Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia.

INTRODUCTION: Improper positioning, attachment, and suckling are constructs for ineffective breastfeeding technique (IBT). IBT results in inadequate intake of breast milk, which leads to poor weight gain, stunting, and declines immunity. Besides, IBT increases the risk of postpartum breast problems. Despite its impact on maternal and child health, breastfeeding technique is not well studied in Ethiopia. Hence, the purpose of this study was to assess the prevalence of IBT and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia. MATERIALS AND METHODS: An institution-based cross-sectional study was conducted among 415 lactating mothers attending public health facilities of South Ari district from March 1-29, 2019. A structured observational checklist and interviewer-administered questionnaires were used. Bivariable and multivariable analyses were carried out using binary logistic regression to assess the association between explanatory variables and IBT. Statistical significance was declared at p-value < 0.05. RESULTS: Overall, the prevalence of IBT was 63.5% [95% confidence interval (CI); 59.0%, 68.0%]. Having no formal education [adjusted odds ratio (AOR): 5.0, 95% CI: 2.3, 10.5], delivering at home [AOR: 4.5; 95% CI; 1.6, 13.1], having breast problems [AOR: 2.5, 95% CI: 1.1, 5.7], being primiparous [AOR: 1.8, 95% CI: 1.0, 3.2], not receiving counseling during pregnancy and postnatal period [AOR: 2.3, 95% CI: 1.4, 3.9 and AOR: 2.5, 95% CI: 1.3, 5.1 respectively] were significantly associated with IBT. CONCLUSION: IBT was very high in the study area. Thus, empowering women, increasing institutional delivery, and providing continuous counseling about breastfeeding throughout the maternal continuum of care is invaluable to improve breastfeeding techniques.

European Network of Pregnancy Registers in Rheumatology (EuNeP)-an overview of procedures and data collection.

BACKGROUND: The collaborative initiative of the European Network of Pregnancy Registers in Rheumatology (EuNeP) aims to combine data available in nationwide pregnancy registers to increase knowledge on pregnancy outcomes in women with inflammatory rheumatic diseases (IRD) and on drug safety during pregnancy and lactation. The objective of this study was to describe the similarities and differences of the member registers. METHODS: From all registers, information about their structure and design was collected, as well as which parameters regarding demographics, maternal outcomes, treatment, course and outcome of pregnancy, and development of the child were available in the respective datasets. Furthermore, the current recruitment status was reported. RESULTS: The four registers (EGR2 (France), RePreg (Switzerland), RevNatus (Norway), and Rhekiss (Germany)) collect information prospectively and nationwide. Patients can be enrolled before conception or during pregnancy. To date, more than 3500 patients in total have been included, and data on 2200 pregnancies with an outcome are available. The distribution of diagnoses in the respective registers varies considerably, and only three entities (rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis) are captured by all the registers. Broad consistency was found in non-disease-specific data items, but differences regarding instruments and categories as well as frequency of data collection were revealed. Disease-specific data items are less homogeneously collected. CONCLUSION: Although the registers in this collaboration have similar designs, we found numerous differences in the variables collected. This survey of the status quo of current pregnancy registers is the first step towards identifying data collected uniformly across registers in order to facilitate joint analyses. TRIAL REGISTRATION: Not applicable.

Association between Delayed Lactogenesis â ¡ and Early Milk Volume among Mothers of Preterm Infants.

PURPOSE: This study aimed to evaluate the effect of delayed lactogenesis Ⅱ on early milk volume in mothers expressing milk for their preterm infants. METHODS: 142 mothers with preterm infants participated in a longitudinal cohort study, the milk volumes over 14 days postpartum between mothers with delayed lactogenesis Ⅱ (≥ 72 hours) and mothers with non-delayed lactogenesis Ⅱ(< 72 hours) were compared using Wilcoxon's rank sum tests. RESULTS: The prevalence of delayed lactogenesisⅡ among mothers of preterm infants was 36.0% (36/100). There existed negative correlations between the onset of lactogenesis Ⅱ and the daily milk volumes( rs = -0.525∼-0.354, p = .002 ∼ p < .001). The milk volumes in every 24-hour of the 14 days postpartum in delayed group were significantly less than that in non-delayed group (p = .002 ∼ p < .001). After controlling for the covariates, pregnancy-induced hypertension syndrome, delayed expression initiation, shorter daily sleeping time were found to be the risk factors for delayed lactogenesis Ⅱ. CONCLUSION: Delayed lactogenesis Ⅱ was associated with lower milk volume in early postpartum period. Women who were at risk for delayed lactogenesis Ⅱ need targeted interventions and additional support during pregnancy and postpartum.

Women's Quality of Life at 6 Weeks Postpartum: Influence of the Discomfort Present in the Puerperium.

Background: Discomfort during the puerperium period is very frequent in the lives of women but the influence of this discomfort on the women's quality of life has been little studied. The objective of this study is to establish the association between discomfort and frequent problems of women in the puerperium and their quality of life score. Methods: A cross-sectional study on postpartum Spanish women was performed. Women older than 18 years and who had had a live birth were included. Less than 1% of women refused to participate in the study. Data were collected on socio-demographic, obstetric and newborn variables, on maternal problems/ discomfort in the postnatal period and on parameters that are quality of life indicators. An ad hoc online questionnaire which included the SF-36 Health Survey was used. Crude mean difference (cMD) and adjusted mean difference (aMD) were calculated through multiple linear regression. Results: 2990 women participated in the study. The greater problems causing quality of life loss were depressive symptoms (aMD = -12.40, CI 95%: -10.79, -14.01), lactation problems (aMD = -4.30, CI 95%: -2.97, -5.63), problems for sexual intercourse after childbirth (aMD = -6.34, CI 95%: -5.07, -7.60) and urinary incontinence (aMD = -4.97, CI 95%: -6.30, -3.65), among others. These have been detected as risk factors that affect the quality of life of the postpartum woman. Conclusions: The discomfort and problems manifested in the 6 weeks after childbirth have an influence that deeply affects the quality of life of postpartum women.

Gestational weight gain is associated with delayed onset of lactogenesis in the TMCHC study: A prospective cohort study.

BACKGROUND & AIMS: Delayed onset of lactogenesis II (OL) negatively affects breastfeeding and consequently, the health of the newborn. Few studies have examined the association between gestational weight gain (GWG) throughout pregnancy and risk of delayed OL. METHODS: We used data from a prospective cohort study in Wuhan of China, which enrolled pregnant women at 8-16 weeks of gestation and followed-up regularly. GWG was assessed by the last available weight measurement (LAWM) during pregnancy and the self-reported pre-pregnancy weight at enrollment. The outcome was delayed OL self-reported after 4 days postpartum. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived from multivariate logistic regression. RESULTS: Delayed OL was reported by 18.4% of the 3282 participants. After adjustment for the demographic, clinical and breastfeeding characteristics, compared to the lowest quartile 1 of GWG, ORs (95% CIs) were 1.20 (0.91, 1.57) for quartile 2, 1.47 (1.13, 1.92) for quartile 3, and 1.42 (1.08, 1.86) for quartile 4 (P for trend = 0.006). When GWG was classified by the 2009 Institute of Medicine (IOM) guidelines, compared with women with adequate GWG, the adjusted ORs (95% CIs) were 0.82 (0.61, 1.10) for inadequate GWG, and 1.13 (0.93, 1.38) for excessive GWG. CONCLUSIONS: Women with higher GWG throughout pregnancy are more likely to suffer from delayed OL in Chinese population.

Determinants of breastfeeding discontinuation in an Italian cohort of mother-infant dyads in the first six months of life: a randomized controlled trial.

BACKGROUND: Among breastfeeding determinants, the marketing of breast milk substitutes might contribute to suboptimal breastfeeding rates. The aim of this study was to investigate the effect of receiving information on breast milk substitutes on breastfeeding rates. METHODS: We conducted a randomized, single-blind, controlled trial from 2012 to 2014 in a northern Italian maternity ward. We enrolled 802 Caucasian mothers who gave birth to healthy, full-term singletons with a birth weight > 2500 g and who were exclusively breastfeeding from delivery to discharge. Mothers who gave birth to infants with congenital diseases, chromosomal abnormalities, perinatal infections and/or cardio-respiratory instability and/or mothers being affected by endocrine and/or metabolic and/or gastrointestinal and/or renal diseases were excluded. Mothers were randomized to either receive (group A, n = 405) or not (group B, n = 397) written information on a breast milk substitute at discharge. Breastfeeding was promoted and supported in all mother-infant pairs equally. The mode of feeding for up to 6 months after delivery was determined by phone interview. To detect a 10% difference between groups in the discontinuation rate of exclusive breastfeeding at three months of age at 5% significance and 80% power, a total of 356 mother-infant pairs per group were needed. RESULTS: The exclusive breastfeeding prevalence was 91% and 92% at 7 days, 79% and 70% at 1 month, 75% and 66% at 2 months, 72% and 62% at 3 months, and 3% and 2% at 6 months in groups A and B, respectively. The relative risk (95% confidence interval) of exclusive breastfeeding (group A vs B) at 7 days and at 1, 2, 3 and 6 months was as follows: 0.99 (0.95-1.03), 1.12 (1.03-1.21), 1.13 (1.03-1.24), 1.15 (1.04-1.27), and 1.49 (0.62-3.61). Nutritional, lifestyle and lactational factors were the primary contributing determinants to early breastfeeding discontinuation. CONCLUSIONS: The present findings indicate that receiving written information on breast milk substitutes at hospital discharge, provided that breastfeeding support and education are offered, does not negatively affect breastfeeding rates. TRIAL REGISTRATION: NCT03208114. Registered 5 July 2017.

The prevalence of Coxiella burnetii shedding in dairy goats at the time of parturition in an endemically infected enterprise and associated milk yield losses.

BACKGROUND: This was a panel study of the prevalence of C. burnetii infection in does in an endemic dairy goat enterprise in Victoria, Australia. Our first objective was to determine the prevalence of does shedding C. burnetii at the time of parturition and to quantify the concentration of genome equivalents (GE) present in each C. burnetii positive sample. Our second objective was to determine the proportion of positive does that were persistent shedders. Our final objective was to quantify the association between C. burnetii qPCR status at the time of kidding and daily milk volumes produced during the subsequent lactation. RESULTS: Vaginal swabs (n= 490) were collected from does at the time of kidding and analysed using a quantitative polymerase chain reaction (qPCR) assay. Shedding of C. burnetii was detected in 15% (95% CI: 12% to 18%) of the sampled does. Does were classified as qPCR-negative, qPCR-positive low and qPCR-positive high based on the estimated concentration of GE from the qPCR. Persistent shedding at relatively low concentrations was detected in 20% (95% CI: 10% to35%) of shedding does sampled again at their subsequent parturition. After controlling for possible confounders and adjusting for variation in daily milk yields at the individual doe level, daily milk yields for qPCR-positive high does were reduced by 17% (95% CI: 3% to 32%) compared to qPCR-negative does (p= 0.02). CONCLUSIONS: Shedding concentrations of C. burnetii were highly skewed, with a relatively small group of does shedding relatively high quantities of C. burnetii. Further, high shedding does had reduced milk yields compared to qPCR-negative does. Early detection and culling of high shedding does would result in increased farm profitability and reduce the risk of Q fever transmission.

Comparing barriers to breastfeeding success in the first month for non-overweight and overweight women.

BACKGROUND: Women who enter pregnancy overweight or obese tend to have poorer breastfeeding outcomes compared to non-overweight women. Women's experiences of specific breastfeeding-related problems and reasons for use of formula have not been systematically investigated according to pre-pregnancy BMI. The aim of this study was to compare self-reported breastfeeding problems in non-overweight and overweight women and identify the main reasons for use of infant formula during the first month postpartum. METHODS: The present study involved a cross-sectional secondary analysis of data collected as part of a hospital-based longitudinal study of women that commenced in pregnancy (~ 16 weeks). At ~ 4 months postpartum Australian women (N = 477) self-reported breastfeeding problems and reasons for use of infant formula during the first month postpartum. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. Binary logistic regression analyses were used to compare pre-pregnancy weight status groups ("non-overweight" [BMI < 25 km/m2] and "overweight" [BMI ≥25 km/m2]) on self-reported breastfeeding problems and reasons for use of infant formula. Analyses were adjusted for covariates that differed between groups (P < .1). RESULTS: Frequency of self-reported breastfeeding problems was similar across weight status groups. "Not enough milk" was the predominant reason for giving infant formula. Overweight women were more likely than non-overweight women to agree that infant formula was as good as breastmilk. CONCLUSIONS: Overall it does not appear that overweight women are more likely to experience a range of specific breastfeeding problems in the first months compared to non-overweight women. However, the severity and duration of the problems needs to be examined. Breastfeeding interventions need to addresses concerns around milk supply as these are common and are likely to be of universal benefit however overweight women in particular may benefit from guidance regarding the benefits of breastfeeding for both themselves and their infants.

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation.

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Prevalence and factors associated with cracked nipples in the first month postpartum.

BACKGROUND: To assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum. METHODS: This was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30 days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics). RESULTS: The prevalence of cracked nipples was 32 % (95 % confidence interval [95 % CI] 29.4-34.7) in the first 30 days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR] = 3.18, 95 % CI 2.72-3.72); breast engorgement (PR = 1.70, 95 % CI 1.46-1.99); birth in a maternity ward not accredited by the Baby-Friendly Hospital Initiative (PR = 1.51, 95 % CI 1.15-1.99); cesarean section (PR = 1.33, 95 % CI 1.13-1.57); use of a feeding bottle (PR = 1.29, 95 % CI 1.06-1.55); and higher maternal education level (PR = 1.23, 95 % CI 1.04-1.47). CONCLUSIONS: The prevalence of cracked nipples was high in our sample. Most of the factors associated with cracked nipples were related to postnatal characteristics, especially poor breastfeeding technique, which could be improved to help prevent the condition.

A Case Control Study of Diabetes During Pregnancy and Low Milk Supply.

OBJECTIVE: The objective of this study was to determine whether a history of diabetes during pregnancy, as a marker of perinatal glucose intolerance, increases the odds of a diagnosis of low milk supply at a Breastfeeding Medicine Clinic (BMC). MATERIALS AND METHODS: A case-control analysis was conducted of electronic medical records for BMC visits <90 days postpartum. Diabetes was defined as documentation of gestational, type 1, or type 2 diabetes. Cases were defined as those with a low milk supply diagnosis but without latch or nipple problems, and controls as those with latch or nipple problems but without low milk supply. A sensitivity analysis was then conducted by expanding cases to include all low milk supply diagnoses, and controls to include any diagnoses except low milk supply. Odds ratios (OR) and 95% confidence intervals (CI) for diabetes were calculated in cases versus controls, including adjustment for cesarean delivery, preterm birth, polycystic ovary syndrome, hypothyroidism, and infertility. RESULTS: In the primary analysis, 14.9% of 175 cases versus 6.2% of 226 controls had a history of diabetes during pregnancy (OR 2.6 [95% CI 1.3-5.2]; adjusted OR 2.4 [95% CI 1.2-4.9]). In the sensitivity analysis, 14.9% of 249 cases versus 6.1% of 312 controls had diabetes in pregnancy (adjusted OR 2.4 [95% CI 1.4-4.3]). CONCLUSIONS: Women diagnosed with low milk supply were significantly more likely to have had diabetes in pregnancy compared with women with latch or nipple problems and, more generally, compared with women with any other lactation difficulty. Further research is needed to elucidate how maternal glucose intolerance may impede lactation.

Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review.

AIM: To determine if women with diabetes in pregnancy have a delayed onset of lactation through a systematic review of the literature. METHODS: We searched databases including MEDLINE, Web of Science, PubMed, CINAHL Plus and PsychINFO for articles assessing diabetes in pregnancy and lactogenesis. Thirty-one articles were screened and 10 articles were included in the systematic review. We extracted data on diabetes in pregnancy and onset of lactation (secretory activation or lactogenesis II). RESULTS: The 10 studies examining the association between women with diabetes in pregnancy and delayed onset of lactation reported a significant delay in women with diabetes compared with women without diabetes. Two studies assessed the impact of metabolic control on lactogenesis, and found an association between poorer metabolic control and delayed onset of lactation. CONCLUSIONS: Although this review has found evidence of an association between women experiencing diabetes during pregnancy and delayed onset of lactation, the presence of many potential confounding factors need to be acknowledged.

Early Breastfeeding Problems Mediate the Negative Association between Maternal Obesity and Exclusive Breastfeeding at 1 and 2 Months Postpartum.

BACKGROUND: Compared with normal-weight women, women with obesity experience poorer breastfeeding outcomes. Successful breastfeeding among women with obesity is important for achieving national breastfeeding goals. OBJECTIVES: The objectives were to determine whether the negative association between obesity and any or exclusive breastfeeding at 1 and 2 mo postpartum is mediated through breastfeeding problems that occur in the first 2 wk postpartum and if this association differs by parity. METHODS: Mothers (1151 normal-weight and 580 obese) in the Infant Feeding Practices Study II provided information on sociodemographic and psychosocial characteristics, body mass index, and breastfeeding outcomes. At 1 mo postpartum, participants reported the breastfeeding problems they experienced in the first 2 wk postpartum from a predefined list of 17 options. We used factor analysis to condense these problems into 4 explanatory variables; continuous factor scores were computed for use in further analyses. We used maximum likelihood logistic regression to assess mediation of the association between obesity and breastfeeding outcomes through early breastfeeding problems. RESULTS: No significant effect of obesity was found on any breastfeeding at 1 or 2 mo. At 1 mo postpartum, for both primiparous and multiparous women, there was a significant direct effect of obesity on exclusive breastfeeding and a significant indirect effect of obesity through early breastfeeding problems related to the explanatory mediating variable "Insufficient Milk" (throughout the remainder of the Abstract, this factor will be denoted by upper case notation). At 2 mo postpartum both the direct effect of obesity and the indirect effect through Insufficient Milk were significant in primiparous women but only the indirect effect remained significant in multiparous women. CONCLUSIONS: Early problems related to Insufficient Milk may partially explain the association between obesity and poor exclusive breastfeeding outcomes. Women who are obese, particularly those reporting breastfeeding problems that grouped in the Insufficient Milk factor in the early postpartum period, may benefit from additional breastfeeding support.

[Evaluation of risk factors for Mastitis-Metritis-Agalactia in pig farms in Switzerland]. / Erhebung von Risikofaktoren für Mastitis-Metritis-Agalaktie in Schweine- betrieben in der Schweiz.

Mastitis-Metritis-Agalactia (MMA), also known as postpartum dysgalactia syndrome (PPDS) is the most important disease complex in sows after birth. The present study compared 30 MMA problem herds (over 12% of farrowing sows affected) with 30 control farms (less than 10% of farrowing sows affected) to identify risk factors and treatment incidence. Important risk factors identified were in gilts the integration into the herd after the first farrowing, in gestating sows firm fecal consistency as well as in lactating sows soiled troughs, a low flow rate (<2 liters per minute) in drinking nipples and a high prevalence of lameness. The treatment incidence was also significantly different between the two groups. The MMA prevalence could be reduced through optimization of husbandry, feeding and management, which could essentially diminish the use of antibiotics.

Sheehan's syndrome in Xinjiang: Clinical characteristics and laboratory evaluation of 97 patients.

OBJECTIVE: To evaluate the clinical and hormonal characteristics of patients with Sheehan's syndrome in Xinjiang, China. METHODS: 97 cases diagnosed as Sheehan's syndrome in our hospital from 1999 to 2013 were retrospectively reviewed. The medical history, physical examination findings and hormonal profiles were documented and analyzed. RESULTS: The mean age at diagnosis was 43.7±12.4 years, with a mean diagnostic delay of 9.1±9.5 years (range, 1 month-35 years). 10 of our patients (10.3%) had a home birth. 96 of our patients (99.0%) had a history of obstetric hemorrhage. The most common clinical presentation included amenorrhea (80/97, 82.5%), agalactia (2/97, 74.2%) and loss of axillary or pubic hair (83/97, 85.6%). Seventy two of our patients (74.2%) failed to lactate and 80 of our patients (82.5%) failed to resume menstruation. Hypothalamic dysfunction included the hypothalamic-pituitary-gonadal axis (HPG) (LH deficiency: 77/83 patients, 92.8%; FSH deficiency: 73/83 patients, 88%; E2 deficiency: 62 of 82 patients,75.6%), the hypothalamic-pituitary-thyroid (HPT) axis (TSH deficiency: 77/93 patients, 82.8%, TT3 deficiency: 70/ 87 patients, 80.5%, TT4 deficiency: 72/87 patients, 82.8%) and the hypothalamus-pituitary-adrenal (HPA) axis (ACTH deficiency: 19/37 patients, 51.4%, cortisol deficiency: 49/64, 76.6%). CONCLUSIONS: Sheehan's syndrome is still common in Xinjiang, especially in rural areas. Long diagnosis delay in most of the patients indicates that women might be lacking correct diagnosis and treatment. Physicians need to be aware of the most important clues for diagnosis such as lack of lactation in the postpartum period and failure to resume menstruation.

Breastfeeding is natural but not always easy: intervention for common medical problems of breastfeeding mothers - a review of the scientific evidence.

Natural processes do not always function perfectly. In breastfeeding, problems are encountered in up to 80% of mother-infant dyads. Altogether, in Western societies, the difficulties reduce the breastfeeding rate within the first months drastically. To deal with the problems of breastfeeding efficiently requires a profound understanding of its physiology, as well as of its psychological and social determinants. This review focuses on the current knowledge of breastfeeding physiology, only touching the psychosocial factors, which are included in the promotion strategies. Subsequently, it scrutinizes definitions, incidences, prevention, and treatment of breastfeeding problems faced most frequently by nursing mothers and their consultants. Not all measures used in counseling mothers and not all treatments for the most common medical problems withstand a careful evaluation on the basis of current scientific data. However, applying proven prevention strategies will significantly improve the well being of mothers and their infants, and may contribute to an affective attitude that increases the success, frequency, and duration of breastfeeding.

Contagious agalactia due to Mycoplasma spp. in small dairy ruminants: epidemiology and prospects for diagnosis and control.

Contagious agalactia (CA) is a serious disease of small dairy ruminants that has a substantial economic impact on the goat and sheep milk industries. The main aetiological agent of the disease is Mycoplasma agalactiae, although other species, such as Mycoplasma mycoides subsp. capri, Mycoplasma capricolum subsp. capricolum and Mycoplasma putrefaciens, are pathogenic in goats. There are two clinical-epidemiological states of CA in sheep and goats; herds and flocks may exhibit outbreaks of CA or may be chronically infected, the latter with a high incidence of subclinical mastitis and only occasional clinical cases. The complex epidemiology of CA is related to the genetic characteristics and mechanisms of molecular variation of the Mycoplasma spp. involved, along with presence of CA-mycoplasmas in wild ruminant species. In goats, the situation is particularly complex and asymptomatic carriers have been detected in chronically infected herds. The coexistence of other non-pathogenic mycoplasmas in the herd further complicates the diagnosis of CA and the design of efficient strategies to control the disease. Routes of infection, such as the venereal route, may be involved in the establishment of chronic infection in herds. Current challenges include the need for improved diagnostic methods for detection of chronic and subclinical infections and for the design of more efficient vaccines.

[Prevalence and duration of breastfeeding during the first six months of life: factors affecting an early cessation]. / Prevalenza e durata dell'allattamento al seno nei primi sei mesi di vita e fattori che influenzano.

OBJECTIVES: To assess the mean duration, prevalence and reasons that lead to an early cessation of breastfeeding in a group of healthy term infants in the first six months of life. METHODS: Prospective, observational study. One-hundred Caucasian, non smoking mothers, that intended to breastfeed for at least 12 weeks, were enrolled. Information on anthropometric parameters, type of delivery, socio-demographic characteristics, mode of feeding and reasons for stopping breastfeeding have been obtained through three different questionnaires (submitted at enrollment, on the 7th day, at 1, 2, 3 and 6 months). RESULTS: Exclusive breastfeeding gradually decreased from the 7th day to the 6th month of life. Most of the mothers stopped breastfeeding during the first month and a half or after 3 months and a half. Two percent of the mothers stopped on the 7th day whereas at 6 months the percentage of cessation was 14%. The cumulative percentage of interruption at 6th month was 45%. Maternal factors, like sore nipples or delayed onset of lactation, were the most frequent reasons that led to an early cessation, while during the following months inadequate breast milk and latch-on problems were predominant. On the other hand, attending a pre-natal course or having a previous successful breastfeeding experience were significantly associated with a long-lasting breastfeeding. CONCLUSIONS: Promotion of breastfeeding during the prenatal course and a better support for lactation management during the first months seem to be the areas where more efforts are needed to implement breastfeeding rates.

Reasons for failure of exclusive breastfeeding in children less than six months of age.

BACKGROUND: Human milk is the natural food for full term infants and is the most appropriate milk for the human infants. The objective of the study was to determine the frequency of common reasons of failure of exclusive breastfeeding in children less than six months of age. METHODS: It was a cross-sectional study conducted at Rawal institute of health sciences (RIHS) from March to October 2013. Three hundred and ten infant-mother pairs not receiving exclusive breastfeeding were included. RESULTS: The mean infants' age was 99.2 +/- 57.9 days and 185 (59.7%) were male infants. The average number of children in the family was 2.74 +/- 1.86, the mean monthly income was 16,542 +/- 12,761 rupees: 169 (54.5%) infants belonged to urban areas, 122 (39.3%) babies were low birth weight: 241 (77.7%) infants were born in the hospital; majority. i.e.. 135 (43.5%) mothers were illiterate majority, i.e.. 282 (91%) mothers were housewives. In only 2 (0.6%) babies the breast feeding was started within < 1 hour after birth. Among the study group 246 (79.4%) were partially breastfed and 64 (20.6%) were completely bottle-fed, 90 (29%) were already started on complementary feeding and the mean age of starting complementary feeding was 4.54 +/- 0.783 months. The commonest reason of failure of exclusive breastfeeding was insufficient milk production in 289 (93.2%), working mother in 13 (4.2%) mothers, illness of baby in 2 (0.65%), illness of mother in 6 (1.9%) cases. CONCLUSION: The commonest reason of failure of exclusive breastfeeding was insufficient milk production in over 90% cases and was followed by working mother, illness of baby and illness of mother in the remaining.