Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review.

Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.

Mother's Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies.

BACKGROUND: Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. The most significant and preventable of these include HIV, syphilis, and rubella. To achieve elimination, mothers need to be aware of and to understand effective preventive measures against these infections. Lack of comprehensive knowledge on transmission and prevention of MTCT infections is one of the factors hindering achievement of the elimination goals for these infections. The aim of this study was to assess the knowledge of HIV, syphilis, rubella, and associated factors among mothers in the Kilimanjaro region of Tanzania. METHODS: We conducted a community-based cross-sectional study in three districts of the Kilimanjaro region from September to October 2016. The study involved mothers with children up to five years of age. Data collection involved the use of a questionnaire, administered by face-to-face interviews. Logistic regression analysis was used to assess predictors of mothers' knowledge on MTCT infections. RESULTS: A total of 618 mothers were recruited, with a mean age of 29.6 (SD 7.6) years. The overall knowledge on MTCT infections was low. The highest level of knowledge on MTCT infections was regarding HIV (89.2%). Fewer mothers had knowledge of syphilis (27.8%). Rubella was the least known; only 12% of mothers were aware of rubella infection. District of residence and having knowledge of syphilis were predictors for rubella knowledge, while for syphilis knowledge, significant predictors were age group, occupation, and those having knowledge on HIV and rubella. Predictors for HIV knowledge were residential district, having a mobile phone, and those having knowledge of syphilis and rubella. CONCLUSIONS: This study confirmed that mothers have low overall knowledge on MTCT infections. To achieve the MTCT elimination goals, targeted interventions to improve knowledge among women of childbearing age are recommended.

Underweight, Stunting and Wasting among Children in Kilimanjaro Region, Tanzania; a Population-Based Cross-Sectional Study.

This study assessed the prevalence and risk factors associated with underweight, stunting and wasting among children aged 0-24 months in six districts of Kilimanjaro region, northern Tanzania. A cross-sectional population-based study using a multistage, proportionate to size sampling was conducted from June 2010 to March 2011. A structured questionnaire was used to collect sociodemographic, economic, feeding and child information. Anthropometric data were collected by trained field workers, and the data were used to assess child nutritional status. A total of 1870 children were enrolled in this study. The prevalence of children classified as underweight was 46.0%, stunting was 41.9%, and wasting was 24.7%. About 33% were both underweight and stunted, and 12% had all three conditions. In a multivariate logistic regression, child age, child being ill and birth weight were associated with all anthropometric indices. Child being breastfed was associated with being underweight and wasting. Mother's education was associated with being underweight and stunting. Fathers aged 35+ years, and living in the Hai district was associated with stunting, and being female was associated with wasting. The prevalence of child undernutrition is high in this region. Strategies that target each risk factor for child undernutrition may help to reduce the problem in the region.

Predictors of appropriate breastfeeding knowledge among pregnant women in Moshi Urban, Tanzania: a cross-sectional study.

BACKGROUND: Knowledge on infant feeding among pregnant women is essential when promoting optimal breastfeeding practices. This study aimed to assess the knowledge of women on optimal breastfeeding during pregnancy and associated factors as well as performance of the health system in reaching women with information on breastfeeding and infant feeding issues. METHODS: A cross-sectional study was conducted from October 2013 to April 2014 among pregnant women, in their third trimester, attending for routine care at two primary health care facilities in Moshi urban, northern Tanzania. RESULTS: A total of 536 women were enrolled, with mean age of 25.9 (SD 5.7) years. Only 51% (n = 274) reported to have received counselling on breastfeeding from their healthcare providers during the current pregnancy. More than seven out of ten pregnant women were knowledgeable about key issues regarding appropriate breastfeeding practices: importance of colostrum (95%), time of breastfeeding initiation (71%), exclusive breastfeeding (EBF) (81%), and time of introducing complementary feeding (83%). Receiving counselling on breastfeeding during the current pregnancy (Adjusted Odds Ratio [AOR] 3.7; 95% Confidence Interval [CI]: 2.4, 5.7), having two children (AOR 2.6; 95% CI: 1.5, 4.4), having three or more children (AOR 3.5; 95% CI: 1.8, 6.9) and intention to breastfeed the child exclusively (AOR 3.6; 95% CI: 2.0, 6.5) were significantly associated with appropriate breastfeeding knowledge. CONCLUSIONS: The health system failed to reach the 49% of women who did not receive counselling on infant feeding. Pregnant women who had received counselling on optimal breastfeeding and women with more than one child were more likely to have knowledge of optimal breastfeeding practices.