Trajectories of sleep quality and depressive symptoms in women from pregnancy to 3 months postpartum: a prospective cohort study.

Sleep quality and depression during pregnancy often affect women's adaptation to motherhood and are linked with adverse maternal and neonatal outcomes. Using a prospective cohort study comprising 190 pregnant women in central Taiwan, we investigated the trajectories of sleep quality and depressive symptoms and their associated predictors in perinatal women from pregnancy to postpartum. Sleep and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index and the Edinburgh Postnatal Depression Scale, respectively, from mid-pregnancy to 3 months postpartum. We used group-based trajectory modelling and logistic regression modelling to analyse the data collected from the structured questionnaires. Pregnant women (50.5% primipara) with a mean (standard deviation) age of 32.3 (4.1) years were included. We identified three distinctive classes of sleep quality trajectories during the perinatal period: 'stable good' (18.4%), 'increasing poor' (48.9%), and 'stable poor' (32.6%). We further detected three stable trajectories of depressive symptoms: 'stable low' (36.3%), 'stable mild' (42.1%), and 'stable high' (21.6%). A significant association between sleep quality and depression trajectories was evident (p < 0.001). High fatigue symptoms and low social support predicted the high trajectories of poor sleep and depressive symptoms. Distinctive dynamic sleep quality and stable depression trajectories were characterised. Our findings revealed that both the sleep and depression trajectories were closely associated with one another, with common predictors of fatigue symptoms and social support. The early assessment of maternal sleep and depression status is important for identifying at-risk women and initiating interventions tailored to perinatal women to improve their sleep and mental health.

Current Dimensions of Applied Behavior Analysis in Mainland China: A Review of 20 Years of Research.

In the West, the field of applied behavior analysis (ABA) evolved over 7 decades from the experimental analysis of behavior. In this evolutionary process, seven dimensions of ABA emerged: applied, behavioral, analytic, technological, conceptual, effective, and generality. In contrast, ABA was introduced into mainland China only about 20 years ago as a direct result of the rise in autism diagnosis in that country, and only since then has it become an area of research there. The purpose of this study is to critically evaluate ABA research published in China by focusing on its seven dimensions. The results of our review reveal that the level of acceptance of and interest in the seven ABA dimensions varies across the studies sampled. Recommendations for the future development of ABA research in China are offered.

Effectiveness of breastfeeding educational interventions to improve breastfeeding knowledge, attitudes, and skills among nursing, midwifery, and medical students: A systematic review and meta-analysis.

BACKGROUND: Breastfeeding education programs are necessary to prepare healthcare students to address the breastfeeding needs of families. Various breastfeeding educational modules have been used in academic settings; however, the effectiveness of breastfeeding educational interventions remains unclear. OBJECTIVES: To examine the effectiveness of educational interventions to improve the breastfeeding knowledge, attitudes, and skills of nursing, midwifery, and medical students. METHODS: A systematic review was conducted searching academic databases from inception to December 22, 2022. Searches were carried out by two authors independently in PubMed, MEDLINE, Web of Science, Scopus, CINAHL Plus, Embase, Cochrane Library, and ERIC. Joanna Briggs Institute critical appraisal checklist was used. The data were extracted for a random-effects meta-analysis to estimate the standardized mean differences (SMDs) with 95 % confidence interval (CI). Subgroup analyses were performed to identify potential moderators. RESULTS: Thirty-three quasi-experimental studies (12 two-group studies and 21 one-group studies), which included 1313 nursing students, 204 midwifery students, and 1066 medical students, were identified. The students who received educational interventions had significantly higher scores in breastfeeding knowledge (SMD: 0.67, 95 % CI: 0.46, 0.87 for two-group studies; SMD: 1.42, 95 % CI: 0.91, 1.94 for one-group studies), more positive attitudes toward breastfeeding (SMD: 0.43, 95 % CI: 0.22, 0.63 for two-group studies; SMD: 0.98, 95 % CI: 0.32, 1.63 for one-group studies), and higher scores for breastfeeding skills (SMD: 1.52, 95 % CI: 0.46, 2.58 for two-group studies; SMD: 1.33, 95 % CI: 0.43, 2.23 for one-group studies) than the control groups. As a teaching method, clinical practicums were a significant moderator of both breastfeeding knowledge (p = .035) and skills (p < .001). Few studies (n = 5) described the educational framework underpinning the program development. CONCLUSIONS: Breastfeeding educational interventions effectively improve the breastfeeding knowledge, attitudes, and skills of undergraduate nursing, midwifery, and medical students. Incorporating clinical practicums in interventions is important. Future studies to examine useful teaching strategies for enhancing learning outcomes are warranted.

Prevalence of and factors associated with postnatal depression and anxiety among parents of preterm infants: A systematic review and meta-analysis.

BACKGROUND: This study aimed to determine the prevalence of and factors associated with postpartum depression and anxiety among mothers and fathers of preterm infants and to examine the relationships between maternal and paternal symptoms. METHODS: Six electronic databases were searched to identify eligible studies reporting parental depression and anxiety within 1 year postpartum. Data were extracted for a random-effects meta-analysis to estimate the prevalence with 95 % confidence intervals (CIs). Subgroup and meta-regression analyses were conducted to analyze associations between study characteristics and prevalence estimates. RESULTS: In total, 79 studies were included. The meta-analysis of studies on mothers generated estimates of prevalence for depression (29.2 %, 95 % CI, 21.8 %-37.9 %) and anxiety (37.7 %, 95 % CI, 24.1 %-53.6 %). The meta-analysis of fathers indicated a pooled depression prevalence of 17.4 % (95 % CI, 12.5 %-23.8 %) and an anxiety estimate of 18.3 % (95 % CI, 8.1 %-36.3 %). Assessment time points and methods as well as the geographic continent in which the study was conducted were significant moderators of depression and anxiety. Significant inter-correlations were found between mothers' and fathers' depression and anxiety symptoms (p < 0.05). LIMITATIONS: Limited data from specific geographic continents, including Africa and Asia. CONCLUSIONS: Prevalence of depression and anxiety among preterm infants' parents was high, highlighting the need for early psychological screening and assessment. Further research is required to improve services that focus on parents' postpartum psychological needs in the family context.

Brief Report: Increasing Intraverbal Responses to Subcategorical Questions via Tact and Match-to-Sample Instruction.

The purpose of the study was to evaluate the effects of tact and match-to-sample instructions on the increase and maintenance of intraverbal responses to subcategorical questions (i.e., naming multiple items in a subcategory of a category). Three Chinese children on the autism spectrum (2 boys, 1 girl, aged 6-8 years old) participated in this study. Results indicated that intraverbal responses to subcategorical questions emerged or increased for most subcategories for all three participants following the completion of instruction without direct training.

Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: A single-blind randomised controlled trial.

OBJECTIVE: To evaluate the effects of an integrated childbirth education intervention on reducing childbirth fear, anxiety, and depression, and improving dispositional mindfulness. DESIGN: A two-arm parallel, single-blind randomised controlled trial. SETTING: A teaching hospital in Northern Taiwan. PARTICIPANTS: Pregnant women ≥ 20 years of age with a singleton pregnancy (12-24 weeks gestation) and their support partners were recruited. All women included in the study had a score of ≥ 7 points on a fear of childbirth visual analogue scale. INTERVENTIONS: The intervention group (n = 53) received an 8-week course in a childbirth education programme, which included (1) childbirth education using simulation-based learning that highlighted coping with labour pain and (2) instruction in mindfulness breathing, body scans, stretching, sitting meditation, and mindfulness walking. Support partners were invited to participate. The control group (n = 53) received the usual standard prenatal care. MEASUREMENTS: The primary outcome of fear of childbirth was assessed using the Wijma Delivery Expectancy/Experience Questionnaire. The secondary outcomes of anxiety, depression, and dispositional mindfulness were assessed with the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory Scale, and the Mindful Attention Awareness Scale, respectively. Repeated data were collected at baseline, 36 weeks gestation, and 1 week postpartum. FINDINGS: Ninety-one mothers completed the study, with a mean age of 33.9 years (SD = 4.4), and most were primipara (n = 83). The baseline measurements did not differ between the groups. Compared with the control group, there were significant differences in all measures from baseline for the intervention group: the scores were significantly lower for fear of childbirth (mean difference (MD) =-14.8 ∼ -23.7, p < .01), symptoms of anxiety (MD =-7.4 ∼ -6.4, p < .01), and depression (MD =-3.7 ∼ -3.5, p < .01); the levels of dispositional mindfulness were significantly higher (MD =4.9 ∼ 5.7, p < .01) at 36 weeks gestation, and 1 week postpartum. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The 8-week integrated childbirth education intervention was effective in reducing the fear of childbirth in pregnant women. The mindfulness techniques were easily learnt and applied by the participants. Using these techniques during pregnancy and labour enhanced participants' mental health and coping. The integrated childbirth education which includes pregnant women and their support partners could be easily taught by midwives in other contexts.

College Instructors' Theories of Intelligence and Awareness of Student Dyslexia as Related to the Feedback Provided for the Student's Writing Assignment.

Research indicates that teachers' theories of intelligence (incremental vs. entity) are likely to affect their teaching practices, and some teachers hold lower expectations for students with learning disabilities. This study explored the relationships between college instructors' theories of intelligence and the feedback they provided based on a student's writing sample under two conditions: the student's dyslexia was mentioned versus not mentioned. One hundred and one college instructors completed a survey. Results of path analysis indicated the instructors who endorsed the incremental theory of intelligence gave significantly more encouraging comments than those who endorsed the entity theory. Instructors' theories of intelligence did not predict the grade assigned, the number of weaknesses pointed out, and the number of suggestions provided. The instructors informed of the student's dyslexia gave significantly higher grades than those not informed, but the instructors' feedback did not differ. No significant interaction between instructors' theories of intelligence and awareness of student dyslexia was found.

The Effects of Tact Training on Echolalia in Children with Autism Spectrum Disorder in China.

Echolalia can negatively impact multiple skill areas in children diagnosed with autism spectrum disorder (ASD), including skills related to academic and social performance. The purpose of this study was to employ a multiple probe across participants design to evaluate the effects of tact training on delayed echolalia in three children in China diagnosed with ASD. The results of this study indicated that tact training was effective in decreasing echolalia and increasing appropriate tacts for all three children. The effects were maintained 7 weeks following the completion of training.

Improving Eye Contact and Gaze Following in Children with Autism Spectrum Disorder: Systematic Withdrawal of Stimulus Prompts and Tangible Reinforcers.

The purpose of this study was to investigate the effects of a procedure involving systematic withdrawal of stimulus prompts and tangible reinforcers on the acquisition, maintenance, and generalization of eye contact and gaze following for two children with ASD in China. Two boys with ASD (5-6 years of age) participated. A concurrent multiple probe design across behaviors and participants was used. Results indicate that the procedure effectively established eye contact and gaze following for both children. Generalization to new instructors occurred in the free play setting, and the acquired behaviors were maintained for 1 month following training. Eye contact was maintained with social consequences for one child; the other child required tokens along with social consequences to maintain eye contact. Social consequences were sufficient to maintain gaze following for both children.

Teaching Metaphorical Generation via Tact and Match-to-Sample Instructions: A Brief Report.

The purpose of the study was to examine the effects of an instructional sequence involving simple tact, category tact, and match-to-sample instructions on the emergence of metaphorical extensions about emotions for children with autism spectrum disorder. Three Chinese children (1 girl, 2 boys, 7-8 years old) with autism spectrum disorder participated. Results indicate that the participants' intraverbal responses for metaphorical extensions about emotions emerged or increased without direct training after completion of the instructional sequence to which verbal instruction had been added. All three children maintained the metaphorical extensions about emotions for 4 weeks.

Relationships of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam.

PURPOSE: To examine the associations of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam, a country experiencing rapid economic growth. DESIGN AND METHODS: A cross-sectional study was conducted in a high school in northern Vietnam from July to September 2019. Symptoms of depression and anxiety were respectively assessed using the Center for Epidemiological Studies Depression Scale and the Vietnamese Anxiety Scale. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Internet use and demographic characteristics were obtained using structured questionnaires. A multiple logistic regression was performed. RESULTS: In total, 678 participants with an average age of 16.1 (standard deviation 0.9) years were included. Nearly one-third of the adolescents (30.7%) exhibited excessive internet use (> 4 h/day), 19.6% experienced depressive symptoms, 14.5% presented anxiety symptoms, and 58.8% reported poor sleep quality. Compared to non-excessive internet users, excessive internet users (> 4 h/day) experienced significantly higher levels of depressive symptoms (p = .001), anxiety (p = .008), and poorer sleep quality (p < .001). Students who were female and with fair/poor self-rated health experienced higher depression, anxiety, and poor sleep quality (p < .05). After adjusting for demographic and health-related factors, students with excessive internet use were 58% more likely to experience poor sleep quality (odds ratio, 1.58, 95% confidence interval [1.06, 2.35]). CONCLUSIONS: Excessive internet use in Vietnamese high school students was significantly associated with poor sleep quality, but not with depression or anxiety.

The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers. RESEARCH AIMS: (1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs. METHODS: Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted. RESULTS: Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5-7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: -1.33, 95% CI [-2.26, -0.40]) at postpartum 4-14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1-6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001). CONCLUSIONS: Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

Improving pretend play for children with autism through experiencing the stimulus properties of real objects.

Children with autism spectrum disorder (ASD) often lack symbolic play skills. Attribution of pretend properties (APP) is a type of symbolic play in which a child tacts pretend properties of an object (e.g., smelling a toy flower and saying, "It smells like a rose!"). Three Chinese boys (5-6 years of age) with ASD served as participants. A multiple-probe design across 5 objects was used to determine the effects of an intervention that involved having the child experience and tact sensory properties of real objects (e.g., rose). Corresponding test objects, including mock (e.g., a toy flower) and arbitrary objects (e.g., a stick), were used to evaluate whether tact responses for sensory properties were transferred. Results indicated that all 3 children emitted tacts of stimulus properties for test objects and maintained the skill for 7 to 10 weeks following the intervention. Two participants also tacted novel (nontarget) properties for test objects.

Brief Report: Using Computer-Assisted Multiple Exemplar Instruction to Facilitate the Development of Bidirectional Naming for Children with Autism Spectrum Disorder.

Bidirectional naming is an important ability which enables children to acquire listener and speaker behaviors through exposure to relevant word-object associations. Many children with autism spectrum disorder (ASD) or developmental delays do not demonstrate this ability and require systematic instruction. The purpose of the present study was to evaluate the efficacy of computer-assisted multiple exemplar instruction to facilitate bidirectional naming. Three 5-year-old Chinese boys with ASD participated in a multiple probe across three participants design. The results indicated that all three children's naming performance increased from pretest to posttest, supporting the potential practicality of the instructional system for use in applied settings.

Effects of Video Modeling on the Acquisition, Maintenance, and Generalization of Playing with Imaginary Objects in Children with Autism Spectrum Disorder.

Many children with autism spectrum disorder (ASD) do not have symbolic play skills. One type of symbolic play involves playing with imaginary objects, in which a child displays play actions without actual objects. The purpose of this study was to evaluate the effects of video modeling on the acquisition, maintenance, and generalization of playing with imaginary objects in young children with ASD. Three male Chinese children (aged 4-5 years) with ASD participated in this study. A multiple-probe across three behaviors design was used. The results indicated that video modeling was effective in establishing and maintaining target symbolic play behaviors for the three children. Generalization to untaught imaginary play activities occurred in all three children.

Arranging play activities with missing items to increase object-substitution symbolic play in children with autism spectrum disorder.

PURPOSE: Many children with autism spectrum disorder do not have symbolic play skills. The purpose of this study was to evaluate the effects of a training procedure on the acquisition, maintenance, and generalization of object-substitution symbolic play in children with autism spectrum disorder. METHODS: A single-case experimental design (multiple-probe across four behaviors) was used. One girl (5 years) and two boys (4-5 years) participated in this study. The training procedure involved withdrawing necessary items in play activities, supplying multiple substitutes, and providing hierarchical assistive prompts. Each child's symbolic play responses across baseline, intervention, and follow-up conditions were recorded and graphed. Data analysis involved visual inspection of graphs. RESULTS: The results indicated that the procedure effectively increased and maintained object-substitution symbolic play. Generalization to untaught play activities occurred in all children, and symbolic play increased in the free play setting for one child. CONCLUSIONS: Arranging play activities with missing items increased opportunities for children to engage in symbolic play. The training procedure can be used in clinical and educational settings as an initial step to establish and improve complex play behavior in children with autism spectrum disorder who lack such skills.IMPLICATIONS FOR REHABILITATIONMany children with autism spectrum disorder have inappropriate play behaviors and do not demonstrate symbolic play.Arranging play activities with missing items and systematic assistive prompts effectively increased object-substitution symbolic play.Generalization of symbolic play to untrained play activities occurred after the intervention.

Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study.

BACKGROUND: Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding. OBJECTIVES: To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes. DESIGN: A single-blind, randomised controlled trial. SETTING: A prenatal clinic of a teaching hospital. PARTICIPANTS: First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group. METHODS: A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months. RESULTS: Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p < .001), and postpartum at 1-week (p < .001), 1-month (p < .001) and 3-months (p < .01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p < .001) and 6-months postpartum (MD: 7.0, p < .05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p < .05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p < .02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05). CONCLUSIONS: The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT03807726).

Validation of the Wijma delivery expectancy/experience questionnaire for pregnant women in Malawi: a descriptive, cross-sectional study.

BACKGROUND: Fear of childbirth is a common health concern for women during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is widely used to measure childbirth fear during pregnancy. However, this instrument is yet to be validated in Malawi, Africa. Our study aimed to assess the psychometric properties of the W-DEQ questionnaire in Malawi. METHODS: Healthy pregnant women in the third trimester (N = 476) at a district hospital in Malawi were included. Fear of childbirth, depressive symptoms, and quality of life were assessed using the W-DEQ, the Edinburg Postnatal Depression Scale, and the World Health Organization Quality of Life scale, respectively. The construct validity, reliability, and convergent validity of the W-DEQ were examined using exploratory and confirmatory factor analyses, Cronbach's alpha, and Pearson correlations. RESULTS: The mean age of participants was 28.2 (standard deviation = 6.8) years. Exploratory and confirmatory factor analysis of the Malawian version of the W-DEQ indicated a multidimensional structure with three factors: fear, negative appraisal, and a lack of self-efficacy, with acceptable goodness of model fit. The Malawian version of the W-DEQ showed a satisfactory internal consistency (α = 0.84) and was significantly correlated with depressive symptoms (r = 0.23, p < 0.001) and quality of life (r = - 0.17 ~ -0.26, ps < 0.05). CONCLUSIONS: Our findings support the Malawian W-DEQ version being a reliable and valid instrument for measuring childbirth fear in African women.

The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: a cross-sectional study.

BACKGROUND: Perceived milk supply is an important modifiable factor for optimal breastfeeding. However, little is known about maternal perception of milk supply or how it impacts breastfeeding practices. The aim of this study was to examine relationships of perceived milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact with early initiation and exclusive breastfeeding among mothers of infants less than 6 months of age in Indonesia. METHODS: This was a cross-sectional study conducted in Yogyakarta City, Indonesia between August and October 2015. Maternal perception of milk supply was assessed using the Hill and Humenick Lactation Scale. Data on breastfeeding practices, and maternal and infant factors were collected using a structured questionnaire. Multiple regression and multivariate logistic regression analyses were performed to obtain estimates of associations. RESULTS: Thirty four percent of mothers had initiated breastfeeding within an hour after birth, and 62.4% of mothers were exclusively breastfeeding. High levels of perceived breast milk supply were reported in mothers who practiced skin-to-skin contact or rooming-in with their infants, experienced positive infant sucking behavior, or had high breastfeeding self-efficacy (p < 0.05). Mothers with a higher level of perceived milk production (Odds Ratio [OR] 3.20; 95% Confidence Interval [CI] 1.76, 5.83) or practicing skin-to-skin contact (OR 2.36; 95% CI 1.13, 4.91) were more likely to exclusively breastfeed, while employed mothers were less likely to breastfeed their infants exclusively (OR 0.47; 95% CI 0.24, 0.93). CONCLUSIONS: In this study, skin-to-skin contact and breastfeeding self-efficacy are important determinants of perceived milk supply. Higher perception of milk supply was positively linked with exclusive breastfeeding. Our study highlights the importance of the assessment for mother's perception of milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact in achieving optimal breastfeeding outcomes.

Determinants of breastfeeding practices among mothers in Malawi: a population-based survey.

BACKGROUND: High rates of early initiation and exclusive breastfeeding have been reported in Malawi, yet the underlying factors are unknown. Our objective is to examine the determinants of breastfeeding practices for mothers of infants less than 24 months old in Malawi. METHODS: A cross-sectional study was conducted using nationally representative data from the 2010 Malawi Demographic and Health Survey. Multivariate logistic regression analysis was used. RESULTS: Of 7282 women, 95.4% initiated breastfeeding within 1 hour after birth; thereafter 71.3% of women practiced exclusive breastfeeding, 6.1% predominantly breastfed, and 1.9% chose bottle feeding exclusively. The odds of early initiation were higher among women with frequent antenatal care visits and multiparous mothers. Similarly, frequent antenatal care visits and hospital delivery were positive determinants for exclusive breastfeeding. Infants at 6 months of age were more likely to predominantly breastfeed than they were at 1 month. The odds of bottle feeding were higher among women who were educated, who delivered at a hospital. CONCLUSIONS: Optimal breastfeeding practices are highly prevalent in Malawi. Health care practice emphasizing frequent antenatal care visits that provide breastfeeding education and breastfeeding support in hospital care after childbirth are important for sustaining breastfeeding.