Early initiation of breastfeeding and severe illness in the early newborn period: An observational study in rural Bangladesh

Regulatory roles of non-coding RNAs in programmed cell death pathways and drug resistance in gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract, primarily driven by KIT or PDGFRA mutations. Programmed cell death (PCD), including apoptosis, autophagy, and ferroptosis, plays a crucial role in GIST pathogenesis, progression, and treatment response. Non-coding RNAs (ncRNAs) have emerged as key regulators of PCD pathways, influencing GIST proliferation, metastasis, and drug resistance, particularly in response to tyrosine kinase inhibitors (TKIs) such as imatinib. Apoptosis suppression is strongly associated with poor prognosis, while autophagy contributes to tumor dormancy and TKI resistance. Ferroptosis, a novel iron-dependent cell death pathway, represents a promising therapeutic target. Recent evidence suggests that ncRNAs modulate these PCD pathways through interactions with key molecular regulators such as miR-494, miR-30a, and lncRNAs, which affect signaling networks including PI3K/AKT, MAPK, and mTOR. Furthermore, ncRNAs have mediated secondary resistance to imatinib by promoting autophagic flux and altering ferroptosis sensitivity. Understanding the molecular interplay between ncRNAs and PCD in GIST provides novel insights into disease mechanisms and offers potential therapeutic strategies to overcome drug resistance. Targeting ncRNA-mediated regulation of apoptosis, autophagy, and ferroptosis may enhance treatment efficacy and improve patient outcomes. Future research should focus on elucidating the mechanistic roles of ncRNAs in PCD pathways to develop innovative diagnostic and therapeutic approaches for GIST.

Artificial intelligence applied to the study of human milk and breastfeeding: a scoping review

BACKGROUND

Breastfeeding rates remain below the globally recommended levels, a situation associated with higher infant and neonatal mortality rates. The implementation of artificial intelligence (AI) could help improve and increase breastfeeding rates. This study aimed to identify and synthesize the current information on the use of AI in the analysis of human milk and breastfeeding.

METHODS

A scoping review was conducted according to the PRISMA Extension for Scoping Reviews guidelines. The literature search, performed in December 2023, used predetermined keywords from the PubMed, Scopus, LILACS, and WoS databases. Observational and qualitative studies evaluating AI in the analysis of breastfeeding patterns and human milk composition have been conducted. A thematic analysis was employed to categorize and synthesize the data.

RESULTS

Nineteen studies were included. The primary AI approaches were machine learning, neural networks, and chatbot development. The thematic analysis revealed five major categories: 1. Prediction of exclusive breastfeeding patterns: AI models, such as decision trees and machine learning algorithms, identify factors influencing breastfeeding practices, including maternal experience, hospital policies, and social determinants, highlighting actionable predictors for intervention. 2. Analysis of macronutrients in human milk: AI predicted fat, protein, and nutrient content with high accuracy, improving the operational efficiency of milk banks and nutritional assessments. 3. Education and support for breastfeeding mothers: AI-driven chatbots address breastfeeding concerns, debunked myths, and connect mothers to milk donation programs, demonstrating high engagement and satisfaction rates. 4. Detection and transmission of drugs in breast milk: AI techniques, including neural networks and predictive models, identified drug transfer rates and assessed pharmacological risks during lactation. 5. Identification of environmental contaminants in milk: AI models predict exposure to contaminants, such as polychlorinated biphenyls, based on maternal and environmental factors, aiding in risk assessment.

CONCLUSION

AI-based models have shown the potential to increase breastfeeding rates by identifying high-risk populations and providing tailored support. Additionally, AI has enabled a more precise analysis of human milk composition, drug transfer, and contaminant detection, offering significant insights into lactation science and maternal-infant health. These findings suggest that AI can promote breastfeeding, improve milk safety, and enhance infant nutrition.

Effect of housing construction material on childhood acute respiratory infection: a hospital based case control study in Bangladesh

Despite several studies conducted to investigate housing factors, the effects of housing construction materials on childhood ARI symptoms in Bangladesh remain unclear. Hence, the study aimed to measure such a correlation among children under the age of five. A hospital-based case-control study was conducted, involving 221 cases and 221 controls from January to April 2023. Bivariate and multivariate binary logistic regression was performed to measure the degree of correlation between housing construction materials and childhood ARI symptoms. Households composed of natural floor materials had 2.7 times (95% confidence interval 1.27-5.57) and households composed of natural roof materials had 1.8 times (95% confidence interval 1.01-3.11) higher adjusted odds of having under-five children with ARI symptoms than household composed of the finished floor and finished roof materials respectively. Households with natural wall type were found protective against ARI symptoms with adjusted indoor air pollution determinants. The study indicates that poor housing construction materials are associated with an increased risk of developing ARI symptoms among under-five children in Bangladesh. National policy regarding replacing poor housing materials with concrete, increasing livelihood opportunities, and behavioral strategies programs encouraging to choice of quality housing construction materials could eliminate a fraction of the ARI burden.

Predictors of neonatal mortality in Ethiopia: Cross sectional study using 2005, 2010 and 2016 Ethiopian demographic health survey datasets

Ethiopia is among the countries that have highest neonatal mortality in the world. Despite efforts to reduce neonatal mortality, the country has faced challenges in achieving national and global targets. The study aims to determine the trends and predictors of change in neonatal mortality in Ethiopia for the past 15 years. The study used Ethiopian Demographic Health Survey Datasets (EDHS) from 2005, 2011, and 2016. All live births of reproductive-age women in Ethiopia were included in the study. Multivariate decomposition analysis for the nonlinear response variable (MVDCMP) based on the logit link function was employed to determine the relative contribution of each independent variable to the change in neonatal mortality over the last 15 years. The neonatal mortality rate has decreased by 11 per 1,000 live births, with an annual reduction rate of 2.8% during the survey period. The mortality rate increased in the pastoralist regions of the country from 31 per 1,000 live births to 36 per 1,000 live births, compared to the city and agrarian regions. Maternal ANC visits in 2005 and 2016 (AOR [95%CI] = 0.10 [0.01, 0.81]; 0.01 [0.02, 0.60]) were significantly associated with decreased neonatal mortality. In addition, the decomposition analysis revealed that increased birth interval of more than 24 months and early breastfeeding initiation contributed to the reduction of neonatal mortality by 26% and 10%, respectively, during the survey period. The study found that neonatal mortality is a public health problem in the country, particularly in pastoralist communities. Tailor made maternal and child healthcare interventions that promote early breastfeeding initiation, increased birth intervals and ANC utilization should be implemented to reduce neonatal mortality, particularly in pastoralist communities.

Barriers and enablers to exclusive breastfeeding by mothers in Polokwane, South Africa

Background

Exclusive breastfeeding (EBF) for six months, with the introduction of appropriate complementary feeding thereafter, and breastfeeding continuing for up to 2 years and beyond, is highly recommended. This could save the lives of up to 1.4 million children each year worldwide. Despite this, breastfeeding rates in South Africa remain sub-optimal, with the recommended target of 50% by the World Health Assembly (WHA) not being achieved. The study aimed to investigate the reasons influencing mothers' practice of exclusive breastfeeding in the Polokwane municipality of Limpopo province in South Africa.

Methodology

A cross-sectional health facility-based quantitative and descriptive survey was conducted using a validated-structured questionnaire administered to 146 mothers. The data was analyzed using STATA. Chi-square tests were used to determine the relationship between selected demographic variables and their reasons not to breastfeed exclusively.

Results

Although 94% of the mothers had initiated breastfeeding, at the time of data collection 8% had stopped. Of those who had stopped breastfeeding, 5% did so within one month of starting. Thirty- nine percent of mothers' breastfed exclusively, while 61% practiced mixed feeding. A positive association between exclusive breastfeeding practices and the age of the mother were observed, with older mothers more likely to breastfeed. The reasons mothers stopped breastfeeding were: the mother was ill (45%) or they returned to school or work (27%). Reasons for not breastfeeding were cited as: medical conditions, not enough milk, and infant refusal to breastfeed (33%). Mothers believe that HIV-positive women should breastfeed their infants (57%), and health workers were found to be the main source of HIV information to mothers (77%).

Discussion

Exclusive breastfeeding during the first six months was less practiced. Infant formula and solid foods were introduced at an early age, usually within the first month of breastfeeding. This study sheds light on factors influencing the early initiation of breastfeeding and the practice of EBF as practiced in Polokwane.

Trends and determinants of early initiation of breastfeeding in Indonesia: A multivariate decomposition analysis

BACKGROUND

Early initiation of breastfeeding (EIBF) is key to reducing neonatal morbidity and mortality, however, little is known about the determinants of the trends of EIBF prevalence in Indonesia. This study aims to assess the contributing factors to the changes in the prevalence of EIBF between 2007 and 2017.

METHODS

We analysed data from the 2007, 2012, and 2017 Indonesia Demographic and Health Surveys to estimate the trends in EIBF. A multivariate logistic decomposition model was fitted to examine variables associated with changes in the percentage of EIBF from 2007 to 2017. The contributing factors to changes in EIBF prevalence were categorized into either compositional or behavioural changes, with each of them divided into portions or percentages of contribution (pct) of the independent variables. The former refers to the changes in the distribution of samples, while the latter refers to the changes in the behavioural responses toward EIBF in both surveys. All analyses accounted for the complex study design and potential confounding factors.

RESULTS

An increase in the prevalence of EIBF from 49.9% to 56.5% was recorded between 2012 and 2017, with an overall increase of 16.9 percentage points from 2007 to 2017. At the aggregate level, the compositional differences did not significantly contribute to the changes in the percentage of EIBF, while 98.3pct (p < 0.001) was associated with changes in mothers' behavioural response towards EIBF. The composition changes in the geographical region of Sumatra, and caesarean delivery negatively contributed to the changes in EIBF prevalence with -0.6pct and -14.2pct, respectively. However, the compositional differences in those living in Kalimantan & Sulawesi, first-time mothers, and small-born infants positively contributed to the change. Behaviour changes in mothers with higher education (8.8pct), from higher income households (-17.5pct), and those residing in Sumatra (-8.2pct) and Kalimantan & Sulawesi (-10.2pct) significantly contributed to the upward trend in EIBF prevalence.

CONCLUSIONS

Almost half of the newborns experienced delayed breastfeeding initiation despite the improvement in the prevalence of EIBF. Therefore, further research and interventions on behaviour change in mother's attitudes towards EIBF, especially among those undergoing caesarean delivery, living in Kalimantan or Sulawesi, and from wealthier households, are recommended to close this gap.

Correlates of non-institutional delivery to delayed initiation of breastfeeding in Nigeria: logit-decomposition and subnational analysis of population-based survey

BACKGROUND

Studies have connected newborn delivery settings and modality to optimal breastfeeding, but how it influences untimely initiation, mostly prevalent in sub-Saharan Africa is unknown. Hence, the role of home delivery on delay initiation of breastfeeding (DIBF) in Nigeria was investigated to inform evidence-based strategy for improved breastfeeding practice.

METHODOLOGY

This is a secondary analysis of births (11,469 home and 7632 facility delivery) by 19,101 reproductive age women in the 2018 NDHS. DIBF is the outcome, home birth is the exposure, and explanatory variables were classified as: socio-demographics, obstetrics and economic factors. Descriptive statistics (frequencies and percentages) were reported, and bivariate (chi-square) analysis was carried out at 20% (p < 0.20) cutoff point. Multivariable logistic regression assessed the probability and significance of the outcome per place of birth. Multivariate decomposition further evaluated the endowment and coefficient effect contribution by independent factors to the outcome. Analysis was carried out at p < 0.05 (95% confidence level) on Stata.

RESULTS

56.6% of mothers DIBF, with 37.1% and 19.5% from home and facility delivery, respectively. Home delivery (AOR = 1.34, 95% CI 1.17-1.52) increase the chance of DIBF by 34%, while DIBF probability reduces by 26% in facility delivery (AOR = 0.74, 95% CI 0.65-0.85). DIBF is 5 times more likely in caesarian section delivery (AOR = 5.10, 95% CI 4.08-6.38) compared to virginal birth in facility delivery. Skilled antenatal provider, parity and wealth are negatively associated with DIBF in home birth, while undesired pregnancy, rural residency, partial/no skin-to-skin contact and large child size positively influence DIBF in both home and facility delivery. Skilled antenatal provider (C =  - 66.3%, p < 0.01) and skin-to-skin contact (C =  - 60.6%, p < 0.001) contributed most to reducing the negative DIBF effect with 69% and 31% overall characteristics and coefficient effect component, respectively. DIBF is more likely in Bauchi and Sokoto but less likely in Bayelsa.

CONCLUSIONS

High DIBF prevalent in Nigeria was largely due to elevated rate of home birth, positively associated with DIBF. Caesarian section delivery though heightens the chance of DIBF in facility delivery. Strengthening utilization of skilled provider and skin-to-skin contact can eliminate two-third of the adverse DIBF effect and improve early initiation rate. Adopting this strategy will bridge home-facility delivery gap to achieve optimal breastfeeding practice.

Early Initiation of Breastfeeding (EIBF) and Its Associated Factors Among Mothers With Infants Aged 0 to 6 Months in Jashore District, Bangladesh: A Cross-Sectional Study

OBJECTIVE

Early initiation of breastfeeding (EIBF) is one of the most successful interventions for minimizing newborn morbidity and death. According to the database (Bangladesh Demographic Health Survey 2014), only around half of babies begin breastfeeding during the first hour of life in Bangladesh. The goal of this study was to determine the prevalence of EIBF in the Jashore area while also investigating its associated factors among mothers of infants aged 0 to 6 months in order to better understand the variables that impacted breastfeeding initiation.

METHOD

A cross-sectional study was conducted in the maternity wards of the 3 busiest hospitals in the Jashore district of Bangladesh from May to July 2019. Using random sampling, a total of 423 mother-infant pairs were chosen. Pearson chi-square test and bivariable and multivariable logistic regression statistical analysis were used to identify factors linked to EIBF.

RESULTS

The prevalence of EIBF was 46.3% (196/423). Mothers who had skin-to-skin contact after delivery (adjusted odds ratio [AOR], 2.25; 95% confidential interval [CI], 1.40-3.59), who did not deliver prelacteal food (AOR, 3.68; 95% CI, 1.65-8.21), and who provided colostrum (AOR, 5.89; 95% CI, 1.62-21.49) were more likely to begin breastfeeding within 1 hour than were their counterparts.

CONCLUSIONS

EIBF was found to be strongly linked with skin-to-skin contact after delivery, avoidance of prelacteal feeding, and colostrum feeding practice. As a result, we strongly urge public health officials and health care practitioners to encourage these feeding behaviors in order to increase EIBF.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

Effect of caesarian section delivery on breastfeeding initiation in Nigeria: logit-based decomposition and subnational analysis of cross-sectional survey

OBJECTIVES

This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice.

DESIGN AND SETTINGS

A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria.

PARTICIPANTS

Complete responses from reproductive-age women (15-49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey.

MAIN OUTCOME MEASURES

TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics.

METHODS

Descriptive statistics were reported and graphically presented. Bivariate χ2 analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors' contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17.

RESULTS

44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR 'AOR'=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR 'COR'=63.9: 95% CI=28.2 to 144.9).

CONCLUSIONS

CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother-child contact peculiar to CS women is critical for improved breastfeeding practice.

Determinants of early initiation of breast feeding during COVID-19 pandemic among urban-dwelling mothers from Tigray, Northern Ethiopia: a community-based cross-sectional study

OBJECTIVES

The objective of this study was to assess the practice of early initiation of breast feeding (EIBF) and its determinant factors among urban-dwelling mothers from Tigray during the COVID-19 pandemic.

DESIGN

A community-based cross-sectional study was conducted from April to June 2021. Data were analysed using StataSE Version 16 software. To identify determinant factors of the dependent variable, multivariate logistic regression analyses was used at a statistical significance of p<0.05. The strength of the association was measured by OR and 95% CI.

SETTING AND PARTICIPANTS

The study was conducted among 633 lactating mothers of infants under the age of 6 months living in Mekelle city, Tigray, Northern Ethiopia from April to June 2021. A three-stage cluster sampling was used to select study participants.

MAIN OUTCOME MEASURE

EIBF or no EIBF.

RESULTS

Three hundred and sixty eight (59.6%) mothers/caregivers practised EIBF. Maternal education (adjusted OR, AOR 2.45, 95 % CI 1.01 to 5.88), parity (AOR 1.20, 95 % CI 1.03 to 2.20), caesarean section delivery (AOR 0.47, 95 % CI 0.32 to 0.69) and breastfeeding information and support postdelivery (AOR 1.59, 95% CI 1.10 to 2.31) were found to be significant determinants of EIBF.

CONCLUSIONS

EIBF is defined as initiation of breastfeeding within 1 hour after delivery. EIBF practice was far from optimal. During the COVID-19 pandemic, maternal education, parity, type of delivery and the provision of up-to-date breastfeeding information and support right after delivery determined the time of breastfeeding initiation.

Influence of the Quality of Antenatal Care on Early Breastfeeding Initiation and Exclusive Breastfeeding Among Haitian Women

OBJECTIVE

To assess the influence of the quality of antenatal care on early breastfeeding initiation and exclusive breastfeeding among Haitian women.

DESIGN

Secondary analysis of a cross-sectional household survey.

SETTING

Haiti Demographic and Health Survey, 2016 to 2017.

PARTICIPANTS

Women (N = 2,489) who were 15 to 49 years of age with children younger than 24 months of age.

METHODS

We used multivariable adjusted logistic regression analysis to examine the independent associations between quality of antenatal care and early breastfeeding initiation and exclusive breastfeeding.

RESULTS

The prevalence of early breastfeeding initiation and exclusive breastfeeding were 47.7% and 39.9%, respectively. Approximately 76.0% of the participants received intermediate antenatal care. The odds of early breastfeeding initiation were greater among participants who received antenatal care of intermediate quality than among those who did not receive antenatal care, adjusted OR (AOR) = 1.58, 95% confidence interval (CI) [1.13, 2.20]. Additionally, maternal age of 35 to 49 years (AOR = 1.53, 95% CI [1.10, 2.12]) was positively associated with early breastfeeding initiation. Factors negatively associated with early breastfeeding initiation were cesarean birth (AOR = 0.23, 95% CI [0.12, 0.42]), birth at home (AOR = 0.75, 95% CI [0.34, 0.96]), and birth in a private facility (AOR = 0.57, 95% CI [0.34, 0.96]). Factors negatively associated with exclusive breastfeeding were employment (AOR = 0.57, 95% CI [0.36, 0.90]) and birth in a private facility (AOR = 0.21, 95% CI [0.08, 0.52]).

CONCLUSION

Antenatal care of intermediate quality was positively associated with early breastfeeding initiation among women in Haiti, which highlights the influence that care during pregnancy can have on breastfeeding outcomes.

Prevalence and presentation of neonatal sepsis at a paediatric emergency department in Johannesburg, South Africa

Background

Despite a significant reduction in the prevalence of neonatal sepsis over the past three decades, the prevalence still remains high, especially in low- and middle-income countries. The aim of this study was to determine the prevalence and presenting features of neonatal sepsis at a paediatric emergency centre (PEC).

Methods

Medical records of all neonates presenting to an academic hospital PEC over a six-month period were analysed. Data was compared between neonates with and without sepsis. The odds ratio was calculated to determine factors associated with neonatal sepsis.

Results

Of the 210 neonates who were included, 43 (20.5%) were diagnosed with neonatal sepsis. Of these, 19 (44.2%) presented within the first 72 hours of life (early-onset neonatal sepsis) and 4 (9.3%) died prior to hospital discharge. A history of maternal employment (odds ratio (OR) 2.38, p=0.021), preterm birth (OR 3.24, p=0.019), low birth weight (<2.5kg) (OR 2.67, p=0.026), perinatal human immunodeficiency virus exposure (OR 3.35, p=0.002), not being breast fed (OR 4.36, p=0.001), and signs of lethargy (OR 14.01, p<0.001), dehydration (or 11.14, p<0.001), poor feeding (OR 7.20, p<0.001), irritability (OR 6.93, p<0.001), fever (OR 5.50, p<0.001), vomiting (OR 4.14, p<0.001) and respiratory distress (OR 4.12, p<0.001) were significantly associated with neonatal sepsis.

Conclusion

Among neonates presenting to the PEC, various clinical features on history and examination may be useful in predicting the diagnosis of neonatal sepsis. Clinicians working in the PEC must adopt a high index of suspicion when attending to neonates presenting with these features.

Sex inequality in early initiation of breastfeeding in 24 sub-Saharan African countries: A multi-country analysis of Demographic and Health Surveys

Background

The Sustainable Development Goal (SDG) 3 aims at reducing neonatal and under-5 mortality to below 12 per 1000 and 25 per 1000 live births, respectively, globally by 2030. Studies have found that initiation of breastfeeding within one hour of birth and continuous breastfeeding for over 12 months can positively impact neonatal and infant health. However, there is evidence that the sex of a child may influence the breastfeeding practices of a mother. Thus, we examined sex inequality in early breastfeeding initiation in sub-Saharan Africa.

Materials and methods

Data from Demographic and Health Surveys conducted in 24 sub-Saharan African countries between January 2010 and December 2019 were pooled and analysed. A total of 137,677 women of reproductive age (15–49 years) were considered in this study. Bivariate and multivariable regression analyses were performed, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) with statistical significance at a p-value less than 0.05.

Results

The highest inequality in early initiation of breastfeeding was reported in Togo with a difference of 5.21% between the female and male children, while the lowest inequality was reported in Guinea with 0.48% difference between the female and male children. A higher odds of breastfeeding within 1 hour was observed among female children [cOR = 1.05; 95%(CI = 1.02–1.09)] compared to male children, and this persisted after controlling for the confounders included in this study [aOR = 1.05; 95%(CI = 1.02–1.08)].

Conclusion

We found higher odds for early breastfeeding initiation of female children compared to male children in sub-Saharan Africa. To reduce breastfeeding initiation inequalities, programmes that educate and encourage early initiation of breastfeeding irrespective of the child sex should be promoted among mothers.

Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia

BACKGROUND

The world is now suffering from malnutrition and remains one of the leading causes of death for under 5 children. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Therefore, the aim of this study was to assess the EIBF practices and determinants among children aged less than 24 months in West Belessa district, Northwest Ethiopia, 2019.

METHODS

A community-based cross-sectional study was conducted from January 2 to February 28, 2019 in the West Belessa district. A total of 569 mother-children pairs were participated in the study. Study particnapants were selected by using simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable and Multivariable logistic regression analysis were done. Odds ratio with 95% confidence was done to determine the level of significance value less than .05 considered as significant with the outcome variable.

RESULT

The prevalence of early initiation of breastfeeding (EIBF) was found to be 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR = 2.76, 95%CI [1.21, 6.27]), antenatal care (ANC) (AOR = 3.79, 95%CI [2.58, 9.94]), and number of antenatal care visit (AOR = 1.85, 95%CI [1.03, 3.85]) were significantly associated with early initiation of breastfeeding.

CONCLUSION AND RECOMMENDATION

In this study, more than three fourth of children were received early initiation of breastfeeding within 1 hour after delivery. Age of the mother, antenatal, and number of antenatal care were associated with EIBF. Therefore, during this contact period, improve antenatal services by increasing accessibility and providing counseling is important to improve EIBF utilization.

Prevalence and determinants of early initiation of breastfeeding (EIBF) and prelacteal feeding in Northern Ghana: A cross-sectional survey

BACKGROUND

There is suboptimal early initiation of breastfeeding (EIBF) with widespread prelacteal feeding in Ghana. However, studies exploring the determinants of EIBF and prelacteal feeding are limited in Ghana. The study was conducted to assess the prevalence and determinants of EIBF and prelacteal feeding in Northern Ghana.

METHODS

This cross-sectional study was conducted among 508 mothers with infants aged 0-24 months in the Sagnarigu Municipality of Northern Ghana. The quantitative data were collected using a structured questionnaire adapted from Ghana's demographic and health survey. Multivariate logistic regression was used to identify the independent determinants of EIBF and prelacteal feeding.

RESULTS

The prevalence of EIBF and prelacteal feeding was 72% and 21%, respectively. The independent positive determinants of EIBF were partner support to breastfeed [adjusted Odds ratio (AOR): 1.86, 95% Confidence interval (CI): 1.09-3.17] and exposure to breastfeeding information during pregnancy (AOR = 1.63 (95% CI: 1.01-2.64). Lower odds of EIBF were observed among mothers from extended family (AOR = 0.62, 95% CI: 0.41-0.95). Regarding prelacteal feeding, negative determinants were having a normal weight baby (AOR: 0.50, 95% CI: 0.27-0.90), exposure to breastfeeding information during pregnancy (AOR: 0.54, 95% CI: 0.31-0.92), while experiencing delayed onset of lactation was a risk factor for prelacteal feeding practice (AOR: 2.35, 95% CI: 1.41-3.94).

CONCLUSION

In this study, EIBF was slightly higher than the 2030 global target on EIBF with widespread prelacteal feeding practice. Health programs aimed at improving EIBF should focus on the women partners, nutrition counselling, and support to mothers from the extended family. In the same vein, programs aimed at discouraging prelacteal feeding practice should also target women at risk, such as those with low birthweight babies and women experiencing delayed lactation onset.

Are maternal and child health initiatives helping to reduce under-five mortality in Ghana? Results of a quasi-experimental study using coarsened exact matching

BACKGROUND

Despite a 53 % decline in under-five mortality (U5M) worldwide during the period of the Millennium Development Goals (MDGs), U5M remains a challenge. Under-five mortality decline in Ghana is slow and not parallel with the level of coverage of child health interventions. The interventions promoted to improve child survival include early initiation of breastfeeding, clean postnatal care, and skilled delivery. This study sought to assess the effectiveness of these interventions on U5M in Ghana.

METHODS

A quasi-experimental study was conducted using secondary data of the 2008 and 2014 Ghana Demographic and Health Surveys. Coarsened Exact Matching and logistic regression were done. The interventions assessed were iron intake, early initiation of breastfeeding, clean postnatal care, hygienic disposal of stool, antenatal care visits, skilled delivery, intermittent preventive treatment of malaria in pregnancy, and tetanus toxoid vaccine.

RESULTS

There were 2,045 children under-five years and 40 (1.9 %) deaths in 2008. In 2014, the total number of children under-five years was 4,053, while deaths were 53(1.2 %). In 2014, children less than one month old formed 1.6 % of all children under-five years, but 47.8 % of those who died. Mothers who attended four or more antenatal care visits were 78.2 % in 2008 and 87.0 % in 2014. Coverage levels of improved sanitation and water connection in the home were among the lowest, with 11.6 % for improved sanitation and 7.3 % for water connection in the home in 2014. Fifty-eight (58), 1.4 %, of children received all the eight (8) interventions in 2014, and none of those who received all these interventions died. After controlling for potential confounders, clean postnatal care was associated with a 66% reduction in the average odds of death (aOR = 0.34, 95 %CI:0.14-0.82), while early initiation of breastfeeding was associated with a 62 % reduction in the average odds of death (aOR = 0.38, 95 % CI: 0.21-0.69).

CONCLUSIONS

Two (clean postnatal care and early initiation of breastfeeding) out of eight interventions were associated with a reduction in the average odds of death. Thus, a further decline in under-five mortality in Ghana will require an increase in the coverage levels of these two high-impact interventions.

Maternal and child factors associated with early initiation of breastfeeding in Chad: evidence from nationally representative cross-sectional data

Background

Early initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad.

Methods

We used data from the children's recode file of the 2014–2015 Chad Demographic and Health Survey. A total of 3991 women ages 15–49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

We found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB.

Conclusions

Maternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.

Low birth weight and birth weight status in Bangladesh: A systematic review and meta-analysis

The prevalence of low birth weight (LBW) is high in Bangladesh, but no study has collated recent estimates of LBW prevalence from throughout the country. The aim of this meta-analysis was to evaluate the prevalence of LBW and birth weight status in Bangladesh. We searched PubMed, Medline, Ovo and Google Scholar to find published articles in national and international journals from 2000–2020 and reviewed for relevance. Meta-analysis and Q test were performed to estimate the prevalence and heterogeneity of LBW from all included articles. Meta-regression was done to quantify associations with sample size and study year. Stratified analysis was conducted and effect size calculated for differences in LBW prevalence by sex, division and urban/rural area. In total 48 studies with 166,520 births were found and included in this meta-analysis. The pooled prevalence of LBW was 29.1% (95% CI, 28.9–29.3%) in overall, 29.9% (29.7–30.2%) in rural and 15.7% (14.9–16.6%) in urban areas. There was no significant difference in average birth weight between boys and girls (SD, 0.71; 95% CI, −0.43–1.83). Prevalence of LBW was higher in north-east Bangladesh compared to other zones (p<0.05). The pooled prevalence of LBW did not change significantly for last two decades. The prevalence of LBW in Bangladesh remains high. Lack of improvement suggests an urgent need for scaled up maternal and prenatal interventions and services known to reduce LBW. Urban/rural and divisional differences in rates suggest areas of greatest need.

Socioeconomic inequalities in early initiation and exclusive breastfeeding practices in Bangladesh: findings from the 2018 demographic and health survey

BACKGROUND

Optimal breastfeeding practices including early initiation of breastfeeding and exclusive breastfeeding (EBF) are associated with positive health outcomes. Socioeconomic inequalities in key breastfeeding indicators may play a role in the prevalence of breastfeeding practices. The objective of this study was to examine the socioeconomic inequalities in early initiation of breastfeeding and EBF practices in Bangladesh based on the 2018 Bangladesh Demographic and Health Survey (BDHS).

METHODS

This was a secondary data analysis of the nationally representative 2018 BDHS. Data on 4950 women of reproductive age who had ever given birth and 924 children aged 0-5 months were extracted, for early initiation of breastfeeding and EBF. Early initiation of breastfeeding was determined from children who were put to the breast within the first hour of birth. Exclusive breastfeeding was estimated from children aged 0-5 months who were exclusively breastfed.

RESULTS

The weighted prevalence of early initiation of breastfeeding and EBF were 60.8% (95% CI; 59.0, 62.6%) and 66.8% (95% CI; 63.1, 70.3%), respectively. The estimated prevalence of early initiation among the poorest, poorer, middle, richer and richest households were 67.8, 66.3, 58.4, 56.3 and 54.4%, respectively. Similarly, early initiation prevalence of 64.4, 65.0, 61.1 and 52.3% were estimated among women with no formal education, primary, secondary and higher education, respectively. The estimated prevalence of EBF among the poorest, poorer, middle, richer and richest households were 63.0, 65.2, 67.7, 66.7 and 69.9%, respectively. Similarly, the estimated EBF prevalence were 62.5, 66.0, 66.3 and 68.9% among women with no formal education, primary, secondary and higher education, respectively. Early initiation of breastfeeding was higher among lower household wealth (Conc. Index = - 0.049; SE = 0.006) and lower educational attainment groups (Conc. Index = - 0.035; SE = 0.006).

CONCLUSIONS

Improving optimal breastfeeding practices in Bangladesh should be given utmost priority. A need to address the socioeconomic inequalities in breastfeeding practices was also identified.

Delayed Initiation of Breastfeeding and Role of Mode and Place of Childbirth: Evidence from Health Surveys in 58 Low- and Middle- Income Countries (2012-2017)

Background: Timely initiation of breastfeeding is the first step towards achieving recommended breastfeeding behaviours. Delayed breastfeeding initiation harms neonatal health and survival, including infection associated neonatal mortality. Eighty percent of neonatal deaths occur in the low-and middle-income countries (LMICs), where delayed breastfeeding initiation is the highest. Place and mode of childbirth are important factors determining the time of initiation of breastfeeding. In this study, we report the prevalence of delayed breastfeeding initiation from 58 LMICs and investigate the relationship between place and mode of childbirth and delayed breastfeeding initiation in each country. Methods: We analysed data from the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) collected between 2012 and 2017 and reported by 2019. The study sample comprised all women who had a live birth in the 24 months preceding the survey. ‘Delayed’ initiation of breastfeeding was defined using WHO recommendations as starting breastfeeding after one hour of birth. We coded the stratifying variable for the place and mode of childbirth as “vaginal birth at a facility (VBF)”, “caesarean section birth (CSB) “, and “vaginal birth at home (VBH)”. We used respondent-level sampling weights to account for individual surveys and de-normalised the standard survey weights to ensure the appropriate contribution of data from each country. We report the prevalence and population attributable fractions with robust standard errors. The population attributable risk identifies the proportion of delayed initiation that we could avert among VBH and CSB if everyone had the same risk of delaying breastfeeding as in VBF. Results: The overall prevalence of delayed initiation of breastfeeding was 53.8% (95% CI 53.3, 54.3), ranging from 15.0% (95% CI 13.8, 16.2) in Burundi to 83.4% (95% CI 80.6, 86.0) in Guinea. The prevalence of delayed initiation of breastfeeding was consistently high among women who experienced caesarean section births; however, there was no direct association with each country’s national caesarean section rates. The prevalence of delayed initiation among women who experienced VBF was high in Sub-Saharan Africa and South Asia, even though the CSB rates were low. In some countries, women who give birth vaginally in health facilities were more likely to delay breastfeeding initiation than women who did not. In many places, women who give birth by caesarean section were less likely to delay breastfeeding initiation. Population attributable risk percent for VBH ranged from −28.5% in Ukraine to 22.9% in Moldova, and for CSB, from 10.3% in Guinea to 54.8% in Burundi. On average, across all 58 countries, 24.4% of delayed initiation could be prevented if all women had the same risk of delaying breastfeeding initiation as in VBF. Discussion: In general, women who give birth in a health facility were less likely to experience delayed initiation of breastfeeding. Programs could avert much of the delayed breastfeeding initiation in LMICs if the prevalence of delayed initiation amongst women who experience CSB were the same as amongst women who experience VBF. Crucial reforms of health facilities are required to ensure early breastfeeding practices and to create pro-breastfeeding supportive environments as recommended in intervention packages like the Baby-friendly hospital initiative and Early essential newborn care. The findings from this study will guide program managers to identify countries at varying levels of preparedness to establish and maintain a breastfeeding-friendly environment at health facilities. Thus, governments should prioritise intervention strategies to improve coverage and settings surrounding early initiation of breastfeeding while considering the complex role of place and mode of childbirth.

Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

BACKGROUND

Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF.

METHODS

The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording.

RESULTS

Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting.

CONCLUSIONS

Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

Factors associated with delayed initiation of breastfeeding in health facilities: secondary analysis of Bangladesh demographic and health survey 2014

BACKGROUND

Irrespective of the place and mode of delivery, 'delayed' initiation of breastfeeding beyond the first hour of birth can negatively influence maternal and newborn health outcomes. In Bangladesh, 49% of newborns initiate breastfeeding after the first hour. The rate is higher among deliveries at a health facility (62%). This study investigates the maternal, health service, infant, and household characteristics associated with delayed initiation of breastfeeding among health facility deliveries in Bangladesh.

METHODS

We used data from the 2014 Bangladesh Demographic and Health Survey. We included 1277 last-born children born at a health facility in the 2 years preceding the survey. 'Delayed' breastfeeding was defined using WHO recommendations as initiating after 1 h of birth. We performed univariate and multivariable logistic regression to determine factors associated with delayed initiation.

RESULTS

About three-fifth (n = 785, 62%) of the children born at a health facility delayed initiation of breastfeeding beyond 1 h. After adjusting for potential confounders, we found delayed initiation to be common among women, who delivered by caesarean section (adjusted Odds Ratio (aOR): 2.93; 95% CI 2.17, 3.98), and who were exposed to media less than once a week (aOR: 1.53; 95% CI 1.07, 2.19). Women with a higher body mass index had an increased likelihood of delaying initiation (aOR: 1.05; 95% CI 1.01, 1.11). Multiparous women were less likely to delay (aOR: 0.71; 95% CI 0.53, 0.96).

CONCLUSIONS

Delayed initiation of breastfeeding following caesarean deliveries continues to be a challenge, but several other health facility and maternal factors also contributed to delayed initiation. Interventions to promote early breastfeeding should include strengthening the capacity of healthcare providers to encourage early initiation, especially for caesarean deliveries.

Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh?

BACKGROUND

Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh.

METHOD

We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders.

RESULTS

The prevalence of EIBF practices were 69.6%(95% CI:67.8-71.3); 72.2%(95% CI:67.8-71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3-75.6) mother's in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35-0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12-0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding.

DISCUSSIONS

This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.

Early initiation of breastfeeding, colostrum avoidance, and their associated factors among mothers with under one year old children in rural pastoralist communities of Afar, Northeast Ethiopia: a cross sectional study

Background

Early initiation of breastfeeding (EIBF) is defined as initiation of breastfeeding within 1 h of birth. This is also the time colostrum is secreted with its potential benefits. Globally, two out of five under 5 children die in the first month of life, more than a third of which being on the first day. Neonatal mortality is still a major health problem in Ethiopia. EIBF and colostrum feeding are associated with decreased neonatal morbidity and mortality. With this study, we aim to determine the magnitude and factors associated with EIBF and colostrum avoidance.

Methods

A community based cross-sectional study was conducted from May to June 2016 on 390 mothers in Afar region. Bivariate logistic regression was used to identify the association between the independent and the outcome variables. Multivariable logistic regression was used to determine the independent predictors of EIBF and colostrum avoidance. The strength of the association was measured by odds ratio and 95% confidence interval, and p-value < 0.05 was considered statistically significant. Hosmer and Lemeshow test was used to test model goodness of fitness and multi-collinearity between independent variables was checked.

Results

About 248(63.6%) respondents initiated breastfeeding within 1 h of birth. Mothers whose delivery was attended by a health professional had 4.75 times higher odds (AOR 4.75; 95% CI 1.71, 13.19) of EIBF as compared to those who were attended by others. Trust on nurses to provide pregnancy care (AOR 5.59; 95% CI 1.05, 29.8) was significantly associated with EIBF. About 300(76.9%) respondents discarded colostrum. Mothers who had no discussion with TBA on child nutrition were 6.6 times (AOR 6.63; 95% CI 1.43, 30.63) more likely to avoid colostrum than their counterparts.

Conclusion

More than one-third of infants didn’t start breastfeeding within 1 h of birth and three-fourth of the mothers discarded colostrum. Therefore, it is important to develop and/or strengthen services/advice on EIBF including colostrum feeding. Promoting delivery by health professionals, discussion on child nutrition and building trust between mothers and health professionals can be important community interventions to encourage EIBF and colostrum feeding.

Breastfeeding and the Risk of Infant Illness in Asia: A Review

Infancy remains the most vulnerable period of human life for death, illness, and establishing a lifetime trajectory of growth and health. It is estimated that there are 5.3 million deaths under five years of age worldwide and approximately 800,000 lives could be saved by improving breastfeeding rates and duration. In Asia, an estimated 300,000-350,000 child deaths could be prevented with optimal breastfeeding and the majority would be under 12 months of age. We present a systematic review of studies of infection and breastfeeding in infants in Asia and further review interactions of selected infectious diseases and breastfeeding. Initially, 2459 records of possible interest were identified, 153 full text papers were reviewed in detail, and 13 papers describing diarrhoeal disease and/or acute respiratory tract infection were selected for inclusion in the review. Additional papers were selected to discuss specific diseases and their relationship to breastfeeding. The review found that a variety of methods were used with differing definitions of breastfeeding and diseases. Overall, breastfeeding when compared to the use of infant formula, is associated with significantly lower rates of diarrhoeal disease and lower respiratory tract infection, with a reduction of 50% or more to be expected, especially in infants under six months of age. The relationship between breastfeeding and specific diseases including measles and HTLV1 were reviewed. Breastfeeding reduces some disease rates, but there remain a few conditions where breastfeeding may be contra-indicated.