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Mena-Tudela D, Soriano-Vidal FJ, Vila-Candel R, Quesada JA, Aguilar L, Franco-Antonio C. Effect of Mobile-Based Counselling on Breastfeeding in Spain: A Randomized Controlled Trial Protocol (COMLACT Study). Healthcare (Basel) 2023; 11:healthcare11101434. [PMID: 37239720 DOI: 10.3390/healthcare11101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE The primary aim of this study is to determine the influence of an intervention in women based on a free mobile application (LactApp®, Barcelona, Spain) in maintaining breastfeeding (BF) up to 6 months postpartum. The secondary aim is to assess the effect of health literacy (HL) on breastfeeding duration. METHODS A multicenter, randomized controlled clinical trial of parallel groups will be carried out. Women will be randomly assigned to each of the parallel groups. In the control group, usual clinical practice will be followed from the third trimester of pregnancy to promote BF. In the intervention group, and in addition to usual clinical practice, the women will use a free mobile application (LactApp®) from the third trimester to 6 months postpartum. The type of BF at birth, at 15 days and at 3 and 6 months postpartum and the causes of cessation of BF in both groups will be monitored. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. The study protocol was approved by the Clinical Research Ethics Committee of Hospital de la Ribera (Alzira, Valencia, Spain) in February 2021. A per protocol analysis and an intention-to-treat analysis will be performed. DISCUSSION This study will identify the influence of a mobile application on improving BF rates. If the application proves effective, we will have a tool with free information available to any user at any time of day, which may be complemented by normal clinical practice and be integrated into our health care system. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05432700.
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Affiliation(s)
- Desirée Mena-Tudela
- Department of Nursing, Feminist Institute University Institute for Feminist and Gender Studies, Universitat Jaume I, 12071 Castellon de la Plana, Spain
| | - Francisco Javier Soriano-Vidal
- Department of Nursing, Universitat de València, 46007 Valencia, Spain
- Department of Obstetrics and Gynecology, Xativa-Oninyent Health Department, 46800 Xativa, Spain
| | - Rafael Vila-Candel
- Department of Nursing, Universitat de València, 46007 Valencia, Spain
- Department of Obstetrics and Gynecology, Hospital Universitario de la Ribera, 46600 Alzira, Spain
| | - José Antonio Quesada
- Department of Clinical Medicine, Universidad Miguel Hernández, 03202 Elche, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 Alicante, Spain
| | - Laia Aguilar
- Midwifery at Lactapp Women Health, 08011 Barcelona, Spain
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AlQurashi A, Wani T, Alateeq N, Heena H. Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers. Healthcare (Basel) 2023; 11:healthcare11060878. [PMID: 36981537 PMCID: PMC10048408 DOI: 10.3390/healthcare11060878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
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.
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Venancio SI, Melo DS, Relvas GRB, de Bortoli MC, de Araújo BC, Oliveira CDF, da Silva LALB, de Melo RC, Moreira HDOM, Rodrigues JM. Effective interventions for the promotion of breastfeeding and healthy complementary feeding in the context of Primary Health Care. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021362. [DOI: 10.1590/1984-0462/2023/41/2021362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/06/2022] [Indexed: 12/23/2022]
Abstract
Abstract 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 strengthen the implementation of programs aimed at promoting breastfeeding and complementary feeding in primary health care.
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Bengough T, Dawson S, Cheng H, McFadden A, Gavine A, Rees R, Sacks E, Hannes K. Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis. MATERNAL & CHILD NUTRITION 2022; 18:e13405. [PMID: 36006012 PMCID: PMC9480951 DOI: 10.1111/mcn.13405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/05/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022]
Abstract
Breastfeeding is an integral part of early childhood interventions as it can prevent serious childhood and maternal illnesses. For breastfeeding support programmes to be effective, a better understanding of contextual factors that influence women's engagement and satisfaction with these programmes is needed. The aim of this synthesis is to suggest strategies to increase the level of satisfaction with support programmes and to better match the expectations and needs of women. We systematically searched for studies that used qualitative methods for data collection and analysis and that focused on women's experiences and perceptions regarding breastfeeding support programmes. We applied a maximum variation purposive sampling strategy and used thematic analysis. We assessed the methodological quality of the studies using a modified version of the CASP tool and assessed our confidence in the findings using the GRADE-CERQual approach. We included 51 studies of which we sampled 22 for in-depth analysis. Our sampled studies described the experiences of women with formal breastfeeding support by health care professionals in a hospital setting and informal support as for instance from community support groups. Our findings illustrate that the current models of breastfeeding support are dependent on a variety of contextual factors encouraging and supporting women to initiate and continue breastfeeding. They further highlight the relevance of providing different forms of support based on socio-cultural norms and personal backgrounds of women, especially if the support is one-on-one. Feeding decisions of women are situated within a woman's personal situation and may require diverse forms of support.
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Affiliation(s)
- Theresa Bengough
- Research Group SoMeTHin'K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social SciencesKU LeuvenLeuvenBelgium
- National Centre for Early Childhood InterventionThe Austrian Public Health InstituteViennaAustria
| | - Shoba Dawson
- Faculty of Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Hui‐Lin Cheng
- School of NursingThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | - Alison McFadden
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
| | - Anna Gavine
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
| | - Rebecca Rees
- EPPI‐Centre, Social Science Research Unit, UCL Institute of EducationUniversity College LondonLondonUK
| | - Emma Sacks
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Karin Hannes
- Research Group SoMeTHin'K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social SciencesKU LeuvenLeuvenBelgium
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Cinar N, Karakaya Suzan Ö, Caner I, Peksen S, Tabakoglu P, Cinar V. The Effect of Breastfeeding and an Intensive Breast Milk Nutritional Support Program on Hospitalization Rates for Hyperbilirubinemia in Term Newborns: An Open Randomized Controlled Trial. J Trop Pediatr 2022; 68:6554179. [PMID: 35333352 DOI: 10.1093/tropej/fmac023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effect of breastfeeding and intensive breast milk nutritional support program (IBNSP) on hospitalization rates for hyperbilirubinemia in normal term newborns. METHODS This study's sample consisted of 68 newborn infants (experimental group: 34; control group: 34) born at a university hospital from October 2020 to April 2021. Five steps of breastfeeding and IBNSP were administered to the experimental group for the first 48 h after birth. This program starts at the postpartum first hour and continues until the 48th hour. It includes face-to-face training, practical support on breastfeeding, and one-to-one demonstration and practice methods. The control group received the standard care recommended by the World Health Organization. Both groups' bilirubin levels were measured 24 and 72 h after birth. Participants in both groups were hospitalized for risky (according to bilirubin values) situations. The groups' bilirubin levels and hospitalization rates for hyperbilirubinemia were compared. RESULTS There was no statistically significant difference between the experimental (5.19 ± 1.27) and the control (5.83 ± 1.52) groups' bilirubin levels at 24 h after birth, (t = -1.881, p = 0.064); however, the control group infants (12.03 ± 3.67 mg/dl) had higher bilirubin levels than the infants in the experimental group 72 h after birth (9.55 ± 2.82 mg/dl) (t = -3.122, p = 0.003). The experimental group's hospitalization rate for hyperbilirubinemia (n: 1, 2.9%) was lower than the control group's rate (n: 8, 23.5%), and this difference was statistically significant (X2 = 6.275, p = 0.014). CONCLUSIONS Breastfeeding and IBNSP effectively prevent hospitalization for hyperbilirubinemia and reduce newborns' bilirubin levels.
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Affiliation(s)
- Nursan Cinar
- Department of Nursing, Faculty of Health Sciences, Sakarya University, 5418 Sakarya, Turkey
| | - Özge Karakaya Suzan
- Department of Nursing, Institute of Health Sciences, Sakarya University, 54187 Sakarya, Turkey
| | - Ibrahim Caner
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Sakarya University, 5418 Sakarya, Turkey
| | - Sultan Peksen
- Department of Education, Pregnant Education Class University of Sakarya, Education Research Hospital, Sakarya, Turkey
| | - Pinar Tabakoglu
- Department of Nursing, Institute of Health Sciences, Sakarya University, 54187 Sakarya, Turkey
| | - Vedat Cinar
- Department of Nursing, Institute of Health Sciences, Sakarya University, 54187 Sakarya, Turkey
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Caponero CM, Zoorob DG, Heh V, Moussa HN. The Effect of Video Education on Skin-to-Skin Contact at the Time of Delivery: A Randomized Controlled Trial. AJP Rep 2022; 12:e10-e16. [PMID: 35141030 PMCID: PMC8816630 DOI: 10.1055/s-0041-1741540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The objective of this study was to measure the impact of video education at the time of admission for delivery on intent and participation in skin-to-skin contact (SSC) immediately after birth. Methods This study was a randomized controlled trial of educational intervention in women ( N = 240) of 18 years or older admitted in anticipation of normal spontaneous term delivery. Alternate patients were randomized into video ( N = 120) and no video ( N = 120) groups. Both groups received a survey about SSC. The video group watched an educational DVD and completed a postsurvey about SSC. Results During the preintervention survey, 89.2% of those in the video group compared with 83.3% of those in the no video group indicated that they planned to use SSC ( p = 0.396). After the video, 98.3% planned to do SSC after delivery ( p < 0.001). However, only 59.8% started SSC within 5 minutes of delivery in the video group and only 49.4% started SSC within 5 minutes of delivery in the no video group ( p = 0.17). Conclusion Video education alters the intention and trends toward participation in SSC within 5 minutes of delivery. Despite the plans for SSC, however, there was no significant difference in rates between the two groups. These findings support that obstacles, other than prenatal education, may affect early SSC. Key Points Significant obstacles impact skin-to-skin rate.Video education alters skin-to-skin intent.Video education can improve skin-to-skin rate.Education can happen at the time of delivery.Video education can impact mothers and infants.
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Affiliation(s)
- Catherine M Caponero
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Obstetrics and Gynecology, Kettering Health, Kettering, Ohio
| | - Dani G Zoorob
- Department of Obstetrics and Gynecology Academic Offices, University of Toledo, Toledo, Ohio
| | - Victor Heh
- Office of Academic Affairs, Ohio University College of Osteopathic Medicine, Dublin, Ohio
| | - Hind N Moussa
- Department of Obstetrics and Gynecology, Kettering Health, Kettering, Ohio.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, Ohio
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Wang L, He J. Exclusive breastfeeding of full-term infants during the first 6 months after discharge from a neonatal unit in China: A cross-sectional study. Jpn J Nurs Sci 2021; 19:e12466. [PMID: 34931439 DOI: 10.1111/jjns.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To elucidate breastfeeding patterns, the reasons for stopping exclusive breastfeeding, and the sociodemographic characteristics associated with exclusive breastfeeding of full-term infants during the 6 months after discharge from a neonatal unit in China. METHODS This cross-sectional study included mothers of full-term infants who were discharged from the 40-bed neonatal unit (level IIA) of a tertiary hospital in Hunan province, China between August 2019 and September 2020. Information on breastfeeding patterns was collected through telephone interviews with the mothers 6 months after their infants had been discharged from the neonatal unit. Binary logistic regression was used to determine the factors associated with exclusive breastfeeding. RESULTS This study included 489 mother-infant dyads. At 6 months after discharge, 51.5% of mothers were exclusively breastfeeding, 29.0% of mothers were partially breastfeeding, and 19.4% of mothers were not breastfeeding. The most common reason for stopping breastfeeding was "poor milk supply" (81.2%). Factors associated with exclusive breastfeeding included multiparity, exclusive breastfeeding before the hospitalization, providing breast milk to the hospitalized infant, and a high level of maternal education. CONCLUSIONS In the Chinese culture, mothers who experienced multiparity and higher-level education were more likely to breastfeed their infants to 6 months after discharge from the neonatal unit. In addition, infants who were exclusively breastfed before and during hospitalization were also more likely to be exclusively breastfed after discharge. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.
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Affiliation(s)
- Li Wang
- Nursing Department, Shenzhen University General Hospital, Shen Zhen, China
| | - Junli He
- Department of Pediatrics, Shenzhen University General Hospital, Shen Zhen, China
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Camacho EM, Hussain H. Cost-effectiveness evidence for strategies to promote or support breastfeeding: a systematic search and narrative literature review. BMC Pregnancy Childbirth 2020; 20:757. [PMID: 33272225 PMCID: PMC7712610 DOI: 10.1186/s12884-020-03460-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Global health policy recommends exclusive breastfeeding until infants are 6 months. Little is known about the cost-effectiveness of breastfeeding promotion strategies. This paper presents a systematic search and narrative review of economic evaluations of strategies to support or promote breastfeeding. The aim of the review is to bring together current knowledge to guide researchers and commissioners towards potentially cost-effective strategies to promote or support breastfeeding. METHODS Searches were conducted of electronic databases, including MEDLINE and Scopus, for economic evaluations relevant to breastfeeding, published up to August 2019. Records were screened against pre-specified inclusion/exclusion criteria and quality was assessed using a published checklist. Costs reported in included studies underwent currency conversion and inflation to a single year and currency so that they could be compared. The review protocol was registered on the PROSPERO register of literature reviews (ID, CRD42019141721). RESULTS There were 212 non-duplicate citations. Four were included in the review, which generally indicated that interventions were cost-effective. Two studies reported that breastfeeding promotion for low-birth weight babies in critical care is associated with lower costs and greater health benefits than usual care and so is likely to be cost-effective. Peer-support for breastfeeding was associated with longer duration of exclusivity with costs ranging from £19-£107 per additional month (two studies). CONCLUSIONS There is limited published evidence on the cost-effectiveness of strategies to promote breastfeeding, although the quality of the current evidence is reasonably high. Future studies should integrate evaluations of the effectiveness of strategies with economic analyses.
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Affiliation(s)
- Elizabeth M Camacho
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Oxford Road, Manchester, UK.
| | - Hannah Hussain
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Oxford Road, Manchester, UK
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Pinzón-Villate GY, Alzate-Posada ML, Olaya-Vega GA. Consejería en lactancia materna exclusiva en Instituciones Amigas de la Mujer y la Infancia de Bogotá D.C., Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n3.73940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. En Colombia la práctica de la lactancia materna exclusiva es baja y, pese a las estrategias implementadas para promoverla, aún falta mucho para cumplir con la meta establecida por la Organización Mundial de la Salud (OMS).Objetivo. Describir la situación actual de la consejería en lactancia materna exclusiva (CLME) en Instituciones Amigas de la Mujer y la Infancia (IAMI) de Bogotá D.C., Colombia.Materiales y métodos. Estudio descriptivo transversal. La muestra estuvo constituida por 76 consejeros (miembros del personal en salud) de 12 IAMI, a quienes se les se aplicó una encuesta semiestructurada con preguntas cerradas y abiertas. Para el análisis de las variables numéricas y categóricas se empleó estadística descriptiva y para analizar las respuestas obtenidas mediante preguntas abiertas se usó el software N-Vivo versión 10.Resultados. Los enfermeros y los auxiliares de enfermería fueron los consejeros que tuvieron mayor contacto con las madres lactantes (42% cada grupo). El 91% de los participantes no contaba con formación en CLME según los lineamientos de la OMS, mientras que para el 60% la consejería significaba enseñar o brindar información a las madres sobre cómo lactar.Conclusión. La formación en consejería en lactancia materna se centra en brindar información sobre cómo lactar, mas no en desarrollar habilidades de consejería; además, no hay un consenso entre el personal de salud que se desempeña como consejero en lactancia materna sobre lo que significa la CLME.
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Del Rio-Martínez P, López-García M, Nieto-Martínez C, Cabrera-Cabrera MA, Harillo-Acevedo FD, Mengibar-Carrillo A, González-Gallego M, Maestre-García MÁ. Application and evaluation of the best practice guideline: Breastfeeding. ENFERMERIA CLINICA 2020; 30:168-175. [PMID: 32417115 DOI: 10.1016/j.enfcli.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/18/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyse the progress of care in the promotion of breastfeeding and describe breastfeeding results following the implementation of the RNAO guideline in various types of national health centres. METHOD Quantitative descriptive longitudinal study of the results of implementing the recommendations of the RNAO-Breastfeeding guideline in 9 national health centres following the implementation methodology of the programme of the Best Practice Spotlight Organization®. Process and result variables are collected at hospital level and in primary care by registering on the CAREVID platform. The weighted mean was calculated as a summary statistic. RESULTS The implementation of the recommendations of the Breastfeeding guideline was associated with a relative increase in: skin-to-skin contact 57,7% (p < 0,000), exclusive breastfeeding in the 1st intake 47,8% (p < 0,000), exclusive breastfeeding on hospital discharge 18,4% (p < 0,000) and prenatal education 63,95% (p < 0,00). CONCLUSION The implementation of the RNAO-Breastfeeding guideline in different national health centres has increased the application of the recommendations based on scientific evidence, generalising appropriate breastfeeding care (such as prenatal education, application of skin-to-skin contact and exclusive breastfeeding in the first intake) and is consequently significantly approaching the international recommendations on breastfeeding.
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Affiliation(s)
| | - Maribel López-García
- Unidad de Tocoginecología, Hospital de Mendaro, OSI Debabarrena, Gipuzkoa, España.
| | | | | | | | | | | | - Mª Ángeles Maestre-García
- Unidad de Ginecología y Obstetricia, Hospital Doctor José Molina Orosa, Área de Salud de Lanzarote, Gerencia de Servicios Sanitarios, Arrecife, Lanzarote, España
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12
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Zitkute V, Snieckuviene V, Zakareviciene J, Pestenyte A, Jakaite V, Ramasauskaite D. Reasons for Breastfeeding Cessation in the First Year after Childbirth in Lithuania: A Prospective Cohort Study. MEDICINA-LITHUANIA 2020; 56:medicina56050226. [PMID: 32397497 PMCID: PMC7279242 DOI: 10.3390/medicina56050226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
Background and objectives: to identify the main reasons of breastfeeding cessation in Lithuania and if there is a link between the length of maternity leave and breastfeeding cessation. Materials and methods: a prospective questionnaire study was conducted in a tertiary hospital from 2016 to 2017. The sample size included 449 women. Results: a total of 41% (n = 123) of respondents weaned off by 6 months after birth, and 57.8% (n = 173) between 6 months and 1 year. During the first few days after delivery, mothers did not breastfeed their infants mainly due to shortage of milk (n = 10; 40%) or separation from their baby due to infant health problems (n = 12; 48%) (p < 0.0001). Mothers who did not breastfeed during the first days after birth more often did not start breastfeeding later at home (p = 0.001). Going back to work was not a significant factor in weaning off. Conclusions: breastfeeding initiation and practice during the first few days after birth has a significant impact on the further commitment for full breastfeeding. Additionally, a perceived lack of support and help from both doctors and midwives influences a woman’s decision to choose not to breastfeed.
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Tada K, Shimpuku Y, Sunguya B, Horiuchi S. Evaluation of breastfeeding care and education given to mothers with low-birthweight babies by healthcare workers at a hospital in urban Tanzania: a qualitative study. Int Breastfeed J 2020; 15:36. [PMID: 32375834 PMCID: PMC7201530 DOI: 10.1186/s13006-020-00280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/22/2020] [Indexed: 11/27/2022] Open
Abstract
Background The total neonatal mortality in Tanzania remains high reaching as much as 44,900 deaths per year, particularly among low birthweight (LBW) babies. This makes Tanzania the fourth African country with the highest number of annual neonatal deaths. Studies have shown the advantages of breast milk for LBW babies and the effectiveness of interventions from healthcare workers (HCWs) to encourage mothers to achieve exclusive breastfeeding (EBF). Although these interventions can substantially reduce mortality in this vulnerable group, they remain insufficient in practice particularly in resource-limited countries. Therefore, there is an urgent need to establish the most appropriate interventions for mothers with LBW babies, particularly in these countries. To help address this need, we evaluated the breastfeeding care and education given to mothers with LBW babies by HCWs during hospitalization in Tanzania. Methods A qualitative study using semi-structured interviews with mothers of LBW babies at an urban hospital in Tanzania was conducted. We assessed their understanding of breastfeeding at discharge. All the interviews were conducted in local Swahili and then translated to English. Data were analyzed using content analysis. Results Among the 19 mothers interviewed, only four breastfed their baby within an hour after birth. Nine mothers received no support from HCWs when they breastfeed their baby for the first time. Ten mothers received no education on EBF, and there were mothers who misunderstood the EBF definition. Eight answered that they had difficulty breastfeeding their baby at discharge. Four mothers were dissatisfied with the care and education given by HCWs, and six mothers provided suggestions for improvements. Although six mothers had a high reliance on HCWs, they had difficulty asking HCWs questions because of their authoritative attitude and behavior. Conclusions Mothers with LBW babies need special support to increase their ability to breastfeed and ensure EBF continuance. To address the gaps between the currently provided breastfeeding interventions and the ideal breastfeeding interventions, improvements in the quality and quantity of breastfeeding care and education are required. Training HCWs to systematize standard interventions, confirming mothers’ understanding, and ensuring a comfortable environment for mothers are absolutely needed.
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Affiliation(s)
- Kyoko Tada
- St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nation Road, Upanga, Ilala Municipality, Dar es Salaam, Tanzania
| | - Shigeko Horiuchi
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Shobo OG, Umar N, Gana A, Longtoe P, Idogho O, Anyanti J. Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study. BMJ Open 2020; 10:e032835. [PMID: 32317258 PMCID: PMC7204917 DOI: 10.1136/bmjopen-2019-032835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast feeding of newborns in public primary healthcare facilities (PHCs) in Northeast Nigeria, to influence the planning of programmes targeted at improving newborn care in the region. METHOD We used an explanatory mixed-method approach. We conducted case observation of childbirths and newborn care for the quantitative arm, and interviewed mothers and birth attendants 1 hour after childbirth for the qualitative arm. The analysis for the quantitative arm was done with SPSS V.23. For the qualitative arm, we transcribed the audio files, coded the texts and categorised them using thematic analysis. RESULT We observed 393 and 27 mothers for the quantitative and qualitative arms of the study, respectively. The quantitative arm shows that 39% of mothers did not breastfeed their newborns within 1 hour of birth. The qualitative arm shows that 37% of mothers did not breastfeed within 1 hour of birth. Themes that describe the barriers to early breast feeding in public PHCs are: birth attendants' unwillingness or inability to accommodate mothers' safe traditional practices, ineffective rooming-in practices, staff shortages, lack of privacy in the lying-in ward and poor implementation of visiting-hour policy in public PHCs. The pregnant women denied safe traditional birth practices like chanting, praying or reading religious books during delivery are five times more likely not to breastfeed newborns within the first hour of birth (relative risk=4.5, 95% CI 1.2-17.1) compared with pregnant women allowed these practices. CONCLUSION Stakeholders must increase their focus on improving breastfeeding practices in public PHCs. Instituting policies that protect mothers' privacy and finding innovative ways to accommodate and promote safe traditional practices in the intrapartum and postpartum period in PHCs will improve the early breast feeding of newborns in these PHCs.
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Affiliation(s)
| | - Nasir Umar
- Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Gana
- Office of the Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Peter Longtoe
- Monitoring and Evaluation Department, Society for Family Health, Abuja, Nigeria
| | - Omokhudu Idogho
- Office of the Managing Director, Society for Family Health, Abuja, Nigeria
| | - Jennifer Anyanti
- Office of the Deputy Managing Director, Society for Family Health, Abuja, Nigeria
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15
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Jiang L, Li X, Wang MC, Osgood N, Whaley SE, Crespi CM. Estimating the population impact of hypothetical breastfeeding interventions in a low-income population in Los Angeles County: An agent-based model. PLoS One 2020; 15:e0231134. [PMID: 32271798 PMCID: PMC7145098 DOI: 10.1371/journal.pone.0231134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 03/17/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Breastfeeding has clear benefits. Yet, breastfeeding practices fall short of recommendations in low-income populations including participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). To promote breastfeeding, it is important to understand breastfeeding-related behaviors such as initiation and maintenance within the context of a complex societal system. For individual women, making choices about infant feeding (whether to breastfeed or formula-feed a newborn, or when to stop breastfeeding) is a dynamic process involving interactions with health professionals, family, peers and workplaces. Integrating behavioral change theories with systems science tools such as agent-based modeling can help illuminate patterns of breastfeeding behaviors, identify key factors affecting breastfeeding behaviors within this complex dynamic system, and estimate the population impact of hypothetical interventions. METHODS An agent-based model (ABM) was developed to investigate the influences of multiple levels of factors affecting breastfeeding behaviors among WIC participants. Health behavioral change theories were applied and stakeholder input obtained to improve the model, particularly during the conceptual design and model specification steps. The model was then used to identify critical points for intervention and assess the effects of five common interventions (improving knowledge through education, implementing Baby-Friendly Hospital Initiative practices, providing postpartum breastfeeding counselling, strengthening partner support, and fostering supportive workplace environments.). RESULTS The ABM developed in this study produced outcomes (i.e., breastfeeding rates) that were concordant with empirical data. Increasing the coverage of the five selected interventions produced various levels of improvement in breastfeeding practices in the target population. Specifically, improving breastfeeding knowledge had a positive impact on women's intent to breastfeed, while increasing the availability of the Baby-Friendly Hospital Initiative improved breastfeeding initiation rates. However, neither of these two interventions showed a significant impact on breastfeeding maintenance, which was supported by postpartum breastfeeding counseling, partner support and a supportive workplace environment. These three intervention strategies each improved breastfeeding rates at 6 months from 55.6% to 57.1%, 59.5% and 59.3%, respectively. Increasing the coverage of multiple interventions simultaneously had a synergistic effect on breastfeeding maintenance with their effects being greater than the cumulative effects of increasing the coverage of these interventions individually. CONCLUSION The ABM we developed was helpful for understanding the dynamic process of decision-making regarding infant feeding modalities in a low-income population, and for evaluating the aggregated population-level impact of breastfeeding promotion interventions.
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Affiliation(s)
- Linghui Jiang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Xiaoyan Li
- Department of Computer Science, University of Saskatchewan, Saskatoon, Canada
| | - May C. Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Nathaniel Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Canada
| | - Shannon E. Whaley
- Public Health Foundation Enterprises, Special Supplemental Nutrition Program for Women, Infants, and Children (PHFE-WIC) Program, Los Angeles, California, United States of America
| | - Catherine M. Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
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17
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Aldana-Parra F, Olaya G, Fewtrell M. Effectiveness of a new approach for exclusive breastfeeding counselling on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight or obese women: protocol for a randomized controlled trial. Int Breastfeed J 2020; 15:2. [PMID: 31921328 PMCID: PMC6945425 DOI: 10.1186/s13006-019-0249-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background Maternal overweight, infant feeding and early growth velocity are risk factors for obesity later in life. The first one thousand days are a window of opportunity to program health and disease. Exclusive breastfeeding may protect against obesity; however, it is not consistently practiced. Obesity rates have been increasing worldwide. Overweight or obese women have lower rates of breastfeeding and face mechanical, psychological and biological difficulties. Breastfeeding counselling is a successful strategy to support breastfeeding in normal weight women; but there is a lack of evidence on its effectiveness in overweight women. Our purpose is to evaluate a new approach to exclusive breastfeeding counselling based on Carl Rogers’ Centred-Client Theory in overweight women, and to examine effects on breastfeeding prevalence, infant growth velocity and maternal postpartum weight loss. Methods A two-arm simple randomized controlled trial will be conducted in overweight and obese women recruited in a Baby Friendly Hospital in Bogotá, Colombia. The intervention is exclusive breastfeeding counselling based on Rogers’ theory but adapted for overweight women; it will be performed during the last month of pregnancy, 24 h after delivery and during early infancy (1 and 3 months postpartum). The primary outcomes will be exclusive breastfeeding prevalence, infant growth velocity and maternal weight loss from birth up to 4 months after delivery; and the secondary outcomes will be prolactin and macronutrient levels in breast milk and serum prolactin levels. Intention to treat analysis will be performed to estimate the effect of the new counselling approach compared to standard management on the prevalence of exclusive breastfeeding, infant growth velocity and maternal weight loss. Discussion We hypothesize that the intervention will result in an increase in the initiation and maintenance of exclusive breastfeeding, allowing adequate infant growth velocity and maternal weight loss after delivery. It is hoped that the results of this trial will provide evidence to support public health policy on supporting breastfeeding in this vulnerable group of women. Trial registration (UTN) U1111–1228-9913 February 20th 2019; ISRCTN15922904 February 27th 2019, retrospectively registered.
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Affiliation(s)
- Fanny Aldana-Parra
- 1Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gilma Olaya
- 1Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mary Fewtrell
- 2UCL Great Ormond Street Institute of Child Health, London, UK
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18
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Lassi ZS, Kedzior SGE, Bhutta ZA. Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries. Cochrane Database Syst Rev 2019; 2019:CD007647. [PMID: 31686427 PMCID: PMC6828589 DOI: 10.1002/14651858.cd007647.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems. OBJECTIVES To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables. MAIN RESULTS We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33. AUTHORS' CONCLUSIONS This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.
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Affiliation(s)
- Zohra S Lassi
- University of AdelaideRobinson Research InstituteAdelaideAustraliaAustralia
| | - Sophie GE Kedzior
- Robinson Research Institute, University of AdelaideFaculty of Health and Medical SciencesAdelaideAustralia
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoCanada
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Kassianos AP, Ward E, Rojas-Garcia A, Kurti A, Mitchell FC, Nostikasari D, Payton J, Pascal-Saadi J, Spears CA, Notley C. A systematic review and meta-analysis of interventions incorporating behaviour change techniques to promote breastfeeding among postpartum women. Health Psychol Rev 2019; 13:344-372. [PMID: 31117897 DOI: 10.1080/17437199.2019.1618724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
The benefits of exclusive breastfeeding are well documented, yet few women adhere to recommendations. We report the Behaviour Change Techniques (BCTs) within interventions trialled internationally after pregnancy to promote exclusive and mixed breastfeeding as well as evidence of effectiveness. PsycINFO, EMBASE and MEDLINE databases were screened. Twenty-three (n = 23) studies met inclusion criteria. Three authors independently extracted data, coded interventions using the BCT v.1 taxonomy, and assessed study quality. There was a moderate significant effect of the interventions promoting exclusive breastfeeding up to four weeks postpartum (OR 1.77, [95% CI: 1.47-2.13]) but this effect slightly declined beyond thirteen weeks (OR 1.63, [95% CI: 1.07-2.47]). Twenty-nine BCTs were identified within interventions. 'Credible source' and 'instruction on how to perform the behaviour' were the most prevalent and 'social support (unspecified)' contributed to the effectiveness of exclusive breastfeeding interventions five to eight weeks postpartum. Using BCTs with cognitive and behavioural aspects may help women develop coping mechanisms promoting exclusive breastfeeding. Further trials are needed in countries with low breastfeeding rates such as the UK. The use of programme theory during intervention development and clear description of intervention components is recommended. This meta-analysis provides guidance for trials evaluating postpartum breastfeeding interventions.
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Affiliation(s)
| | - Emma Ward
- b Norwich Medical School, University of East Anglia , Norwich , UK
| | - Antonio Rojas-Garcia
- a Department of Applied Health Research, UCL , London , UK
- c NIHR CLAHRC North Thames , London , UK
| | - Allison Kurti
- d Department of Psychiatry and Psychological Science, University of Vermont , Burlington , VT , USA
| | - Fiona C Mitchell
- e Psychological Sciences and Health, University of Strathclyde , Glasgow , UK
| | - Dian Nostikasari
- f Kinder Institute for Urban Research, Rice University , Houston , TX , USA
| | - Jamie Payton
- g Department of Computer and Information Sciences, Temple University , Philadelphia , PA , USA
| | | | - Claire Adams Spears
- h Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health , Atlanta , GA , USA
| | - Caitlin Notley
- b Norwich Medical School, University of East Anglia , Norwich , UK
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Telephone support for breastfeeding by primary care: A randomised multicentre trial. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Čatipović M, Pirija B, Marković M, Grgurić J. BREASTFEEDING INTENTION AND KNOWLEDGE IN SECONDARY-SCHOOL STUDENTS. Acta Clin Croat 2018; 57:658-668. [PMID: 31168203 PMCID: PMC6544101 DOI: 10.20471/acc.2018.57.04.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Breast milk makes the world healthier and better. Deaths and suffering of thousands of children and mothers each year could be prevented through universal breastfeeding, along with enormous economic savings. The aim of this study was to examine the knowledge of breastfeeding and intention to breastfeed in third-year secondary school students from various high schools and to make a conclusion on the unique and structured education program on breastfeeding in secondary schools. A total of 252 third-year secondary school students from 4 high schools in Bjelovar, Kutina and Pakrac completed an online questionnaire on the knowledge and intention to breastfeed. The results were presented by descriptive statistics methods. Kruskal-Wallis test was conducted for intention scale and χ2-test for questions about knowledge. Logistic regression was used to predict probabilities of a response. The results showed the responses of students from individual schools to be statistically significantly different in some questions of knowledge and some items of intention of breastfeeding. Insufficient breastfeeding information in schools does not provide a basis to third-year secondary school students to make an informed decision about breastfeeding in adulthood. We propose development and use of a unique structured educational program on breastfeeding for secondary school students.
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Affiliation(s)
- Marija Čatipović
- 1Marija Čatipović Specialist Pediatric Office, Bjelovar, Croatia; 2Branka Pirija Specialist Pediatric Office, Kutina, Croatia; 3Feniks Healthcare Institution, Bjelovar, Croatia; 4UNICEF Office for Croatia, Zagreb, Croatia
| | - Branka Pirija
- 1Marija Čatipović Specialist Pediatric Office, Bjelovar, Croatia; 2Branka Pirija Specialist Pediatric Office, Kutina, Croatia; 3Feniks Healthcare Institution, Bjelovar, Croatia; 4UNICEF Office for Croatia, Zagreb, Croatia
| | - Martina Marković
- 1Marija Čatipović Specialist Pediatric Office, Bjelovar, Croatia; 2Branka Pirija Specialist Pediatric Office, Kutina, Croatia; 3Feniks Healthcare Institution, Bjelovar, Croatia; 4UNICEF Office for Croatia, Zagreb, Croatia
| | - Josip Grgurić
- 1Marija Čatipović Specialist Pediatric Office, Bjelovar, Croatia; 2Branka Pirija Specialist Pediatric Office, Kutina, Croatia; 3Feniks Healthcare Institution, Bjelovar, Croatia; 4UNICEF Office for Croatia, Zagreb, Croatia
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Gharib S, Fletcher M, Tucker R, Vohr B, Lechner BE. Effect of Dedicated Lactation Support Services on Breastfeeding Outcomes in Extremely-Low-Birth-Weight Neonates. J Hum Lact 2018; 34:728-736. [PMID: 29161535 DOI: 10.1177/0890334417741304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Sharareh Gharib
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Molly Fletcher
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Richard Tucker
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Betty Vohr
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
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Bengough T, von Elm E, Heyvaert M, Hannes K. Factors that influence women’s engagement with breastfeeding support: a qualitative evidence synthesis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Theresa Bengough
- KU Leuven University; Social Research Methodology Group, Centre for Sociological Research, Faculty of Social Sciences; Parkstraat 45 Leuven Belgium BE 3000
- Austrian Public Health Institute; Department of Health and Society; Stubenring 6 Vienna Austria 1010
| | - Erik von Elm
- Lausanne University Hospital; Cochrane Switzerland, Institute of Social and Preventive Medicine; Route de la Corniche 10 Lausanne Switzerland CH-1010
| | - Mieke Heyvaert
- KU Leuven; Methodology of Educational Sciences Research Group; Andreas Vesaliusstraat 2 - box 3762 Leuven Belgium 3000
| | - Karin Hannes
- KU Leuven University; Social Research Methodology Group, Centre for Sociological Research, Faculty of Social Sciences; Parkstraat 45 Leuven Belgium BE 3000
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Park SH, Ryu S. [Effects of Breastfeeding Interventions on Breastfeeding Rates at 1, 3 and 6 Months Postpartum: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2018; 47:713-730. [PMID: 29326404 DOI: 10.4040/jkan.2017.47.6.713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/04/2017] [Accepted: 12/22/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was a systematic review and meta-analysis designed to evaluate the effects of breastfeeding intervention on breastfeeding rates. METHODS Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a systematic search was conducted using eight core electronic databases and other sources including gray literature from January 9 to 19, 2017. Two reviewers independently select the studies and assessed methodological risk of bias of studies using the Cochrane criteria. The topics of breastfeeding interventions were analyzed using descriptive analysis and the effects of intervention were meta-analyzed using the Review Manager 5.2 software. RESULTS A total of 16 studies were included in the review and 15 were included for meta-analysis. The most frequently used intervention topics were the importance of good latch-on and frequency of feeding and determining adequate intake followed. The pooled total effect of breastfeeding intervention was 1.08 (95% CI 1.03~1.13). In the subgroup analysis, neither pre-nor post-childbirth intervention was effective on the breastfeeding rates at 1, 3, and 6 months, and neither group nor individual interventions had an effect. Only the 1 month breastfeeding rate was found to be affected by the individual intervention with the persistent strategies 1.21 (95% CI 1.04~1.40). CONCLUSION Effective breastfeeding interventions are needed to help the mother to start breastfeeding after childbirth and continue for at least six months. It should be programmed such that individuals can acquire information and specific breastfeeding skills. After returning home, there should be continuous support strategies for breastfeeding as well as managing various difficulties related to childcare.
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Affiliation(s)
- Seol Hui Park
- Department of Nursing, MIZ-I Hospital, Mokpo, Korea.
| | - Seang Ryu
- Department of Nursing, Mokpo National University, Muan, Korea
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Gottschlich MM, Mayes T, Allgeier C, James L, Khoury J, Pan B, van Aalst JA. A Retrospective Study Identifying Breast Milk Feeding Disparities in Infants with Cleft Palate. J Acad Nutr Diet 2018; 118:2154-2161. [PMID: 30007797 DOI: 10.1016/j.jand.2018.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/08/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast milk represents the optimal substrate for all infants, including those with a cleft palate for whom growth may be compromised. OBJECTIVES Frequency of breast milk feeding at the breast and per feeder (bottle, cup, enteral tube) in infants with cleft palate was determined and compared with rates reported by the Centers for Disease Control and Prevention. A secondary aim was to review growth status of the infants. DESIGN This study represents a 5-year retrospective review using the electronic medical record. PARTICIPANTS AND SETTING Patients were ≤12 months old at the time of the initial, presurgical encounter after a diagnosis of cleft palate had been made and were treated at one of two pediatric cleft palate and craniofacial centers in Ohio between September 30, 2010, and September 30, 2015. MAIN OUTCOME MEASURES Outcomes measured were breast milk use, reported by mothers and documented in patients' electronic medical records, chronological body weight, as well as weight for length and weight-for-age z scores and percentiles. STATISTICAL ANALYSES PERFORMED Descriptive statistics included median with interquartile range and frequency with percentages. World Health Organization z scores were estimated using the Centers for Disease Control and Prevention programs for weight, weight for length, and weight for age at first visit. Comparisons of infants treated at the two hospitals were done using the Wilcoxon rank-sum test or the χ2 test. RESULTS Breast milk consumption (26 infants were breastfed and 84 received human breast milk administered with a device) was 29.5%, markedly below the 2016 Centers for Disease Control and Prevention national statistics for ever receiving breast milk (81%). Anthropometric findings included z scores of -0.95 and -0.42 for weight for age and weight for length, respectively. CONCLUSIONS Infants with cleft palate were seldom breastfed, nor was breast milk frequently used. In addition, median weight-for-age and weight-for-length z scores suggest that growth of infants with cleft palate was below normative standards.
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Yogman M, Lavin A, Cohen G, Lemmon KM, Mattson G, Rafferty JR, Wissow LS. The Prenatal Visit. Pediatrics 2018; 142:peds.2018-1218. [PMID: 29941679 DOI: 10.1542/peds.2018-1218] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A pediatric prenatal visit during the third trimester is recommended for all expectant families as an important first step in establishing a child's medical home, as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition As advocates for children and their families, pediatricians can support and guide expectant parents in the prenatal period. Prenatal visits allow general pediatricians to establish a supportive and trusting relationship with both parents, gather basic information from expectant parents, offer information and advice regarding the infant, and may identify psychosocial risks early and high-risk conditions that may require special care. There are several possible formats for this first visit. The one used depends on the experience and preference of the parents, the style of the pediatrician's practice, and pragmatic issues of payment.
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Affiliation(s)
- Michael Yogman
- Harvard Medical School and Mount Auburn Hospital, Boston, Massachusetts; and
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Abstract
Telehealth is a rapidly growing healthcare modality that can be utilized to deliver breastfeeding education and support to increase breastfeeding outcomes including exclusivity and duration. The purpose of this integrative review is to explore and evaluate the strength of the current research evidence supporting the effectiveness of telehealth to deliver breastfeeding education and support. The review was conducted using five electronic databases to search English language articles related to telehealth and breastfeeding from 2009 to 2016. Eleven studies were identified as meeting the inclusion criteria, and included a total of 4,896 participants in five countries. Results from the review suggest that telehealth is a promising modality for breastfeeding education and support and is perceived as an acceptable and beneficial delivery method. More research is needed to determine which specific modalities are most effective and how they are best implemented.
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Ross-Cowdery M, Lewis CA, Papic M, Corbelli J, Schwarz EB. Counseling About the Maternal Health Benefits of Breastfeeding and Mothers' Intentions to Breastfeed. Matern Child Health J 2018; 21:234-241. [PMID: 27443655 DOI: 10.1007/s10995-016-2130-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives To evaluate the impact of counseling regarding the maternal health effects of lactation on pregnant women's intentions to breastfeed. Methods Women seeking prenatal care at an urban university hospital completed surveys before and after receiving a 5-min counseling intervention regarding the maternal health effects of breastfeeding. The counseling was delivered by student volunteers using a script and one-page infographic. Participants were asked the likelihood that breastfeeding affects maternal risk of multiple chronic conditions using 7-point Likert scales. We compared pre/post changes in individual item responses and a summary score of knowledge of the maternal health benefits of lactation (MHBL) using paired t tests. Multivariable logistic regression was used to examine the impact of increases in knowledge of MHBL on participants' intentions to breastfeed. Results The average age of the 65 participants was 24 ± 6 years. Most (72 %) were African-American and few (9 %) had college degrees. Half (50 %) had previously given birth, but few (21 %) had previously breastfed. Before counseling, few were aware of any benefits of lactation for maternal health. After counseling, knowledge of MHBL increased (mean knowledge score improved from 19/35 to 26/35, p < 0.001). Improvement in MHBL knowledge score was associated with increased intention to try breastfeeding (aOR 1.20, 95 % CI 1.02-1.42), of wanting to breastfeed (aOR 1.45, 95 % CI 1.13-1.86), and feeling that breastfeeding is important (aOR 1.21, 95 % CI 1.03-1.42). Conclusions for Practice Brief structured counseling regarding the effects of lactation on maternal health can increase awareness of the maternal health benefits of breastfeeding and strengthen pregnant women's intentions to breastfeed.
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Affiliation(s)
| | - Carrie A Lewis
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Melissa Papic
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Eleanor Bimla Schwarz
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA. .,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, Davis, 4150 V Street, PSSB 2400 [room 2506], Sacramento, CA, 95817, USA.
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Balaguer Martínez JV, Valcarce Pérez I, Esquivel Ojeda JN, Hernández Gil A, Martín Jiménez MDP, Bernad Albareda M. [Telephone support for breastfeeding by primary care: a randomised multicentre trial]. An Pediatr (Barc) 2018; 89:344-351. [PMID: 29576447 DOI: 10.1016/j.anpedi.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate a telephone support programme for mothers who breastfeed for the first 6 months. METHODS A randomised unmasked clinical trial was conducted in 5 urban Primary Care centres that included mothers with healthy newborns who were breastfeeding exclusively (EBF) or partially (PBF). The control group received the usual care. The intervention group also received telephone support for breastfeeding on a weekly basis for the first 2months and then every 2weeks until the sixth month. The type of breastfeeding was recorded in the usual check-up visit (1, 2, 4 and 6 months). RESULTS The study included 193 patients in the intervention group, and 187 in a control group. The greatest increase in the percentage of EBF was observed at 6 months: 21.4% in the control group compared to 30.1% in the intervention group. However, in the adjusted odds ratios analysis, confidence intervals did not show statistical significance. The odds ratio at 1 month, 2 months, 4 months, and 6 months for EBF were 1.45 (0.91-2.31), 1.35 (0.87-2.08), 1.21 (0.80-1.81), and 1.58 (0.99-2.53), respectively. The odds ratio in the same age groups for any type of breastfeeding (EBF + PBF) were 1.65 (0.39-7.00), 2.08 (0.94-4.61), 1.37 (0.79-2.38), and 1.60 (0.98-2.61), respectively. CONCLUSIONS Telephone intervention was not effective enough to generalise it.
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Mesters I, Gijsbers B, Bartholomew LK. Promoting Sustained Breastfeeding of Infants at Risk for Asthma: Explaining the "Active Ingredients" of an Effective Program Using Intervention Mapping. Front Public Health 2018; 6:87. [PMID: 29616209 PMCID: PMC5869925 DOI: 10.3389/fpubh.2018.00087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/05/2018] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Ilse Mesters
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Barbara Gijsbers
- Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - L Kay Bartholomew
- Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
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Senghore T, Omotosho TA, Ceesay O, Williams DCH. Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: a cross-sectional study. Int Breastfeed J 2018; 13:9. [PMID: 29507600 PMCID: PMC5833059 DOI: 10.1186/s13006-018-0154-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/15/2018] [Indexed: 11/20/2022] Open
Abstract
Background Despite consistent evidence showing the importance of exclusive breastfeeding (EBF) for six months, it remains a sub-optimal practice in The Gambia. This study aimed at investigating the determinants of EBF knowledge and intention to or practice of EBF. Methods A cross-sectional study was conducted among 334 women receiving care at the Edward Francis Small Teaching Hospital (EFSTH) from December 2015 to February 2016. Using a structured interviewer-administered questionnaire, knowledge on EBF was determined and scored. Participants scoring above or equal to the median were determined to have sufficient EBF knowledge. Multivariate logistic regression analyses were used to identify predictors of EBF knowledge and intention to or practice of exclusive breastfeeding. Results The proportion of women with sufficient exclusive breastfeeding knowledge and intended to or practice EBF were 60.2% and 38.6% respectively, while only 34.4% received EBF counseling. Earning ≥1500 GMD monthly (Adjusted Odds Ratio [aOR] 1.98; 95% Confidence Interval [Cl] 1.24, 3.16), having positive attitude (aOR 2.40; 95% Cl 1.40, 4.10) and partner supporting EBF (aOR 2.18; 95% Cl 1.23, 3.87) predicted sufficient EBF knowledge. Mothers aged 26–34 years (aOR 0.50; 9 5% Cl 0.31, 0.82) and EBF counseling (aOR 2.68; 95% Cl 1.68, 4.29) significantly associated with intention to or practice of exclusive breastfeeding. Conclusion In conclusion, improving EBF rates will, therefore, require improved access to information on EBF targeting low socio-economically disadvantaged and older mothers. In addition, emphasis on strengthening the ongoing EBF counseling already within the health system is required.
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Affiliation(s)
- Thomas Senghore
- Department of Nursing and Reproductive Health, School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
| | - Tobiloba Alex Omotosho
- Department of Nursing and Reproductive Health, School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
| | - Omar Ceesay
- Department of Nursing and Reproductive Health, School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
| | - Daisy Clara H Williams
- Department of Nursing and Reproductive Health, School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
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Kim SK, Park S, Oh J, Kim J, Ahn S. Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2018; 80:94-105. [PMID: 29407349 DOI: 10.1016/j.ijnurstu.2018.01.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/24/2017] [Accepted: 01/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that mothers practice exclusive breastfeeding (EBF) of their infants for 6 months. Various breastfeeding support interventions have been developed to encourage mothers to maintain breastfeeding practices. Research aim: This study aims to review how effectively breastfeeding support interventions enable mothers to practice EBF for 6 months and to suggest the best intervention strategies. METHODS Six databases were searched, including MEDLINE, EMBASE, Cochrane, CINAHL, PsycINFO, and KoreaMed. The authors independently extracted data from journals written in English or Korean and published between January 2000 and August 2017. Randomized controlled trials (RCTs) reporting EBF until 6 months were screened. RESULTS A total of 27 RCTs were reviewed, and 36,051 mothers were included. The effectiveness of breastfeeding support interventions to promote EBF for 6 months was significant (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 1.81-3.76). A further subgroup analysis of intervention effects shows that a baby friendly hospital initiative (BFHI) intervention (OR = 5.21; 95% CI: 2.15-12.61), a combined intervention (OR = 3.56; 95% CI: 1.74-7.26), a professional provider led intervention (OR = 2.76; 95% CI: 1.76-4.33), having a protocol available for the provider training program (OR = 2.87; 95% CI: 1.89-4.37) and implementation during both the prenatal and postnatal periods (OR = 3.32; 95% CI: 1.83-6.03) increased the rate of EBF for 6 months. CONCLUSION We suggest considering a multicomponent intervention as the primary strategy and implementing BFHI interventions within hospitals. Evidence indicates that intervention effectiveness increases when a protocol is available for provider training, when interventions are conducted from the pre- to postnatal period, when the hospital and community are connected, and when healthcare professionals are involved.
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Affiliation(s)
| | - Seyeon Park
- Chungnam National University, Daejeon, South Korea
| | - Jiwon Oh
- Chungnam National University, Daejeon, South Korea
| | - Jisoon Kim
- Chungnam National University, Daejeon, South Korea
| | - Sukhee Ahn
- Chungnam National University, Daejeon, South Korea.
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Alberdi G, O'Sullivan EJ, Scully H, Kelly N, Kincaid R, Murtagh R, Murray S, McGuinness D, Clive A, Brosnan M, Sheehy L, Dunn E, McAuliffe FM. A feasibility study of a multidimensional breastfeeding-support intervention in Ireland. Midwifery 2017; 58:86-92. [PMID: 29324318 DOI: 10.1016/j.midw.2017.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/26/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breastfeeding is the optimum mode of infant feeding. Despite this, most global populations do not achieve the World Health Organisation's recommendation of exclusive breast milk for the first 6 months of life. Irish breastfeeding rates are among the lowest in Europe, necessitating a well-designed breastfeeding-support intervention. AIM To evaluate the feasibility and acceptability of a multidimensional breastfeeding intervention in a rural and an urban maternity setting in Ireland. DESIGN A feasibility study of a breastfeeding-support intervention. SETTING Participants were recruited from The National Maternity Hospital (Dublin, urban) and Wexford General Hospital (Wexford, rural). Questionnaires were completed antenatally, at 6 weeks postpartum and at 3 months postpartum to assess acceptability of the intervention and determine breastfeeding status. PARTICIPANTS Pregnant women were recruited in the 3rd trimester, alongside a support partner. INTERVENTION The intervention consisted of an antenatal class (including the physiology and practical approaches to breastfeeding), a one-to-one breastfeeding consultation with a lactation consultant after birth, access to a breastfeeding helpline, online resources, and a postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant. RESULTS One hundred women from The National Maternity Hospital, Dublin and 27 women from Wexford General Hospital were recruited. The antenatal class was attended by 77 women in Dublin and 23 in Wexford; thus, 100 women participated in the intervention. Seventy-six women had a one-to-one postnatal consultation with a lactation consultant in Dublin and 23 in Wexford. Fifty and 45 women in Dublin, and 15 and 15 in Wexford responded to the 6-week and 3-month questionnaires, respectively. At 3 months postpartum, 70% of respondents from Dublin and 60% from Wexford were breastfeeding. Mothers perceived the one-to-one consultation with the lactation consultant during postnatal hospitalization as the most helpful part of the intervention. Inclusion of a support partner was universally viewed positively as a means to support the mother's decision to initiate and continue breastfeeding. CONCLUSION This multidimensional intervention is well-accepted and feasible to carry out within an Irish cohort, in both urban and rural areas. Data from this feasibility study will be used to design a randomized controlled trial of a breastfeeding-support intervention.
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Affiliation(s)
- Goiuri Alberdi
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland.
| | | | - Helena Scully
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland.
| | - Niamh Kelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland.
| | | | | | | | | | | | - Mary Brosnan
- The National Maternity Hospital, Dublin 2, Ireland.
| | | | | | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Ireland; The National Maternity Hospital, Dublin 2, Ireland.
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Gurley-Calvez T, Bullinger L, Kapinos KA. Effect of the Affordable Care Act on Breastfeeding Outcomes. Am J Public Health 2017; 108:277-283. [PMID: 29267066 DOI: 10.2105/ajph.2017.304108] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess how the 2012 Affordable Care Act (ACA) policy change, which required most private health insurance plans to cover lactation-support services and breastfeeding equipment (without cost-sharing), affected breastfeeding outcomes. METHODS We used a regression-adjusted difference-in-differences approach with cross-sectional observational data from the US National Immunization Survey from 2008 to 2014 to estimate the effect of the ACA policy change on breastfeeding outcomes, including initiation, duration, and age at first formula feeding. The sample included children aged 19 to 23 months covered by private health insurance or Medicaid. RESULTS The ACA policy change was associated with an increase in breastfeeding duration by 10% (0.57 months; P = .007) and duration of exclusive breastfeeding by 21% (0.74 months; P = .001) among the eligible population. Results indicate no significant effects on breastfeeding initiation and age at first formula feeding. CONCLUSIONS Reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding, particularly the duration of breastfeeding and the amount of time before formula supplementation.
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Affiliation(s)
- Tami Gurley-Calvez
- Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA
| | - Lindsey Bullinger
- Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA
| | - Kandice A Kapinos
- Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA
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Sun K, Chen M, Yin Y, Wu L, Gao L. Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months. J Child Health Care 2017; 21:353-363. [PMID: 29119825 DOI: 10.1177/1367493517719160] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reasons why mothers in mainland China stop breastfeeding before their infants were six months old was investigated. Five hundred sixty-two mothers within two to three days after delivery in a hospital in Guangzhou, China, were followed up via telephone interview at one, four, and six months postpartum between January and August 2015 to assess their infant's feeding patterns and mother's reasons for breastfeeding cessation. Measures included the questionnaire about sociodemographic, psychosocial, and perinatal characteristics, the Breastfeeding Outcome Questionnaire and the Breastfeeding Self-efficacy Scale-Short Form. Compared with mothers who continued breastfeeding for at least six months, the mothers who stopped breastfeeding were less likely to have attended the perinatal classes, used more inhospital formula, and were less self-efficacious regarding breastfeeding and less intention to exclusive breastfeeding. The reasons that 180 mothers stopped breastfeeding before their infants were six months old were analyzed with content analysis. The reasons given for breastfeeding cessation were insufficient milk supply, medical reasons, lactational factors, and return to work. Lactational factors were nipple soreness and mastitis. In order to prolong breastfeeding, pregnant women should be encouraged to attend more prenatal classes. Attendance would enhance self-efficacy and intention to breastfeed longer. Strategies helping working mothers to continue breastfeeding are also needed.
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Affiliation(s)
- Ke Sun
- 1 Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Miaoxia Chen
- 1 Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuzhu Yin
- 1 Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lingling Wu
- 1 Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lingling Gao
- 2 School of Nursing, Sun Yat-sen University, Guangzhou, China
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Chekol DA, Biks GA, Gelaw YA, Melsew YA. Exclusive breastfeeding and mothers' employment status in Gondar town, Northwest Ethiopia: a comparative cross-sectional study. Int Breastfeed J 2017. [PMID: 28638435 PMCID: PMC5473972 DOI: 10.1186/s13006-017-0118-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Exclusive breastfeeding is defined as feeding an infant breast milk only, for the first six months. In Ethiopia, more than half of infants do not receive exclusive breastfeeding. Workplace barriers contribute to these low rates of exclusive breastfeeding practices. Understanding the sociodemographic, health related, behavioral and economic factors is crucial to promote the practice of exclusive breastfeeding in Ethiopia. Therefore, the aim of this study was to assess the extent of exclusive breastfeeding practice and associated factors among employed and unemployed mothers with children of age 7–12 months in Gondar town, northwest Ethiopia, 2015. Methods A community based comparative cross-sectional study was conducted in October 2015. Simple random sampling technique was used to select 649 eligible mothers with children age 7–12 months during the study period. A structured and pretested interviewer administered questionnaire was used to collect the data. Three logistic regression models: whole sample, employed and not employed, were fitted. Results A total of 649 (333 unemployed and 316 employed) mothers were interviewed. The mean duration of mothers to exclusively breastfeed was 4.77 months (± 1.36 Standard Deviation [SD]). Exclusive breastfeeding was higher among unemployed 48.0% with 95% Confidence Interval (CI) (42.0%, 54.0%) than employed (20.9%) with 95% CI (16.0%, 25.0%). Parity of three children and above (Adjusted Odds Ratio [AOR] = 3.48), and having social support (AOR = 3.45) were positively associated with exclusive breastfeeding while poor knowledge (AOR = 0.30), wealth index of the medium level (AOR = 0.38) were negatively associated among employed mothers. In the case of unemployed mothers, vaginal delivery (AOR = 2.60) and having social support (AOR = 3.03) were positively associated with exclusive breastfeeding while, poor knowledge (AOR = 0.28), and not having antenatal care (AOR = 0.56) were negatively associated. Conclusions The overall exclusive breastfeeding practice of mothers was low. However, unemployed mothers breastfeed more than employed mothers. Providing a special support for employed mothers and revising either the legislation of the two month postpartum maternity leave or applying different alternatives is recommended. Electronic supplementary material The online version of this article (doi:10.1186/s13006-017-0118-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Gashaw Andargie Biks
- Department of Health Service management and Health Economics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yalemzewod Assefa Gelaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yayehirad Alemu Melsew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
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Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
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Invested in Success: A Qualitative Study of the Experience of CenteringPregnancy Group Prenatal Care for Perinatal Educators. J Perinat Educ 2017; 26:125-135. [PMID: 30723376 DOI: 10.1891/1058-1243.26.3.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to understand the central meaning of the experience of providing CenteringPregnancy for perinatal educators who were facilitators for the group sessions. Four perinatal educators participated in one-on-one interviews and/or a validation focus group. Six themes emerged: (a) "stepping back and taking on a different role," (b) "supporting transformation," (c) "getting to knowing," (d) "working together to bridge the gap," (e) "creating the environment," and (f) "fostering community." These themes contributed to the core phenomenon of being "invested in success." Through bridging gaps and inconsistencies in information received from educators and physicians, this model of CenteringPregnancy provides an opportunity for women to act on relevant information more fully than more traditional didactic approaches to perinatal education.
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Girard LC, Côté SM, de Lauzon-Guillain B, Dubois L, Falissard B, Forhan A, Doyle O, Bernard JY, Heude B, Saurel-Cubizolles MJ, Kaminski M, Boivin M, Tremblay RE. Factors Associated with Breastfeeding Initiation: A Comparison between France and French-Speaking Canada. PLoS One 2016; 11:e0166946. [PMID: 27902741 PMCID: PMC5130209 DOI: 10.1371/journal.pone.0166946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background Breastfeeding is associated with multiple domains of health for both mothers and children. Nevertheless, breastfeeding initiation is low within certain developed countries. Furthermore, comparative studies of initiation rates using harmonised data across multiple regions is scarce. Objective The aim of the present study was to investigate and compare individual-level determinants of breastfeeding initiation using two French-speaking cohorts. Methods Participants included ~ 3,900 mothers enrolled in two cohort studies in Canada and France. Interviews, questionnaires, and medical records were utilised to collect information on maternal, family, and medical factors associated with breastfeeding initiation. Results Rates of breastfeeding initiation were similar across cohorts, slightly above 70%. Women in both Canada and France who had higher levels of maternal education, were born outside of their respective countries and who did not smoke during pregnancy were more likely to initiate breastfeeding with the cohort infant. Notably, cohort effects of maternal education at the university level were found, whereby having ‘some university’ was not statistically significant for mothers in France. Further, younger mothers in Canada, who delivered by caesarean section and who had previous children, had reduced odds of breastfeeding initiation. These results were not found for mothers in France. Conclusions and Implications for Practice While some similar determinants were observed, programming efforts to increase breastfeeding initiation should be tailored to the characteristics of specific geographical regions which may be heavily impacted by the social, cultural and political climate of the region, in addition to individual and family level factors.
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Affiliation(s)
- Lisa-Christine Girard
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Sylvana M. Côté
- Department of Social and Preventive Medicine, Université de Montreal, Montreal, Canada
- Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation, Russia
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Canada
| | - Blandine de Lauzon-Guillain
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Lise Dubois
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Bruno Falissard
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Paris, France
| | - Anne Forhan
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Orla Doyle
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- School of Economics, University College Dublin, Dublin, Ireland
| | - Jonathan Y. Bernard
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Barbara Heude
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Marie-Josephe Saurel-Cubizolles
- Paris Descartes University, Paris, France
- INSERM UMR 1153- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris, France
| | - Monique Kaminski
- Paris Descartes University, Paris, France
- INSERM UMR 1153- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris, France
| | - Michel Boivin
- Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation, Russia
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Canada
- School of Psychology, Université Laval, Quebec, Canada
| | - Richard E. Tremblay
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Canada
- Departments of Pediatrics and Psychology, Université de Montreal, Montréal, Canada
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Dennison BA, Nguyen TQ, Gregg DJ, Fan W, Xu C. The Impact of Hospital Resources and Availability of Professional Lactation Support on Maternity Care: Results of Breastfeeding Surveys 2009-2014. Breastfeed Med 2016; 11:479-486. [PMID: 27644007 DOI: 10.1089/bfm.2016.0072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Breastfeeding provides maternal and infant health benefits. Maternity care practices encompassed in the 10 Steps to Successful Breastfeeding are positively associated with improved breastfeeding outcomes. This study assessed changes in maternity care practices and lactation support. MATERIALS AND METHODS In 2009, 2011, and 2014, New York (NY) hospitals providing maternity care services were surveyed to assess the implementation of 9 of the 10 Steps to Successful Breastfeeding, professional lactation support, distribution of formula and discharge packs, and patient and hospital barriers to breastfeeding success. Generalized estimating equations were used to evaluate changes over time. RESULTS Surveys were completed by 138/138 (2009), 128/129 (2011), and 125/125 (2014) NY hospitals. During this time period, the percent of hospitals reporting implementation of Steps 2, 4, 6, or 9 increased, and the mean number of 9 steps implemented increased from 4.3 to 5.3. Hospitals distributing formula samples at discharge to breastfeeding mothers decreased significantly from 39 (32%) to 3 (2%). Professional lactation staffing ratios (N/1,000 births) of both International Board Certified Lactation Consultants and Certified Lactation Counselors increased between 2009 and 2011, but then decreased between 2011 and 2014. Reported barriers to breastfeeding support changed, with reductions in mixed messages from staff, but increases in lack of financial resources for breastfeeding support, inadequate prenatal education, mothers not being prepared, and family not being receptive to breastfeeding. CONCLUSIONS Between 2009 and 2014, NY hospitals reported increased barriers and a reduction in professional lactation support, which may have contributed to the limited improvements in breastfeeding support.
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Affiliation(s)
- Barbara A Dennison
- 1 New York State Department of Health, Albany, New York.,2 School of Public Health, University at Albany, State University of New York , Rensselaer, New York
| | | | | | - Wei Fan
- 1 New York State Department of Health, Albany, New York
| | - Changning Xu
- 1 New York State Department of Health, Albany, New York
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Nguyen TT, Withers M, Hajeebhoy N, Frongillo EA. Infant Formula Feeding at Birth Is Common and Inversely Associated with Subsequent Breastfeeding Behavior in Vietnam. J Nutr 2016; 146:2102-2108. [PMID: 27605404 PMCID: PMC5037877 DOI: 10.3945/jn.116.235077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/02/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The association between infant formula feeding at birth and subsequent feeding patterns in a low- or middle-income context is not clear. OBJECTIVE We examined the association of infant formula feeding during the first 3 d after birth with subsequent infant formula feeding and early breastfeeding cessation in Vietnam. METHODS In a cross-sectional survey, we interviewed 10,681 mothers with children aged 0-23 mo (mean age: 8.2 mo; 52% boys) about their feeding practices during the first 3 d after birth and on the previous day. We used stratified analysis, multiple logistic regression, propensity score-matching analysis, and structural equation modeling to minimize the limitation of the cross-sectional design and to ensure the consistency of the findings. RESULTS Infant formula feeding during the first 3 d after birth (50%) was associated with a higher prevalence of subsequent infant formula feeding [stratified analysis: 7-28% higher (nonoverlapping 95% CIs for most comparisons); propensity score-matching analysis: 13% higher (P < 0.001); multiple logistic regression: OR: 1.47 (95% CI: 1.30, 1.67)]. This practice was also associated with a higher prevalence of early breastfeeding cessation (e.g., <24 mo) [propensity score-matching analysis: 2% (P = 0.08); OR: 1.33 (95% CI: 1.12, 1.59)]. Structural equation modeling showed that infant formula feeding during the first 3 d after birth was associated with a higher prevalence of subsequent infant formula feeding (β: 0.244; P < 0.001), which in turn was linked to early breastfeeding cessation (β: 0.285; P < 0.001). CONCLUSIONS Infant formula feeding during the first 3 d after birth was associated with increased subsequent infant formula feeding and the early cessation of breastfeeding, which underscores the need to make early, exclusive breastfeeding normative and to create environments that support it.
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Affiliation(s)
| | - Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, CA; and
| | | | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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Patel S, Patel S. The Effectiveness of Lactation Consultants and Lactation Counselors on Breastfeeding Outcomes. J Hum Lact 2016; 32:530-41. [PMID: 26644419 DOI: 10.1177/0890334415618668] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
Breastfeeding for all infants starting at birth and continuing until at least 6 months of age has been recommended by the World Health Organization and the American Academy of Pediatrics. The health benefits to infants and mothers have been demonstrated in many studies. Dedicated lactation specialists may play a role in providing education and support to pregnant women and new mothers wishing to breastfeed to improve breastfeeding outcomes. The objective of this review was to assess if lactation education or support programs using lactation consultants or lactation counselors would improve rates of initiation and duration of any breastfeeding and exclusive breastfeeding compared with usual practice. A systematic literature review of the evidence was conducted using electronic databases. The review was limited to randomized trials and yielded 16 studies with 5084 participants. It was found that breastfeeding interventions using lactation consultants and counselors increase the number of women initiating breastfeeding (odds ratio [OR] for any initiation vs not initiating breastfeeding = 1.35; 95% confidence interval [CI], 1.10-1.67). The interventions improve any breastfeeding rates (OR for any breastfeeding up to 1 month vs not breastfeeding = 1.49; 95% CI, 1.09-2.04). In addition, there were beneficial effects on exclusive breastfeeding rates (OR for exclusive breastfeeding up to 1 month vs not exclusive breastfeeding = 1.71; 95% CI, 1.20-2.44). Most of the evidence would suggest developing and improving postpartum support programs incorporating lactation consultants and lactation counselors.
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Affiliation(s)
- Sanjay Patel
- Duke Primary Care Wake Forest, Duke University Health Systems, Durham, NC, USA
| | - Shveta Patel
- Wake County Human Services, Care Coordination for Children, Northern Regional Centre, Wake Forest, NC, USA
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Adhisivam B, Vishnu Bhat B, Poorna R, Thulasingam M, Pournami F, Joy R. Postnatal counseling on exclusive breastfeeding using video - experience from a tertiary care teaching hospital, south India. J Matern Fetal Neonatal Med 2016; 30:834-838. [PMID: 27160763 DOI: 10.1080/14767058.2016.1188379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Adequate antenatal counseling combined with postnatal lactation support is likely to improve exclusive breastfeeding rates. OBJECTIVE To assess the impact of a postnatal video based health education program in promoting exclusive breastfeeding among primiparous mothers. METHODS This interventional study was done in a tertiary care teaching hospital, south India. Primiparous mothers in one postnatal ward (group A) received routine lactation counseling. A similar group of primiparous mothers in another postnatal ward (group B) were administered a video based health education program on exclusive breastfeeding in the local language Tamil in addition to the routine lactation counseling. The exclusive breastfeeding rates of these two groups of mothers were compared. Their knowledge and perceptions after intervention were also compared using a pretested questionnaire. RESULTS Among 878 primiparous mothers, 94% fed colostrum and 43% initiated breastfeeding within one hour of delivery. Correct attachment was noted with 96% and 13% had lactation issues. Group B had marginally better exclusive breastfeeding rate at six months but not statistically significant. Mothers in group B had a statistically significant better knowledge score post-intervention compared to those in Group A. Use of gripe water was more in group A compared to group B. CONCLUSION The video based health education program when combined with routine lactation counseling improved the knowledge regarding exclusive breastfeeding among postnatal primiparous mothers better than with routine lactation counseling alone. However, both interventions had similar effect on exclusive breastfeeding rate at six months.
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Affiliation(s)
- B Adhisivam
- a Department of Neonatology and Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - B Vishnu Bhat
- a Department of Neonatology and Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Rachel Poorna
- a Department of Neonatology and Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Mahalakshmy Thulasingam
- a Department of Neonatology and Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Femitha Pournami
- a Department of Neonatology and Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Rojo Joy
- a Department of Neonatology and Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
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Cattaneo A, Bettinelli ME, Chapin E, Macaluso A, Córdova do Espírito Santo L, Murante AM, Montico M. Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study. BMJ Open 2016; 6:e010232. [PMID: 27154476 PMCID: PMC4861096 DOI: 10.1136/bmjopen-2015-010232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months. DESIGN Controlled, non-randomised trial. SETTING 18 Local Health Authorities in 9 regions of Italy. PARTICIPANTS 5094 mother/infant dyads in 3 cohorts were followed up to 12 months after birth in 3 rounds of data collection: at baseline, after implementation of the intervention in the early intervention group and after implementation in the late intervention group. 689 (14%) dyads did not complete the study. INTERVENTION Implementation of the 7 steps of the BFCI. MAIN OUTCOME MEASURES The rate of exclusive breast feeding at 6 months was the primary outcome; breast feeding at discharge, 3 and 12 months was also measured. RESULTS The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account. CONCLUSIONS The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.
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Affiliation(s)
- Adriano Cattaneo
- Health Services Research and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Maria Enrica Bettinelli
- Maternal and Child Health Unit, Department of Primary Care, Local Health Authority, Milan, Italy
| | - Elise Chapin
- Baby Friendly Initiatives, Italian Committee for UNICEF, Rome, Italy
| | - Anna Macaluso
- Health Services Research and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Anna Maria Murante
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marcella Montico
- Department of Epidemiology and Biostatistics, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Bascom EM, Napolitano MA. Breastfeeding Duration and Primary Reasons for Breastfeeding Cessation among Women with Postpartum Depressive Symptoms. J Hum Lact 2016; 32:282-91. [PMID: 26644420 DOI: 10.1177/0890334415619908] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although postpartum depression is associated with lower breastfeeding initiation rates and shorter breastfeeding duration, the potential mechanisms through which this relationship functions are not well understood. OBJECTIVE This study examined the breastfeeding behaviors of women with postpartum depressive symptoms (PDS) to identify potential motivations for early breastfeeding cessation. METHODS An analysis of quantitative data from the Infant Feeding Practices Study II examined the relationship between PDS and breastfeeding behaviors, including breastfeeding duration and primary reasons for early breastfeeding cessation. RESULTS Of the women in the sample, 30.9% met criteria for mild PDS. Women with PDS had shorter overall (18.4 vs 21.8 weeks, P = .001) and exclusive breastfeeding duration (3.6 vs 4.7 weeks, P = .012) than women without PDS. A larger proportion of women with PDS stopped breastfeeding before 6 months (68.7% vs 57.2%, P < .001). After controlling for socioeconomic status, education, marital status, employment status, race/ethnicity, maternal age, parity, and breastfeeding intentions, presence of PDS significantly predicted higher odds of reporting "too many household duties" (OR = 1.90, P = .011) as a primary reason for breastfeeding cessation among women who stopped breastfeeding before 6 months. After controlling for these same covariates, women with PDS had, on average, 2.4 weeks shorter breastfeeding duration than women without PDS (P = .025). CONCLUSION There is a high prevalence of depressive symptoms among new mothers, and most do not breastfeed for recommended time periods. Increased PDS screening during prenatal and postpartum visits and promotion of lactation support services may better address the high rates of PDS and suboptimal breastfeeding behavior.
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Affiliation(s)
- Erin McElderry Bascom
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melissa A Napolitano
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Venancio SI, Giugliani ERJ, Silva OLDO, Stefanello J, Benicio MHD, dos Reis MCG, Issler RMS, Santo LCDE, Cardoso MRA, Rios GS. [Association between the degree of implementation of the Brazilian Breastfeeding Network and breastfeeding indicators]. CAD SAUDE PUBLICA 2016; 32:e00010315. [PMID: 27027452 DOI: 10.1590/0102-311x00010315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/23/2015] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.
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Wouk K, Lara-Cinisomo S, Stuebe AM, Poole C, Petrick JL, McKenney KM. Clinical Interventions to Promote Breastfeeding by Latinas: A Meta-analysis. Pediatrics 2016; 137:peds.2015-2423. [PMID: 26668300 PMCID: PMC4702022 DOI: 10.1542/peds.2015-2423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 01/08/2023] Open
Abstract
CONTEXT Breastfeeding duration and exclusivity among Latinas fall below recommended levels, indicating a need for targeted interventions. The effectiveness of clinical breastfeeding interventions for Latinas remains unclear. OBJECTIVE To systematically review the documented effectiveness of clinical breastfeeding interventions on any and exclusive breastfeeding among Latinas. DATA SOURCES English-language publications in Medline, CINAHL, and Embase were searched through May 28, 2015. STUDY SELECTION Fourteen prospective, controlled studies describing 17 interventions met inclusion criteria. DATA EXTRACTION Extracted study characteristics include study design, population characteristics, intervention components, timing and intensity of delivery, provider type, control procedures, and outcome measures. RESULTS Random-effects meta-analyses estimated risk differences (RDs) between breastfeeding mothers in intervention and control arms of each study and 95% prediction intervals (PIs) within which 95% of intervals cover the true value estimated by a future study. Interventions increased any breastfeeding at 1 to 3 and 4 to 6 months (RD 0.04 [95% PI -0.15 to 0.23] and 0.08 [-0.08 to 0.25], respectively) and exclusive breastfeeding at 1 to 3 and 4 to 6 months (0.04 [-0.09 to 0.18] and 0.01 [-0.01 to 0.02]). Funnel plot asymmetry suggested publication bias for initiation and 1- to 3-month any breastfeeding. Estimates were slightly larger among interventions with prenatal and postpartum components, 3 to 6 patient contacts, and delivery by an International Board Certified Lactation Consultant or lay provider. LIMITATIONS The published evidence for Latinas is limited, and studies have varying methodologic rigor. CONCLUSIONS Breastfeeding interventions targeting Latinas increased any and exclusive breastfeeding compared with usual care.
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Affiliation(s)
- Kathryn Wouk
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, and
| | - Sandraluz Lara-Cinisomo
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;,Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Alison M. Stuebe
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, and,Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jessica L. Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Kathryn M. McKenney
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Rosen-Carole C, Hartman S. ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015. Breastfeed Med 2015; 10:451-7. [PMID: 26651541 PMCID: PMC4685902 DOI: 10.1089/bfm.2015.29016.ros] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Casey Rosen-Carole
- Department of General Pediatrics, University of Rochester, Rochester, New York
| | - Scott Hartman
- Department of Family Medicine, University of Rochester, Rochester, New York
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Maust A, Koroma AS, Abla C, Molokwu N, Ryan KN, Singh L, Manary MJ. Severe and Moderate Acute Malnutrition Can Be Successfully Managed with an Integrated Protocol in Sierra Leone. J Nutr 2015; 145:2604-9. [PMID: 26423737 DOI: 10.3945/jn.115.214957] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Global acute malnutrition (GAM) is the sum of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of different foods and protocols for MAM and SAM treatment can be cumbersome in emergency settings. OBJECTIVE Our objective was to determine the recovery and coverage rates for GAM of an integrated protocol with a single food product, ready-to-use therapeutic food (RUTF), compared with standard management. METHODS This was a cluster-randomized controlled trial in Sierra Leone conducted in 10 centers treating GAM in children aged 6-59 mo. The integrated protocol used midupper arm circumference (MUAC) as the criterion for admission and discharge, with a MUAC <12.5 cm defining malnutrition. The protocol included a decreasing ration of RUTF and health maintenance messages delivered by peers. Standard therapy treated MAM with a fortified blended flour and SAM with RUTF and used weight-for-height to determine admission to the treatment program. Coverage rates were the number of children who received treatment/number of children in the community eligible for treatment. RESULTS Most of the children receiving integrated management had MAM (774 of 1100; 70%), whereas among those receiving standard management, SAM predominated (537 of 857; 63%; P = 0.0001). Coverage was 71% in the communities served by integrated management and 55% in the communities served by standard care (P = 0.0005). GAM recovery in the integrated management protocol was 910 of 1100 (83%) children and was 682 of 857 (79%) children in the standard therapy protocol. CONCLUSION Integrated management of GAM in children is an acceptable alternative to standard management and provides greater community coverage. This trial was registered at clinicaltrials.gov as NCT01785680.
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Affiliation(s)
- Amanda Maust
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Aminata S Koroma
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - Nneka Molokwu
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Kelsey N Ryan
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Lauren Singh
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Mark J Manary
- Department of Pediatrics, Washington University, St. Louis, MO; Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
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Piette JD, Striplin D, Marinec N, Chen J, Aikens JE. A randomized trial of mobile health support for heart failure patients and their informal caregivers: impacts on caregiver-reported outcomes. Med Care 2015; 53:692-9. [PMID: 26125415 PMCID: PMC4503477 DOI: 10.1097/mlr.0000000000000378] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers' efforts. OBJECTIVES To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management. RESEARCH DESIGN Randomized comparative effectiveness trial. SUBJECTS A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system. All patients participated with a "CarePartner" or informal caregiver outside their household. INTERVENTION Patients randomized to "standard mHealth" received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. "mobile health+CarePartner" (mHealth+CP) patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners. MEASURES At baseline, 6, and 12 months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support. RESULTS mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months (both P≤0.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (P≤0.03 for interactions between arm and baseline strain/depression at both endpoints). Although most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all P<0.05). mHealth+CP CarePartners reported more frequently attending patients' medical visits at 6 months (P=0.049) and greater involvement in medication adherence at both endpoints (both P≤0.032). CONCLUSIONS When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners' engagement in self-care.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana Striplin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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