PROBIT)

Article

Full-text available

Jan 2001

Context Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries.Objective To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants.Design The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996–December 1997 with a 1-year follow-up.Setting Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.Participants A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up.Interventions Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.Main Outcome Measures Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups.Results Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P = .01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).Conclusions Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.

Promoção da amamentação em localidade urbana da região sul do Brasil: estudo de intervenção randomizado

Article

Full-text available

Aug 1994

Foi realizado em Pelotas, RS, Brasil, estudo de intervenção randomizado, para a promoção do aleitamento materno. Grupo de 450 mães e lactentes foram visitados em casa aos 5, 10 e 20 dias após o nascimento, e comparados com um grupo-controle do mesmo número. Noventa e dois por cento das famílias no grupo de intervenção receberam as três visitas planejadas. A avaliação do padrão de aleitamento materno e causas de desmame aconteceu seis meses depois do nascimento para ambos os grupos. Noventa e quatro por cento do grupo de intervenção e noventa e dois por cento do grupo-controle foram encontrados na visita de avaliação. A intervenção aumentou a duração do aleitamento (mediana de 120 dias no grupo de intervenção, contra 105 dias no grupo-controle; p=0,03) e retardou a introdução do leite artificial (mediana de idade de 90 dias no grupo de intervenção e 60 dias no grupo-controle; p=0,01). As causas de desmame foram classificadas como subjacentes, intermediárias, e imediatas. A causa subjacente mais comum foi "o bebê chora muito", sugerindo que as mães devem ser instruídas a respeito dos padrões normais de comportamento do lactente nas primeiras semanas de vida, em particular da necessidade que a criança tem de chorar e o fato de que isto, não necessariamente, significa fome.

Risk Factors for Deaths due to Respiratory Infections among Brazilian Infants

Article

Full-text available

Jan 1990

Victora C G (Departmento de Medicina Social, Universidade Federal de Pelotas, CP 464, 96001 Pelotas, RS, Brazil), Smith P G, Barros F C, Vaughan J P and Fuchs S C. Risk factors for deaths due to respiratory infections among Brezilian infants. International Journal of Epidemiology 1989, 18: 918–925. In a population based case-control study, 127 Brazilian infants who died due to a respiratory infection were compared with 254 neighbourhood controls. The main risk factors associated with mortality were low socioeconomic status (including low levels of parental education) and—after adjustment for socioeconomic status—lack of breastfeeding, lack of supplementation with non-milk foods, crowding, the number of under-fives in the family, lack of a flush toilet, low birthweight, low weight-for-age and having a young mother. In a multivariate analysis, the variables found to be most closely associated with mortality were breastfeeding, education of the father, the number of under-fives, family income and birthweight. Having a low weight-for-age was also strongly associated with mortality but the retrospective nature of the study makes this finding difficult to interpret.

Breast-feeding counseling in a diarrhoeal disease hospital

Article

Full-text available

Feb 1996
B WORLD HEALTH ORGAN

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother-infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practices.

Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee Infant Feeding Study. BMJ 316, 21-25

Article

Full-text available

Feb 1998

To investigate the relation of infant feeding practice to childhood respiratory illness, growth, body composition, and blood pressure. Follow up study of a cohort of children (mean age 7.3 years) who had detailed infant feeding and demographic data collected prospectively during the first two years of life. Dundee. 674 infants, of whom 545 (81%) were available for study. Data on respiratory illness were available for 545 children (mean age 7.3 (range 6.1-9.9) years); height for 410 children; weight and body mass index for 412 children; body composition for 405 children; blood pressure for 301 children (mean age 7.2 (range 6.9-10.0) years). Respiratory illness, weight, height, body mass index, percentage body fat, and blood pressure in relation to duration of breast feeding and timing of introduction of solids. After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower (17.0% (95% confidence interval 15.9% to 18.1%) for exclusive breast feeding, 31.0% (26.8% to 35.2%) for partial breast feeding, and 32.2% (30.7% to 33.7%) for bottle feeding. Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood (21.0% (19.9% to 22.1%) v 9.7% (8.6% to 10.8%)). It was also associated with increased percentage body fat and weight in childhood (mean body fat 18.5% (18.2% to 18.8%) v 16.5% (16.0% to 17.0%); weight standard deviation score 0.02 (-0.02 to 0.06) v -0.09 (-0.16 to 0.02). Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk (mean 94.2 (93.5 to 94.9) mm Hg v 90.7 (89.9 to 91.7) mm Hg). The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.

Odds Ratios Should Be Avoided When Events Are Common [Letter]

Article

Full-text available

Dec 1998

Editor—A news item stated that “a review article written by authors with affiliations to the tobacco industry is 88 times more likely to conclude that passive smoking is not harmful than if the review was written by authors with no connection to the tobacco industry.”1 We are concerned that readers may have interpreted this huge effect at face value. The proportions being compared (which were not given in the news item) were 29/31 (94%) and 10/75 (13%). The relative risk here is 7, which indicates a strong association but is an order of magnitude lower than the reported odds ratio of 88.2 This value is correct but is seriously misleading if presented or interpreted as meaning that the relative risk that affiliated authors would draw favourable conclusions was 88, as it was in this news item. The odds ratio is valuable in case-control studies where events are usually rare and the relative risk cannot validly be estimated directly. In prospective studies interpretation of the odds ratio as an approximation to the relative risk becomes unreliable when events are common, and thus its use for prospective studies, especially randomised trials and systematic reviews, has been criticised.3,4 The distortion is especially large when the event rate is high in only one group, as in this example. The odds ratio should not be interpreted as an approximate relative risk unless the events are rare in both groups (say, less than 20-30%). The odds ratio remains especially useful when researchers need to adjust for other variables, for which logistic regression is the usual approach. While such analyses are valid, when the objective is to communicate study results to an audience unfamiliar with the relation between odds ratios and relative risks, surely it makes no sense also to report the relative risk when this differs markedly from the odds ratio.

Efficacy of home-based peer counselling to promote exclusive breastfeeding: A randomised controlled trial

Article

Full-text available

Apr 1999

Exclusive breastfeeding is recommended worldwide but not commonly practised. We undertook a randomised controlled study of the efficacy of home-based peer counselling to increase the proportion of exclusive breastfeeding among mothers and infants residing in periurban Mexico City. Two intervention groups with different counselling frequencies, six visits (44) and three visits (52), were compared with a control group (34) that had no intervention. From March, 1995, to September, 1996, 170 pregnant women were identified by census and invited to participate in the study. Home visits were made during pregnancy and early post partum by peer counsellors recruited from the same community and trained by La Leche League. Data were collected by independent interview. Exclusive breastfeeding was defined by WHO criteria. 130 women participated in the study. Only 12 women refused participation. Study groups did not differ in baseline factors. At 3 months post partum, exclusive breastfeeding was practised by 67% of six-visit, 50% of three-visit, and 12% of control mothers (intervention groups vs controls, p<0.001; six-visit vs three-visit, p=0.02). Duration of breastfeeding was significantly (p=0.02) longer in intervention groups than in controls, and fewer intervention than control infants had an episode of diarrhoea (12% vs 26%, p=0.03). This is the first reported community-based randomised trial of breastfeeding promotion. Early and repeated contact with peer counsellors was associated with a significant increase in breastfeeding exclusivity and duration. The two-fold decrease in diarrhoea demonstrates the importance of breastfeeding promotion to infant health.

Breast-feeding and cognitive development: A meta-analysis

Article

Full-text available

Nov 1999

Although the results of many clinical studies suggest that breast-fed children score higher on tests of cognitive function than do formula-fed children, some investigators have suggested that these differences are related to confounding covariables such as socioeconomic status or maternal education. Our objective was to conduct a meta-analysis of observed differences in cognitive development between breast-fed and formula-fed children. In this meta-analysis we defined the effect estimate as the mean difference in cognitive function between breast-fed and formula-fed groups and calculated average effects using fixed-effects and random-effects models. Of 20 studies meeting initial inclusion criteria, 11 studies controlled for >/=5 covariates and presented unadjusted and adjusted results. An unadjusted benefit of 5.32 (95% CI: 4.51, 6.14) points in cognitive function was observed for breast-fed compared with formula-fed children. After adjustment for covariates, the increment in cognitive function was 3.16 (95% CI: 2.35, 3.98) points. This adjusted difference was significant and homogeneous. Significantly higher levels of cognitive function were seen in breast-fed than in formula-fed children at 6-23 mo of age and these differences were stable across successive ages. Low-birth-weight infants showed larger differences (5.18 points; 95% CI: 3.59, 6.77) than did normal-birth-weight infants (2.66 points; 95% CI: 2.15, 3.17) suggesting that premature infants derive more benefits in cognitive development from breast milk than do full-term infants. Finally, the cognitive developmental benefits of breast-feeding increased with duration. This meta-analysis indicated that, after adjustment for appropriate key cofactors, breast-feeding was associated with significantly higher scores for cognitive development than was formula feeding.

Costs and effectiveness of community postnatal support workers: Randomised controlled trial

Article

Full-text available

Oct 2000

To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. Randomised controlled trial with six month follow up. Recruitment in a university teaching hospital and care provided in women's homes. 623 postnatal women allocated at random to intervention (311) or control (312) group. Intervention: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. Main outcome measure: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.

Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: A randomised controlled trial

Article

Full-text available

Nov 2000

Most mothers breastfeed in Bangladesh, but they rarely practise exclusive breastfeeding. Hospital-based strategies for breastfeeding promotion cannot reach them because about 95% have home deliveries. We postulated that with the intervention of trained peer counsellors, mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months. 40 adjacent zones in Dhaka were randomised to intervention or control groups. Women were enrolled during the last trimester of pregnancy between February and December, 1996. In the intervention group, 15 home-based counselling visits were scheduled, with two visits in the last trimester, three early postpartum (within 48 h, on day 5, between days 10 and 14), and fortnightly thereafter until the infant was 5 months old. Peer counsellors were local mothers who received 10 days' training. 363 women were enrolled in each group. Peer counselling significantly improved breastfeeding practices. For the primary outcome, the prevalence of exclusive breastfeeding at 5 months was 202/228 (70%) for the intervention group and 17/285 (6%) for the control group (difference=64%; 95% CI 57%-71%, p>0.0001). For the secondary outcomes, mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods. At day 4, significantly more mothers in the intervention group breastfed exclusively than controls. Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding. We recommend incorporation of peer counsellors in mother and child health programmes in developing countries.

Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus

Article

Full-text available

Jan 2001

Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries. To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants. The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up. Thirty-one maternity hospitals and polyclinics in the Republic of Belarus. A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up. Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies. Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups. Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28). Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.

Breast-feeding in a Low-Income Population

Article

Jul 1995
Arch Pediatr Adolesc Med

Nancy B. Brent

Objective: To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income, inner-city population.Design: A randomized, nonblinded clinical control trial. Patients were followed up through pregnancy, delivery, and the first year of the infant's life or until the time of weaning from the breast, whichever came first.Setting: The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income, inner-city population.Patients: There were a total of 108 patients: 51 were randomized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant, and 57 were randomized to the control group that received the standard of care at the institution. Patients in the control group were not seen by the lactation consultant. The two groups were similar demographically.Intervention: This program consisted of individual prenatal lactation consultation, daily rounds by the lactation consultant on the postpartum unit, and outpatient follow-up at 48 hours after discharge, at the time that the infant was 1 week of age, and at all future health supervision visits for infants up to 1 year of age.Main Outcome Measures: The incidence and duration of breast-feeding.Results: There was a markedly higher incidence of breast-feeding in the intervention group, as compared with that of the control group (61% vs 32%, respectively; P=.002). The duration of breast-feeding was also significantly longer in the intervention group (P=.005).Conclusions: This lactation program increased the incidence and duration of breast-feeding in our low-income cohort. We suggest that similar efforts that are applied to analogous populations may increase the incidence and duration of breast-feeding in low-income populations in the United States.(Arch Pediatr Adolesc Med. 1995;149:798-803)

Breast-Feeding in a Low-Income Population

Article

Feb 1996

Impact on breastfeeding practices promoted by lay counselors: A randomized and controlled clinical trial

Article

Feb 1998
J CLIN EPIDEMIOL

Effect of Breastfeeding on Infant and Child Mortality Due to Infectious Diseases in Less Developed Countries: A Pooled Analysis

Article

Jun 2000
Ambul Child Health

Richard Reading

A randomized controlled trial evaluating the effect of peer (mother-to-mother) support on breastfeeding duration among primiparous women [microform].

Article

Thesis (Ph. D.)--University of Toronto, 1999. Includes bibliographical references.

Health Effects of Breastfeeding for Mothers

Article

Feb 1997

Lactation results in a number of physiological adaptations which exert direct effects on maternal health, some of which may confer both short and long term advantages for breast feeding mothers. Breast feeding in the early postpartum period promotes a more rapid return of the uterus to its prepregnant state through the actions of oxytocin. Breast feeding may also lead to a more rapid return to prepregnancy weight. Among studies that had good data on duration and intensity of lactation, the majority show a significant association between lactation and weight loss. However, there is no evidence that lactation prevents obesity. Lactation also affects glucose and lipid metabolism. The long term effects of these adaptations are unknown but may have implications for preventing subsequent development of diabetes and heart disease. Lactation delays the return of ovulation and significantly reduces fertility during the period of lactational amenorrhoea. This process is linked with feeding patterns and may therefore be affected by practices such as scheduled feedings and the timing of introduction of complementary foods. While the evidence from epidemiologic studies is mixed, several large studies have shown that extended lactation is associated with reduced risk of premenopausal breast, ovarian and endometrial cancers. Although bone mineralization declines during lactation, repletion takes place after weaning. As a result, breast feeding does not appear to cause long term depletion of bone nor does it increase risk of osteoporosis. Many of the physiological effects of lactation are dependent on the stimulation of the hypothalamic-pituitary axis and milk removal and thus may vary with infant feeding practices. Well controlled studies are needed that include detailed information regarding infant feeding practices in addition to the total duration of any breast feeding. Future feeding recommendations should reflect careful consideration of how such practices affect both infant and maternal health.

A prospective study of individual causes of breastfeeding

Article

Aug 1979
Acta Paediatr Scand

A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty-four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding.

A Simple Method for Analysis of Clustered Binary Data

Article

Jul 1992

A simple method for comparing independent groups of clustered binary data with group-specific covariates is proposed. It is based on the concepts of design effect and effective sample size widely used in sample surveys, and assumes no specific models for the intracluster correlations. It can be implemented using any standard computer program for the analysis of independent binary data after a small amount of preprocessing. The method is applied to a variety of problems involving clustered binary data: testing homogeneity of proportions, estimating dose-response models and testing for trend in proportions, and performing the Mantel-Haenszel chi-squared test for independence in a series of 2 x 2 tables and estimating the common odds ratio and its variance. Illustrative applications of the method are also presented.

Addendum to report of partial hypoxanthine-guanine phosphoribosyl transferase deficiency

Article

Mar 1992
J Pediatr

Breastfeeding and urinary tract infection

Article

Aug 1990

Breast Milk and Neonatal Necrotising Enterocolitis

Article

Dec 1990

In a prospective multicentre study on 926 preterm infants formally assigned to their early diet, necrotising enterocolitis developed in 51 (5.5%). Mortality was 26% in stringently confirmed cases. In exclusively formula-fed babies confirmed disease was 6-10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk. Pasteurised donor milk seemed to be as protective as raw maternal milk. Among babies born at more than 30 weeks' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk; it was 20 times more common in those fed formula only. Other risk factors included very low gestational age, respiratory disease, umbilical artery catheterisation, and polycythaemia. In formula-fed but not breast-milk-fed infants, delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis. With the fall in the use of breast milk in British neonatal units, exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year. About 100 of these infants would die.

Protective effect of breast feeding against infection

Article

Feb 1990

To assess the relations between breast feeding and infant illness in the first two years of life with particular reference to gastrointestinal disease. Prospective observational study of mothers and babies followed up for 24 months after birth. Community setting in Dundee. 750 pairs of mothers and infants, 76 of whom were excluded because the babies were preterm (less than 38 weeks), low birth weight (less than 2500 g), or treated in special care for more than 48 hours. Of the remaining cohort of 674, 618 were followed up for two years. Detailed observations of infant feeding and illness were made at two weeks, and one, two, three, four, five, six, nine, 12, 15, 18, 21, and 24 months by health visitors. The prevalence of gastrointestinal disease in infants during follow up. After confounding variables were corrected for babies who were breast fed for 13 weeks or more (227) had significantly less gastrointestinal illness than those who were bottle fed from birth (267) at ages 0-13 weeks (p less than 0.01; 95% confidence interval for reduction in incidence 6.6% to 16.8%), 14-26 weeks (p less than 0.01), 27-39 weeks (p less than 0.05), and 40-52 weeks (p less than 0.05). This reduction in illness was found whether or not supplements were introduced before 13 weeks, was maintained beyond the period of breast feeding itself, and was accompanied by a reduction in the rate of hospital admission. By contrast, babies who were breast fed for less than 13 weeks (180) had rates of gastrointestinal illness similar to those observed in bottle fed babies. Smaller reductions in the rates of respiratory illness were observed at ages 0-13 and 40-52 weeks (p less than 0.05) in babies who were breast fed for more than 13 weeks. There was no consistent protective effect of breast feeding against ear, eye, mouth, or skin infections, infantile colic, eczema, or nappy rash. Breast feeding during the first 13 weeks of life confers protection against gastrointestinal illness that persists beyond the period of breast feeding itself.

Early diet of preterm infants and development of allergic or atopic disease: Randomised prospective study

Article

Apr 1990

To study the effect of early diet on the development of allergic reactions in infants born preterm. Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. 777 Infants with a birth weight less than 1850 g born during 1982 to 1984. Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.

THe effect of postpartum lactation counseling on the duration of breast-feeding in low-income women

Article

May 1990
Am J Dis Child

We investigated the effectiveness of a program of intensive postpartum support for low-income, breast-feeding women and identified potential predictors of prolonged breast-feeding in this population. Ninety-seven low-income women were randomized to receive intensive postpartum education and support for breast-feeding or to receive only the routine assistance provided by the obstetrical nurses. Both groups were telephoned 6 weeks post partum to determine the method of infant feeding then, and those still breast-feeding were contacted monthly until complete weaning had occurred. No significant difference in breast-feeding duration between the two groups was noted. There was no association between duration of nursing and race, marital status, or the need to return to work or school. Earlier age at introduction of supplement, younger maternal age, and participation in prenatal classes predicted breast-feeding duration by logistic regression.

The influence of additional information, advice and support on the success of breast feeding in working class primiparas

Article

Sep 1988

S Jenner

A sample of 38 white working class primiparas intending to breast feed were alternately assigned to either an experimental or control group during the last trimester of pregnancy. All women were visited at home antenatally for a structured interview on their attitudes towards and information on breast feeding. The experimental group were visited twice before the birth, seen within the first 5 days in hospital, and visited immediately after they returned home, to enable the provision of information, advice and support regarding breast feeding. All women were seen again at 3 months postpartum. There was a significant difference between the two groups in level of breast feeding success, and explanations for this effect are put forward in terms of the experimental intervention components.

Commercial Discharge Packs and Breast-Feeding Counseling: Effects on Infant-Feeding Practices in a Randomized Trial

Article

Jan 1988

A randomized controlled trial was conducted to evaluate two interventions for prolonging the duration of breast-feeding in a multiethnic sample of 343 low-income urban women. One intervention compared research breast-feeding bedside counseling by a trained counselor, who also made eight telephone calls during the first 3 months of the infant's life, with the routine breast-feeding counseling provided in the hospital by nurses. The other intervention compared commercial discharge packs provided by formula companies with research discharge packs designed to be consistent with the WHO Code of Marketing of Breastmilk Substitutes. When infants were 4 months old, a telephone interviewer unaware of treatment status contacted 95% (324/343) of the women to determine the infants' feeding and health histories. Compared with routine counseling, research counseling delayed the first introduction of solid foods to the infant's diet (P = .03, one-tailed) but did not exert a statistically significant effect on breast-feeding by 4 months' postpartum. Women who received the research discharge pack, compared with those who received the commercial pack, were more likely to prolong exclusive breast-feeding (P = .004, one-tailed), to be partially breast-feeding at 4 months postpartum (P = .04, one-tailed), and to delay the daily use of solid foods in the infant's diet (P = .017, one-tailed). Among the women who received research counseling, the research discharge pack was associated with lower rates of rehospitalization of infants than was the commercial pack (1% v 14%; P = .014, two-tailed). We conclude that in high-risk maternity populations, commercial discharge materials for breast-feeding women should be replaced by materials consistent with the WHO Code.

Evaluating the effect of a breastfeeding consultant on the duration of breastfeeding

Article

May 1986

We used a randomized controlled trial of 270 breastfeeding consultant on the duration of breastfeeding. No significant differences were found between the experimental and control groups in the duration of breastfeeding. There were no significant differences between groups in knowledge about lactation at the end of the study. Duration was influenced by maternal age, education, period of decision for breastfeeding, intended duration of breastfeeding, infant's age at first breastfeeding, and knowledge about lactation at birth, all of which were statistically significant. Controlling singly for any of the above significant factors did not materially affect the overall absence of relationship between study groups for duration of breastfeeding. However, in one subgroup there was evidence of a possible beneficial effect from the consultant's services; among women deciding to breastfeed after the first trimester of pregnancy, a significantly greater proportion in the experimental group continued to breastfeed to 6 months (31% vs 9%).

Infant feeding and subsequent risk of atopic eczema

Article

Sep 1985
Arch Dis Child

An attempted controlled trial of exclusively breast fed neonates with atopic parents, to assess the effectiveness of breast feeding in preventing atopic allergy, was not successfully achieved. Analysis of the data as an observational study, however, provided evidence that breast feeding offers some protection against eczema in genetically vulnerable infants. Feeds of soya preparations were associated with eczema as often as cows' milk based feeds.

Lactation nurse increases duration of breast feeding

Article

Sep 1985
Arch Dis Child

In a randomised controlled trial a lactation nurse assisted mothers during the early weeks after parturition both in hospital and at home. All mothers who started breast feeding were entered into the trial. The lactation nurse significantly extended duration in the study group compared with controls, particularly during the first four weeks and among women of lower social class.

The Development of the Maternal Breastfeeding Evaluation Scale

Article

Jul 1994

A Maternal Breastfeeding Evaluation Scale was developed from categories identified in qualitative research. Content validity was tested according to procedures described by Imle and Atwood' and Lynn. ² A sample of 442 women who had breastfed completed an instrument of 56 Likert-scale items. A retest questionnaire was completed by a subsample of 28 women. Exploratory factor analysis resulted in three factors, accounting for 38.5 percent of the variance: Maternal Enjoyment/Role Attainment (29 percent), Infant Satisfaction/Growth (5 percent), and Lifestyle/Maternal Body Image (4 percent). A revised 30-item MBFES was developed using items loading strongly on these three factors. Cronbach's alphas for the revised scale and subscales were .93, .93, .88, and .80, respectively. Test-retest correlations (n=28) were .93, .93, .94, and .82, respectively (p<.001 for all).

[Promotion of breast-feeding in urban localities of southern Brazil: a randomized intervention study]

Article

Sep 1994

A randomized intervention trial to promote breast-feeding was carried out in southern Brazil. A group of 450 mothers and babies was visited at home 5, 10 and 20 days after birth and compared to a non-visited control group of the same size. Ninety-two per cent of the families visited received the three home visits planned. The evaluation of breast-feeding patterns and reasons for weaning took place 6 months after birth for both groups. Ninety-four per cent of the group visited and 92% of the non-visited controls group were traced on the occasion of the assessment. The intervention increased the duration of breast-feeding (median duration of 120 days in the group visited and 105 days in the controls; p = 0.03) and delayed the introduction of milk bottles (median age of introduction of 90 days in the group visited and 60 days in the controls; p = 0.01). Causes of weaning were classified as underlying, intermediate and immediate. The most common underlying cause of weaning was "the baby cried too much", which suggests that mothers should be taught about normal patterns of infant behaviour in the first weeks of life, particularly the need for crying, and the fact that this not necessarily reflects hunger.

Controlled Study of a Regular Telephone Support Program given by Women Volunteers on the Establishment of Breastfeeding (in French)

Article

Mar 1995

The goal of this controlled trial was to evaluate the impact of a volunteer telephone support program on the ability of the mothers to reach their breastfeeding objectives and to reduce the number of difficulties while nursing. Two hundred expectant women were randomly assigned to two groups. The first group received the usual services from the professionals and the second had the extra service from a trained volunteer. By comparing the proportions of women still breastfeeding at each month, the present study showed that this type of support was ineffective in meeting the objectives. The gap between the intended length of breastfeeding and the duration achieved was equally large in both groups. Only 30% breastfed for the length of time envisaged during pregnancy. Strategies to increase the effectiveness of this type of service are suggested.

A prospective cohort study on breast-feeding and otitis media in Sweden

Article

Apr 1994

This study analyzed the effect of breast-feeding on the frequency of acute otitis media. The protocol was designed to examine each child at 2, 6 and 10 months of age. At each visit nasopharyngeal cultures were obtained, the feeding pattern was recorded and the acute otitis media (AOM) episodes were documented. The analysis was based on 400 children from whom complete information was obtained. They represented 83% of the newborns in the study areas. By 1 year of age 85 (21%) children had experienced 111 AOM episodes; 63 (16%) had 1 and 22 (6%) had 2 or more episodes. The AOM frequency was significantly lower in the breast-fed than in the non-breast-fed children in each age group (P < 0.05). The first AOM episode occurred significantly earlier in children who were weaned before 6 months of age than in the remaining groups. The frequency of nasopharyngeal cultures positive for Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae was significantly higher in children with AOM. At 4 to 7 and 8 to 12 months of age, the AOM frequency was significantly higher in children with day-care contact and siblings (P < 0.05 and < 0.01, respectively). The frequency of upper respiratory tract infections was increased in children with AOM but significantly reduced in the breast-fed group.

Prenatal and Postnatal Factors in Predicting Later Blood Pressure among Children: Cardiovascular Risk in Young Finns

Article

Nov 1996

A negative correlation between birth weight and subsequent blood pressure has been reported, but in some studies this correlation has not been found. We analyzed the effect of birth weight and pubertal development and several pre- and postnatal factors on subsequent blood pressure among 2500 children and adolescents in a follow-up study with three surveys conducted with 3-y intervals. The correlations between birth weight and systolic blood pressure varied from -0.04 to 0.02 among the female subjects and from -0.05 to -0.04 among the male subjects in each survey. A somewhat stronger relation was found among the postpubertal female and male subjects (correlation coefficient -0.09 and -0.05) in the last survey. When adjusted for weight, the correlations became negative and more often significant. The decrease in the adjusted mean systolic blood pressure was about 2 mm Hg when birth weight increased from the lowest to the highest tertile. Other factors affecting systolic blood pressure were current age (mean change up to 1.8 mm Hg/ y) and weight (mean change up to 1.2 mm Hg/kg), the duration of breast feeding over 3 mo (mean change up to -6.5 mm Hg), and a birth rank order over four (mean change up to 5.0 mm Hg) presented as the mean difference from the baseline. According to the multiple regression analysis, a history of mother's high blood pressure during pregnancy (p < 0.05) predicted future blood pressure more eminently than birth weight. In conclusion, our results based on healthy children and adolescents offer support for the theory of low birth weight as a predicting factor for future blood pressure. However, other pre- and postnatal factors seem to be important as well.

The incidence and duration of breast feeding

Article

Nov 1997
EARLY HUM DEV

Information obtained from a variety of sources shows different rates of initiation and duration of breast feeding and different supplementation strategies. Among populations of developing countries, in general, the mothers resident in rural-areas are more likely to breast feed than those in urban areas; in addition the better off or more highly educated are less likely to breast feed. In contrast in the developed countries, the better educated and the higher social class mothers are more likely to breast feed. There is some evidence that delay in initiation of breast feeding, lack of professional support, conflicting advice from health professionals and the presence of free samples of artificial milk (whether or not given to the mother) can result in a mother failing to establish breast feeding. Additionally, mothers who smoke cigarettes are less likely to breast feed successfully. Whilst breast feeding is almost universal in a number of developing countries, many also commonly use complementary feeds. In some countries, particularly in Asia, it is still commonplace for a child not to be given the mother's colostrum, and therefore for the first breast feed to occur well after the first 24 h.

Breast-feeding promotion in a diarrhoea programme in rural communities

Article

Sep 1997
J Diarrhoeal Dis Res

Breast-feeding promotion is an important intervention for the control of infant diarrhoea. This study assesses the impact of a breast-feeding counselling programme on the prevalence of exclusive breast feeding in rural communities in Nigeria. Mothers attending primary care facilities because their infants had acute diarrhoea were randomised into two groups. The study group (n = 82) received individual, focused breast-feeding counselling, while the controls (n = 79) had routine advice for diarrhoea. Both groups were monitored and followed with home visits to determine infant-feeding practices. The results showed marked increases in exclusive breast-feeding prevalence for the intervention group at day 7 (49% vs. 6% control; p < 0.0001) and day 21 (46% vs. 8%; p < 0.0001). Moreover, diarrhoea re-occurrence at day 21 was less in the intervention group (12%) than controls (18%). It is concluded that focused breast-feeding counselling can increase exclusive breast feeding and reduce the prevalence of diarrhoea in rural communities.

Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran

Article

Jan 1999
B WORLD HEALTH ORGAN

This quasi-experimental study was conducted in Shiraz, the Islamic Republic of Iran, on 120 pairs of mothers and infants in a maternity hospital that had a rooming-in programme. All 59 mothers in the study group received breastfeeding education, face-to-face, after delivery and during follow-up for 4 months in the mother and child health (MCH) centre or in their homes; the remaining 61 mothers comprised the control group. Exclusive breastfeeding rates were significantly higher in the study group (54%) than in the control group (6.5%), but 5% and 18% of infants, respectively, in the study and control groups had stopped breastfeeding by the age of 4 months. The mean number of days of diarrhoea experienced by infants in the study group were significantly lower (P < or = 0.004) than in the control group. At the end of 4 months, the mean weight and length of the infants were significantly higher (both P < 0.05) in the study group than in the control group. The findings indicate that rooming-in is very important for promoting exclusive breastfeeding and that there is a need for continuous breastfeeding education of mothers.

The Effect of Individualized Professional Support on Duration of Breastfeeding: A Randomized Controlled Trial

Article

Dec 2000

A trial was conducted with 51 women randomly assigned either to a conventional nursing care group or to an individualized professional support group to examine the effect of professional support on breastfeeding status at 4 weeks postpartum. All participants identified themselves as having no prior support. At 4 weeks postpartum, 17 out of 25 (68%) and 26 out of 26 (100%) women in the control and intervention groups, respectively, continued to breastfeed (P = .005). Results indicate that postpartum care augmented with individualized professional support commenced in the hospital and continued in the community significantly increases the duration of breastfeeding among women who identify themselves as being without support for the first month postpartum.

Early nutrition in preterm infants and later blood pressure: Two cohorts after randomised trials

Article

Mar 2001

Despite data relating body size in early life to later cardiovascular outcomes, the hypothesis that nutrition affects such outcomes has not been established. Breastfeeding has been associated with lower blood pressure in later life, but previous studies have not controlled for possible confounding factors by using a randomised design with prospective follow-up. We undertook such a study to test the hypothesis that early diet programmes blood pressure in later life in children randomly assigned different diets at birth. Blood pressure was measured at age 13-16 years in 216 (23%) of a cohort of 926 children who were born prematurely and had participated at birth in two parallel randomised trials in five neonatal units in the UK. Dietary interventions were: donated banked breastmilk versus preterm formula and standard term formula versus preterm formula. Children followed up at age 13-16 years were similar to those not followed up in terms of social class and anthropometry at birth. Mean arterial blood pressure at age 13-16 years was lower in the 66 children assigned banked breastmilk (alone or in addition to mother's milk) than in the 64 assigned preterm formula (mean 81.9 [SD 7.8] vs 86.1 [6.5] mm Hg; 95% CI for difference -6.6 to -1.6; p=0.001). In non-randomised analyses, the proportion of enteral intake as human milk in the neonatal period was inversely related to later mean arterial pressure (beta=-0.3 mm Hg per 10% increase [95% CI -0.5 to -0.1]; p=0.006). No differences were found in the term formula (n=44) versus preterm formula (n=42) comparison. Breastmilk consumption was associated with lower later blood pressure in children born prematurely. Our data provide experimental evidence of programming of a cardiovascular risk factor by early diet and further support the long-term beneficial effects of breastmilk.

Optimal duration of exclusive breastfeeding

Article

Feb 2002

Exclusive breastfeeding for six months (versus three to four months) reduces gastrointestinal infection, does not impair growth, and helps the mother lose weight. The results of two controlled trials and 18 other studies suggest that exclusive breastfeeding (no solids or liquids besides human milk, other than vitamins and medications) for six months has several advantages over exclusive breastfeeding for three to four months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections or of allergic diseases have been demonstrated. No adverse effects on growth have been documented with exclusive breastfeeding for six months, but a reduced level of iron has been observed in developing-country settings.

Issues in the meta-analysis of cluster randomized trials

Article

Oct 2002

Meta-analyses involving the synthesis of evidence from cluster randomization trials are being increasingly reported. These analyses raise challenging methodologic issues beyond those raised by meta-analyses which include only individually randomized trials. In this paper we review and comment on a selected number of these issues, including problems of study heterogeneity, difficulties in estimating design effects from individual trials and the choice of statistical methods. Copyright © 2002 John Wiley & Sons, Ltd.

Odds ratios should be avoided when events are common Breast-feeding promotion in a diarrhoea programme in rural communities

161-166

Altman Dg
Jj
Sackett
Dl

Altman DG, Deeks JJ, Sackett DL. Odds ratios should be avoided when events are common. British Medical Journal 1998; 317:1318. 25 Davies-Adetugbo AA, Adetugbo K, Orewole Y, Fabiyi AK. Breast-feeding promotion in a diarrhoea programme in rural communities. Journal of Diarrhoeal Diseases Research 1997; 15:161–166.

Support for breastfeeding mothers. (Cochrane Review) The Cochrane Library, Issue 1. Oxford: Update Software

Jan 1999

J Sikorski
Mj

18 Sikorski J, Renfrew MJ. Support for breastfeeding mothers. (Cochrane Review). The Cochrane Library, Issue 1. Oxford: Update Software, 1999.

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Jan 1992
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Leite Ajm
R Puccini
A Atallah
A Cunha
M Machado
A Capiberibe

21 Leite AJM, Puccini R, Atallah A, Cunha A, Machado M, Capiberibe A, et al. Impact on breastfeeding practices promoted by lay counselors: a randomized and controlled clinical trial. Clinical Epidemiology 1998; 51(Suppl.):10S. 22 Rao JNK, Scott AJ. A simple method for the analysis of clustered binary data. Biometrics 1992; 48:577–585.

Support for breastfeeding mothers. (Cochrane Review) The Cochrane Library, Issue 1. Oxford: Update Software Randomised intervention study to increase breastfeeding prevalence in southern Brazil

Jan 1994
277-283

J Sikorski
Mj
S Pindoria
Fc Wade
R Halpern
Victora Cg
Teixera Am
Beria
Ja

Sikorski J, Renfrew MJ, Pindoria S, Wade A. Support for breastfeeding mothers. (Cochrane Review). The Cochrane Library, Issue 1. Oxford: Update Software, 2002. 20 Barros FC, Halpern R, Victora CG, Teixera AM, Beria JA. Randomised intervention study to increase breastfeeding prevalence in southern Brazil. Revista Saude Publica 1994; 28:277–283.

Jan 1992
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Pisacane A

Essai contrôlé d’un soutien téléphonique régulier donné par une bénévole sur le déroulement et l’issue de l’allaitement

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Mongeon M

Effect of breastfeeding on infant and child mortality due to infectious disease in less developed countries: a pooled analysis

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451

WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality

Support for breastfeeding mothers: A systematic review

Abstract

No full-text available

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