Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review

The Effect of Alternating Application of Cold and Hot Compresses on Reduction of Breast Engorgement Among Lactating Mothers

BACKGROUND

Breast engorgement is a common issue that affects breastfeeding initiation and continuation. Engorgement can cause exhaustion, making it difficult to care for and feed the infant, and it can cause a mother to wean her baby before she intends to initiate breastfeeding. This study aimed to determine the effectiveness of the alternating application of cold and hot compresses in reducing breast engorgement among lactating mothers. Design, sample size and setting: A quasi-experimental study design is used to conduct this study. A purposeful sample of 100 lactating mothers was screened in the postnatal ward for the presence of breast engorgement. The 100 mothers with engorgement were divided into two equal groups of 50 mothers each - the first group (the intervention) and the second group (the control) - at the postnatal ward of King Abdulaziz Hospital-National Guard in Alahsa City. Sampling and tools: The data collection was conducted over five months, from January 2023 until May 2023. Data collection was done through a structured interview questionnaire sheet. The questionnaire was divided into six parts: socio-demographic data, obstetric and initial women assessment, the six-point engorgement scale (SPES), the visual analog scale (VAS), the LATCH breastfeeding charting scale, and the Infant Breastfeeding Assessment Tool (IBFAT).

RESULT

The present study found no statistically significant difference between the study intervention and control groups in breast engorgement, LATCH level, or overall level of breastfeeding assessment before the intervention. While, in terms of breast engorgement, pain level, attachment, and LATCH, the overall levels of infant breastfeeding assessment across study time had a statistically significant variance among the study and control groups after the intervention at p values=<0.001.

CONCLUSION AND RECOMMENDATIONS

The alternating application of cold and hot compresses can have a significant role in reducing breast engorgement among lactating mothers. Women should be encouraged to use hot compresses and cold gel packs as an alternative treatment to reduce engorgement and promote comfort. In addition, the study results can be utilized to aid Saudi Arabian nurses and midwives in understanding the advantages of applying a cold gel pack and a hot compress and to decrease levels of engorgement, improve latch, and relieve discomfort.

"We always felt psychologically unstable": A qualitative study of midwives' experiences in providing maternity care during the COVID-19 pandemic in Tanzania

AIM

We explored midwives' experiences and challenges in providing maternity care during the period of the first surge of the COVID-19 pandemic in Dodoma.

DESIGN

Phenomenological study design was used to explore midwives' experiences and challenges in providing maternity care during the COVID-19 pandemic in Tanzania.

METHODS

We conducted interviews with a total of 23 midwives, using semi-structured interviews and an audio recorder. Five focus group discussions (FGDs) were conducted. To analyse the data, we used interpretive phenomenological thematic data analysis with NVivo software. To analyse templates, we followed a step-by-step process, starting with familiarizing ourselves with the data, followed by preliminary coding, organizing themes, developing an initial coding template, using the initial template, refining the template and finally applying it to the entire dataset.

RESULTS

It was found that three themes and eight subthemes merged in the current study. The main themes were ① mental health distress, ② work environment challenges and ③ isolation of midwives by different groups.

PUBLIC CONTRIBUTION

Reducing risk and protecting midwives from infectious diseases will improve the workforce, reduce the number of hospital stays, reduce the cost of hospital services, improve birth outcomes and indirectly improve family, community and national economies.

CONCLUSION

Due to the system's failure to provide psychological support, protective environment and isolation rooms for confirmed or suspected cases put midwives at a higher risk of contracting the virus and had to work in a stressful environment. In addition to having the right tools, midwives must also receive emotional and psychological support in order to be at their best. The system must ensure that midwives are ready for uncertain times, such as pandemic infectious disease outbreaks, by providing protective work place environment such as personal protective equipment, psychological support and isolation room for confirmed COVID-19 cases.

Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review

Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of  feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.