Consumer testing of the preliminary Paediatric Food-Based Dietary Guidelines (PFBDG) among mothers with infants younger than 6 months in selected urban and rural areas in the Western Cape

Mothers' understanding of the term 'exclusive breastfeeding': a systematic review

There is a lack of knowledge and understanding of the term exclusive breastfeeding (EBF) among health professionals. The purpose of this review was to examine the best available literature on mothers' understanding of the term EBF. A systematic search of eight electronic databases (Medline, Embase, CINAHL, CDSR, CENTRAL, Cab Abstracts, Scopus and African Index Medicus) was conducted (Protocol registration in PROSPERO: CRD42015019402). All study designs were eligible for inclusion. Studies were included if they: (1) involved mothers aged 18 years or older; (2) assessed mothers' knowledge/understanding/awareness of the term 'EBF'; (3) used the 1991 WHO definition of EBF and (4) were published between 1988 and 2015. Two reviewers retrieved articles, assessed study quality and performed data extraction. Of the 1700 articles identified, 21 articles met the inclusion criteria. Quantitative findings were pooled to calculate a proportion rate of 70.9% of mothers who could correctly define EBF, although the range varied between 3.1 and 100%. Qualitative findings revealed three themes: (1) EBF was understood by mothers as not mixing two milks; (2) the term 'exclusive' in EBF was incorrectly understood as not giving breast milk and (3) mothers believing that water can be given while exclusively breastfeeding. Research investigating aspects of self-reported EBF may consequently be unreliable. A standardised tool to assess mothers' knowledge of EBF could provide more accurate data. Public health campaigns should emphasise EBF to target mothers, while addressing the education of health professionals to ensure that they do not provide conflicting advice.

An Explorative Qualitative Study of Experiences and Challenges to Exclusive Breastfeeding Among Mothers in Rural Zimbabwe

Breastfeeding is one of the most effective public health interventions known to reduce illness and deaths in infants and young children. While Zimbabwe has a breastfeeding culture, exclusive breastfeeding has remained low over the last decade. This study explored factors that enable and hinder exclusive breastfeeding in a rural district of Zimbabwe. Ten mothers and 5 key informants with breastfeeding experience were interviewed. Interviews were audiotaped, transcribed in Ndebele, translated into English, and analyzed using thematic analysis. Notable gaps still exist regarding mothers’ understanding of exclusive breastfeeding. Hunger, myths, and traditional beliefs around breastfeeding, as well as mixed and inconsistent messages regarding HIV/AIDS and breastfeeding, remain barriers to exclusive breastfeeding in the study area. Support from significant others, good nutrition for the breastfeeding mother, and knowledge about breastfeeding emerged as factors enabling exclusive breastfeeding. Messaging on breastfeeding and HIV/AIDS need to be consistent. Breastfeeding messages ought to be context specific, targeting custodians of tradition and belief systems, including men and significant others, to create a supportive and enabling environment for mothers to exclusively breastfeed. Whether hunger and differences in breastfeeding patterns between boys and girls affect infant feeding practices warrants further research.

Patient and Public Involvement in Clinical Practice Guidelines

Background. The role of patient and public involvement programs (PPIPs) in developing and implementing clinical practice guidelines (CPGs) has generated great interest. Purpose. The authors sought to identify key components of PPIPs used in developing and implementing CPGs. Data sources. The authors searched bibliographic databases and contacted relevant organizations. Study selection. In total, 2161 articles and reports were retrieved on PPIPs in the development and implementation of CPGs. Of these, 71 qualified for inclusion in the review. Data extraction. Reviewers independently extracted data on key components of PPIPs and barriers and facilitators to their operation. Data synthesis. Over half of the studies were published after 2002, and more than half originated from the United States, the United Kingdom, Australia, and Germany. CPGs that involved patients and the public addressed a variety of health problems, especially mental health and cancer. The most frequently cited objective for using PPIPs in developing CPGs was to incorporate patients’ values or perspectives in CPG recommendations. Patients and their families and caregivers were the parties most often involved. Methods used to recruit PPIP participants included soliciting through patient/public organizations, sending invitations, and receiving referrals and recruits from clinicians. Patients and the public most often participated by taking part in a CPG working group, workshop, meeting, seminar, literature review, or consultation such as a focus group, individual interview, or survey. Patients and the public principally helped formulate recommendations and revise drafts. Limitations. The authors did not contact the authors of the studies. Conclusion. This literature review provides an extensive knowledge base for making PPIPs more effective when developing and implementing CPGs. More research is needed to assess the impact of PPIPs and resources they require.