Effectiveness of a Postpartum Breastfeeding Support Group Intervention in Promoting Exclusive Breastfeeding and Perceived Self-Efficacy: A Multicentre Randomized Clinical Trial.

There are numerous recognized benefits of breastfeeding; however, sociocultural, individual, and environmental factors influence its initiation and continuation, sometimes leading to breastfeeding rates that are lower than recommended by international guidelines. The aim of this study was to evaluate the effectiveness of a group intervention led by midwives supporting breastfeeding during the postpartum period in promoting exclusive breastfeeding, as well as to assess the impact of this intervention on perceived self-efficacy. This was a non-blind, multicentric, cluster-randomized controlled trial. Recruitment started October 2021, concluding May 2023. A total of 382 women from Andalusia (Spain) participated in the study. The results showed that at 4 months postpartum there was a higher prevalence of breastfeeding in the intervention group compared to formula feeding (p = 0.01), as well as a higher prevalence of exclusive breastfeeding (p = 0.03), and also at 6 months (p = 0.01). Perceived self-efficacy was similar in both groups for the first two months after delivery, which then remained stable until 4 months and decreased slightly at 6 months in both groups (p = 0.99). The intervention improved the average scores of perceived self-efficacy and indirectly caused higher rates of exclusive breastfeeding (p = 0.005). In conclusion, the midwife-led group intervention supporting breastfeeding proved to be effective at maintaining exclusive breastfeeding at 6 months postpartum and also at increasing perceived self-efficacy.

Assessment of breast-feeding and weaning practices of under-fives and their associated co-morbidities in urban and rural areas of Ahmedabad City, Gujarat, India.

Introduction: Shaping up the post-2015 development agenda is of crucial importance in the development process around the Globe as 20151 was the last year of milllenium development goals. It is the right time to asses our own progress vis-a-vis the Millennium development goals. Appropriate feeding and weaning practices are the key contributor for decreasing morbidities and mortalities in under-five children. As per national family health survey-5 (NFHS-5), only 55.8% of the Indian infants between 0 and 6 months were exclusively breastfed in Gujarat. Children age 6-8 months receiving solid or semi-solid food and breast milk were only 49.4% in Gujarat. Only 5.8% of breastfeeding infants aged 6-23 months receive an adequate diet in Gujarat. Hence the following study was done to know the practice of breastfeeding and weaning in mothers of urban and rural area of Ahmedabad city, Gujarat. Objective: The primary objective of this study was to describe the breastfeeding and newborn care practices and the factors affecting the initiation and duration of breastfeeding in urban and rural areas of Ahmedabad city, Gujarat and the secondary objective was to describe the comorbidities associated with them. Methods: Cross-sectional study was done in anganwadis of slums of urban and rural field practice area of B.J. Medical College, Ahmedabad. Results: Half of the under-five children were provided jaggery as pre-lacteal feed both in urban (45%) and rural (53%) area. In urban area most common reason for providing pre lacteal feeds was due to family customs (55%) followed by their belief that it leads to help in removal of meconium from gut (22%) followed by as advised from their relatives (23%) as compared to in rural area where there was belief that it leads to help in removal of meconium from gut (52%) followed by family customs (31%) and advise from relatives (17%). There were 7.5% under-five children in urban area in whom breastfeeding was not initiated immediately compared to rural area in which there were 42% under-five children. Conclusion: Frequent occurrence of acute illness among under-fives may have lead to undernutrition.

Effects of responsive breastfeeding intervention on breastfeeding and infant growth in China: A randomised controlled trial.

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self-determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother-infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self-efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post-partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post-partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self-perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post-partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post-partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: -2.09; 95% CI: -2.88 to -1.31; p < 0.001), 6 weeks post-partum (MD: -4.35; 95% CI: -5.20 to -3.49; p < 0.001) and 3 months (MD: -4.89; 95% CI: -5.70 to -4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post-partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post-partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post-partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post-partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post-partum, the intervention group's infants showed slower weight (t = -0.90, p = 0.371) and length (t = -0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post-partum, there was a significant difference in both weight (t = -3.46, p = 0.001) and length (t = -2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self-confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow-up in future research.

Exclusive breastfeeding and its association with intimate partner violence during pregnancy: analysis from Pakistan demographic and health survey.

BACKGROUND: Intimate partner violence (IPV) is a global social issue and increasingly asks for the attention of policymakers. IPV is one of the main factors that affect the health of pregnant women and their infants during pregnancy and after childbirth; it will not only cause direct harm to women themselves but also reduce women's exclusive breastfeeding (EBF) behavior and pose a threat to newborn health. Existing facts on the association between IPV and EBF in the Pakistani context are negligible and incomplete to an enduring measure of IPV practice. To this effect, the present study aims to investigate the relationship between EBF and IPV practiced during the prenatal period and post-delivery. METHODS: The statistics study has drawn from the Pakistan Demographic and Health Survey (PDHS) 2018. A total of 1191 breastfeeding females aged 15-49 with children under 6 months were selected for the present study. T-test or chi-square test of Univariate test of hypothesis; Logistic regression model was utilized to explore the potential impact of IPV on female exclusive breastfeeding from three dimensions of physical, sexual and psychological violence, to provide data support for the Pakistani government to formulate policies to promote female EBF. All investigations have been performed in STATA software 16.0 (Stata Corp, College Station, TX, USA) at 95% confidence interval. RESULTS: Among the 1191 participants, 43.6% (520 / 1191) of the females were EBF, while the rates of physical, sexual, and emotional IPV were 47.44%, 30.23%, and 51.72%, respectively. Logistic regression analysis showed that females who have experienced physical IPV were 32% less likely to be exclusively breastfed (aOR = 0.68; 95% CI; 0.490, 0.980; P < 0.05), the chances of EBF were reduced by 22% in women who experienced IPV (aOR = 0.78; 95 CI; 0.55, 1.00; P < 0.05), females who experienced emotional IPV were 31% less probable to exclusively breastfed (aOR = 0.69; 95% CI; 0.47, 0.92; P < 0.05). CONCLUSIONS: This study determines the adverse effects of sexual and psychological violence on EBF practices in women. Policymakers in Pakistan should actively implement assistance programs to reduce IPV, emphasize monitoring women's experiences of IPV before and after giving birth, and encourage women to break the "culture of silence" when they experience IPV to maximize their access to assistance.

Relationship between skin-to-skin contact during the first hour of life and duration of exclusive breastfeeding.

BACKGROUND: Exclusive breastfeeding (BF) has the greatest potential impact on child mortality of any preventive intervention. Skin-to-skin contact (SSC) during the first hour of life is beneficial for initiating BF; however, routine separation of mother and infant is still common. This work aimed to demonstrate that SSC during the first hour of life is associated with a greater frequency and duration of exclusive BF. METHODS: This is an observational case-control study. We reviewed the medical records of patients born between 2016 and 2022 classified as cases or controls based on the history of SSC in the first hour of life. Statistical analysis was performed using SPSS version 28. RESULTS: We included 362 medical records, of which 200 (55.2%) had SSC and were considered cases; the 162 (44.8%) who did not have SSC were considered controls. Those who received SSC were more likely to receive exclusive BF at 3 (163 [81.5%] vs. 94 [58%], p < 0.001) and 6 months of age (147 [73.5%] vs. 83 [51.2%], p < 0.001). CONCLUSIONS: Patients who received SSC in the first hour of life were more likely to receive exclusive BF at 3 and 6 months of age. Promoting and respecting this practice is essential to increase the possibility of a newborn to be exclusively breastfed for the first 6 months of life.

INTRODUCCIÓN: La lactancia materna exclusiva (LME) es la intervención preventiva con mayor impacto en mortalidad infantil. El contacto piel con piel (CPP) durante la primera hora de vida es un periodo crítico para establecer la lactancia; sin embargo, la separación rutinaria del recién nacido de su madre es frecuente. El objetivo de este trabajo fue demostrar que el CPP durante la primera hora se asocia con mayor frecuencia y duración de LME. MÉTODOS: Se llevó a cabo un estudio observacional de casos y controles. Se revisaron expedientes de pacientes de nuestra consulta pediátrica que nacieron entre 2016 y 2022. Se clasificaron como casos y controles de acuerdo con el antecedente de haber recibido CPP durante la primera hora de vida. Se realizó el análisis estadístico en SPSS version 28. RESULTADOS: Se incluyeron 362 expedientes, de los cuales 200 (55.2%) recibieron CPP en la primera hora de vida y fueron considerados casos; los 162 (44.8%) que no lo hicieron fueron considerados controles. Aquellos que recibieron CPP tuvieron con mayor frecuencia LME a los 3 (163 [81.5%] vs. 94 [58%], p < 0.001) y 6 meses de edad (147 [73.5%] vs. 83 [51.2%], p < 0.001). CONCLUSIONES: La frecuencia con la cual los pacientes lograron tener lactancia materna exclusiva a los 3 y 6 meses es mayor en aquellos en los que se respeta el CPP en la primera hora de vida. Promover y respetar esta práctica es fundamental para incrementar las probabilidades de que los lactantes reciban LME durante sus primeros 6 meses de vida.

Factors Influencing Exclusive Breastfeeding in Saudi Arabia.

BACKGROUND: Exclusive breastfeeding is defined as the practice of providing infants with breast milk as their sole source of nourishment for the first six months of life. This study investigated the factors influencing exclusive breastfeeding practices in Makkah, Saudi Arabia. METHODS: The study employed a descriptive cross-sectional study design. Data gathered from 340 mothers attending the Maternity and Childhood Hospital in Makkah provided insights into the demographic profiles and postpartum practices of participants. RESULTS: The study revealed the significance of early breastfeeding initiation and the provision of pre-birth breastfeeding information in extending the duration of exclusive breastfeeding. There was a statistically significant difference between mothers who had Cesarean section deliveries and those who had natural deliveries in terms of exclusive breastfeeding duration. CONCLUSIONS: These findings have essential implications for healthcare professionals, policymakers, and future research endeavors, emphasizing the importance of healthcare education and timely support in promoting extended exclusive breastfeeding practices.

Breastfeeding, Chestfeeding, and Lactating Parents' Experiences With Online Support Groups: An Integrative Review.

INTRODUCTION: The aim of this integrative review is to understand (1) how parents in specific populations engage with online breastfeeding, chestfeeding, or lactation support groups, (2) how these support groups influence extended breastfeeding duration and other outcomes, and (3) whether the use of support groups by these specific populations has changed since the start of the COVID-19 pandemic. METHODS: Of the articles identified across 4 electronic databases, 10 studies met the inclusion criteria; they were published between 2013 and 2023, written in English, and focused on the use of online peer support groups for breastfeeding, chestfeeding, and lactation support in specific populations. Eight of these studies are qualitative, 1 is a randomized controlled trial, and 1 is mixed methods. RESULTS: Eight themes were identified: (1) overcoming lack of real world support, (2) normalization, (3) practical support, (4) emotional support and shared experiences, (5) building a bridge to in-person relationships, (6) reciprocity and activism, (7) self-efficacy and outcomes, and (8) issues with online support groups. DISCUSSION: Specific subpopulations of breastfeeding, chestfeeding, and lactating parents and their partners found comfort in online support groups because they normalized more unique feeding practices and offered a space to provide and receive encouragement. Additionally, this review includes fathers/partners as a previously ignored subpopulation who benefit from education and support with breastfeeding, chestfeeding, and lactation. This subpopulation is also an area for expanded research on the use of online support groups by partners of lactating parents.

The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis.

Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67-1.04; I2 = 78%; Cochran's Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65-0.99; I2 = 70%; Cochran's Q = 0.02).    Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts. What is Known: • Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight. • However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures. What is New: • When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures. • When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.

The Role of Skin-to-Skin Contact and Breastfeeding in the First Hour Post Delivery in Reducing Excessive Weight Loss.

BACKGROUND AND AIMS: An excessive weight loss (EWL) of >10% after birth is associated with serious health outcomes. The aim of this study was to determine factors that can reduce weight loss in full-term, exclusively breastfed infants after birth. METHODS: This is a retrospective, observational, single-center study. We included 642 healthy, full-term, exclusively breastfed neonates born in 2019 in a baby-friendly hospital, and their healthy mothers. The exclusion criteria were as follows: supplementation with formula, multiple pregnancies, and neonates or mothers with health issues. RESULTS: The mean percentage of neonatal weight loss after 24 h of life was 5.13%, and that after 48 h was 6.34%. Neonates delivered via a caesarean section lost more weight after 24 and 48 h of life than those delivered via vaginal delivery (p < 0.01). There is a noticeable pattern that neonates tend to lose more weight if they do not get skin-to-skin contact (SSC) and breastfeeding within the first hour after birth (p > 0.05). CONCLUSIONS: Neonates born via a CS tend to lose more weight after 24 and 48 h of life. Immediate SSC and breastfeeding in the first hour after delivery may decrease the excessive weight loss.

The Effect of Breastfeeding Practices of Undernourished Mothers in Rural Sierra Leone on Infant Growth and Mortality.

Breastfeeding provides optimal infant nutrition; however, <50% of infants are exclusively breastfed (EBF) for 6 months. We aimed to describe breastfeeding practices and their effects on growth and mortality among a high-risk mother-infant cohort in rural Sierra Leone. This was a secondary analysis of data from a randomized nutrition intervention trial among undernourished pregnant women. The study's primary outcomes were infant weight and length gains at 6 weeks of age. We included 1270 singleton infants in the analysis, with 1092 (85.6%) having 24-week outcome data. At 6 weeks, 88% were EBF, but the rate of EBF decreased to 17% at 24 weeks. The EBF infants at 6 weeks had improved length (difference of 0.9 mm/week; 95% CI 0.4 to 1.3; p < 0.001) and weight (difference of 40 g/week; 95% CI 24 to 53; p < 0.001) gains compared to the non-EBF infants. At 12 weeks, the EBF infants had improved weight (difference of 12 g/week; 95% CI 2 to 22; p = 0.024) gain. The EBF infants had lower mortality than the infants who were not EBF (hazard ratio of 0.39; 95% CI 0.18 to 0.84; p = 0.017). In summary, the infants who were EBF had greater weight and length gain and reduced mortality than those who were not EBF. Efforts to improve breastfeeding should thus be prioritized to improve infant health.

Clinical significance and main parameters promoting the breast­feeding strategy (Review).

Breastfeeding provides numerous nutritional and immunological benefits, promotes neurological and cognitive development, and protects against chronic and infectious diseases, rendering it beneficial to the survival and well-being of infants. According to international recommendations, infants should be exclusively breastfed for the first 6 months. However, despite global health recommendations and funding initiatives, exclusive breastfeeding rates remain low worldwide. A number of studies attribute the low rates to factors that can be grouped into demographic, psychosocial, economic and midwifery factors, and outline the profile of each mother who opts to exclusively breastfeed her infant. In addition, the number of previous pregnancies, induced labor, the use of epidurals at birth or the possibility of the newborn being delivered prematurely, and the need for admission to an intensive care unit are the factors that reduce the likelihood of exclusive breastfeeding. Further research is required to understand the factors influencing the initiation and maintenance of exclusive breastfeeding, as international interventions have been ineffective. The aim of the present review was to provide an up-to-date summary of these various factors in an aim to assist health care professionals and policy makers in developing effective interventions with which to promote and support exclusive breastfeeding.

Undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia: A community-based study.

BACKGROUND: An exclusive breastfeeding period is a time when the infant's feeding depends on only breast milk. Inadequate maternal nutrition during this period could lead to insufficient infant feeding, which can further lead to childhood undernutrition and developmental restrictions. Evidently, the burden of maternal undernutrition was higher in resource-limited countries, including Ethiopia. OBJECTIVES: This study aimed to assess the proportion of undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia. DESIGN: The study used a community-based cross-sectional design. METHODS: The study was conducted among 442 nursing mothers from 10 to 30 June 2022. The participants were selected using multistage sampling techniques. An interviewer-administered structured questionnaire was used to collect information. Statistical software EpiData version 3.1 and SPSS version 20 were used for data entry and analysis, respectively. The factors associated with undernutrition were identified using a binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used to include the variable in the multivariable analysis, whereas p-value less than 0.05 was an odds ratio used to declare an independent association at a 95% confidence interval. RESULTS: The proportion of undernutrition among the participants was found to be 24.8% in the study area. Poor intake of extra meals (adjusted odds ratio = 2.104; 95% confidence interval: 1.208, 3.664), poor dietary diversity habits (adjusted odds ratio = 3.605; 95% confidence interval: 2.112, 6.153), a lack of nutrition information (adjusted odds ratio = 1.853; 95% confidence interval: 1.070, 3.212), and household food insecurity (adjusted odds ratio = 4.424; 95% confidence interval: 2.639, 7.417) were identified as factors enhancing undernutrition among exclusive breastfeeding mothers in the area. CONCLUSION: A quarter of exclusive breastfeeding mothers were undernourished in the area. Poor dietary diversity habits, poor intake of extra meals, a lack of nutrition information, and household food insecurity were found to be the factors determining undernutrition. Hence, it is important to reinforce nutrition intervention programs, including maternal nutrition education and counseling.

A study identified undernutrition among exclusive breastfeeding mothers in Southwest EthiopiaAdequate nutrition for a nursing mother is crucial for the health of both the baby and the mother. Frequent breastfeeding, especially in exclusive breastfeeding (EBF) mothers, increases the physiological demand for nutrients. Consequently, inadequate nutrition during this period can lead to undernutrition. Undernutrition during this crucial period can result in the detriment of a newborn's growth and development. The problem is common in resource-limited settings, including Ethiopia. The study was conducted to assess the magnitude of undernutrition in the general nursing period. However, this problem, in particular the EBF period, was poorly studied before including the study area. A community-based cross-sectional study was conducted to assess the prevalence of undernutrition and its associated factors among EBF mothers in southwest Ethiopia. Accordingly, of the total of 435 participants involved in the study, about 108 (24.8%) of EBF mothers were undernourished. The participants' poor intake of extra meals (adjusted odds ratio (AOR) = 2.104; 95% confidence interval (CI): 1.208, 3.664), poor dietary diversity habits (AOR = 3.605; 95% CI: 2.112, 6.153), a lack of nutrition information (AOR = 1.853; 95% CI: 1.070, 3.212), and household food insecurity (AOR = 4.424; 95% CI: 2.639, 7.417) were identified as factors enhancing undernutrition among EBF mothers in the area. Generally, the study identified about one-fourth of EBF mothers as undernourished in the area. Hence, the concerned bodies need to strengthen nutritional information dissemination to the community. Moreover, food supplementation should be planned for food-insecure households in the area.

'Breastfeeding exclusivity, difficulties, and support in the first days after hospital discharge: A correlational study'.

OBJECTIVE: Global breastfeeding rates are not optimal, and the early postpartum period represents a critical time for breastfeeding initiation. The Baby-Friendly Hospital Initiative endeavours to provide mothers with evidence-based breastfeeding support in birth hospitals. This study examined factors associated with breastfeeding exclusivity and breastfeeding difficulties in the first days after being discharged from Baby-Friendly designated hospital. The adequacy of breastfeeding support and maternal preferences for optimal support were also reported. STUDY DESIGN: A non-experimental correlational study was conducted between May 2021 and October 2022. A total of n = 80 breastfeeding mothers completed a semi-structured questionnaire within two weeks of discharge from Baby-Friendly hospital in Finland. The questionnaire included demographic and obstetric background information and six questions on breastfeeding exclusivity, breastfeeding difficulties, and breastfeeding support. Descriptive statistical analysis and multivariate binary logistic regression analysis were performed. RESULTS: The mean age of the mothers was 30.6 years (SD 5.4), and half of the mothers were primiparas (49 %). Most mothers gave birth vaginally (85 %) to a full-term infant (84 %). Most (85 %) had made some prenatal plans for breastfeeding, and the median planned duration of breastfeeding was 12 months. Half of the infants (53 %) received supplemental milk while in the hospital. Most mothers (81 %) were exclusively breastfeeding after hospital discharge. Mothers whose infants received supplemental milk in the hospital had an increased odds of non-exclusive breastfeeding (aOR 16.5 [CI 95 % 1.7-156.7], p 0.015). Approximately one-third of the mothers (39 %) experienced breastfeeding difficulties. Primiparous mothers had increased odds of experiencing breastfeeding difficulties (aOR 3.41 [CI 95 % 1.2-9.8], p 0.023). Mothers who received adequate postnatal breastfeeding support in birth hospital had decreased odds of experiencing breastfeeding difficulties (aOR 0.16 [CI 95 % 0.03-0.8], p 0.026). Mothers were mainly satisfied with breastfeeding support, although timelier access to support was preferred after hospital discharge. CONCLUSION: Adequate in-hospital postnatal breastfeeding support, including avoidance of non-medical supplementation, contributes to successful breastfeeding after hospital discharge in terms of more exclusive breastfeeding and fewer breastfeeding difficulties. Primiparous mothers need emphasized support to mitigate breastfeeding difficulties. Timelier access to breastfeeding support after discharge is needed.

Use of At-Breast Supplementers to Facilitate Feeding Solely at the Breast for Infants with Retrognathia: Two Case Studies.

Objective: Infants with significant retrognathia often have difficulty forming a latch adequate to establish exclusive breastfeeding. This article describes the use of at-breast supplementers (ABSs) to facilitate extended breastfeeding relationships, even when supplementation is necessary for growth. Methods: Two cases are described where infants with severe retrognathia initially struggled with weight gain necessitating supplementation but were able to ultimately exclusively feed at-breast with the use of ABSs. Results: While the two cases differed in the form of supplemental milk used and duration of ABS use, both dyads breastfed for beyond 2 years. Conclusions: Feeding solely at the breast and subsequent extended breastfeeding may be possible even for infants who require supplementation, including those with anatomical or functional challenges such as retrognathia. The ABS is a relatively simple system that may be beneficial for difficulties such as poor latch and low milk supply. More awareness and education is needed so that clinicians consider supporting dyads with this approach.

Influence of maternal characteristics and infant feeding patterns on infant growth from birth till 18 months: The MISC study.

BACKGROUND: The growth and development of infants during the first 1000 days of life are crucial for their health. OBJECTIVES: This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months. METHODS: Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates. RESULTS: Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively). CONCLUSION: The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth.

Understanding mother-to-child transmission of HIV among mothers engaged in HIV care in Kenya: a case report.

BACKGROUND: Mother-to-child transmission of HIV, which may occur in utero, during birth, or through breastmilk, is now largely preventable with the advancement of HIV testing and treatment for women and their infants. Globally, great progress has been recorded over the years, with a 58% decline in new infections in children from 2010 to 2022. Currently, Kenya is among the countries with the highest rates of mother-to-child transmission of HIV despite consistent efforts to promote prevention of mother to child transmission strategies. METHODS: This case report presents the experiences of a woman, engaged in HIV care in Kenya, whose baby contracted HIV. The data used to describe this case come from surveys, provider notes, health records, observational notes, notes from phone call consultations, and one in-depth interview. All data sources were carefully reviewed, compared and complied to describe the timeline of events and context of the participant's experience. RESULTS: We found multiple factors which may have contributed to this case of mother-to-child transmission of HIV. Antenatal care was initiated late in pregnancy (during the third trimester), and as a result, HIV diagnosis and treatment also occurred late in pregnancy. In addition, a lack of coordination between the clinic providing antenatal care and HIV treatment, and the hospital providing labor and delivery services led to breastfeeding initiation prior to the administration of infant HIV prophylaxis medications. Finally, poor maternal adherence to HIV medications went undetected and unaddressed until it was revealed by routine viral load monitoring three months after initiating HIV treatment (more than two months postpartum). CONCLUSIONS: Our case report shows the continued need for more intensive and integrated care for mothers living with HIV and their infants including support for pregnant women newly diagnosed with HIV, coordination of perinatal and HIV care, provisions for routine monitoring of HIV medication adherence, intensive follow-up care including point of care testing for HIV exposed infants and in person breastfeeding support. Our case report contributes an important perspective especially in light of the current UNAIDS Global AIDS Strategy which recently inspired the Global Alliance to end AIDS in Children.

Level of completion of a continuum of age-appropriate infant feeding practices and barriers among breastfeeding mothers in Ethiopia: a mixed methods study.

BACKGROUND: Ethiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face. METHODS: In this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently. RESULTS: This study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers' complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers. CONCLUSION: The level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers' optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers' education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.

Breastfeeding Intentions among Pregnant Women Enrolled in a Healthy Start Program in Arkansas.

INTRODUCTION: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. METHODS: The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program. RESULTS: The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding. DISCUSSION: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods.

Infant feeding practices and associated factors among HIV-positive mothers of infants aged 0-6 months at public health facilities in Addis Ababa, Ethiopia.

BACKGROUND: In the era of HIV infection, exclusive breast-feeding highly recommended for infants aged less than 6 months. Avoidance of exclusive breast-feeding by HIV-infected mothers recommended when replacement feeding is acceptable, feasible, affordable, sustainable and safe. The prevalence of exclusive breast-feeding has remained very low worldwide. Despite this fact, there is limited information on infant feeding practices of HIV-positive mothers and factors that affect the practice in the current study area. OBJECTIVE: This study assessed the magnitude of infant feeding practice and associated factors among HIV-positive mothers of infants aged 0-6 months at public health facilities in Addis Ababa, Ethiopia. METHODS: A multicenter facility-based cross-sectional study design was employed among a total of 397 study participants. The study participants were selected using a simple random sampling technique. The completeness of the data was checked, coded, cleaned and entered into Epi-data version 4.6 software, and exported to SPSS version 24 for analysis. Descriptive statistics and Binary logistic regression model were employed for the analysis with adjusted odds ratio (AOR) with a 95% CI and a P value ≤ 0.05 to determine the strength of association between infant feeding practice and its independent factors. RESULTS: The overall magnitude of appropriate infant feeding practice among HIV-positive mothers was 82.6% (95% CI 80.9-88.2). Good knowledge of mother's toward infant feeding (AOR: 1.26, 95%, CI 1.11-3.34), better household monthly income, ≥ 6001 Ethiopian birr (AOR: 1.62, 95% CI 1.33-5.14) and favorable attitude of mother's toward infant feeding (AOR: 1.71, 95% CI 1.01-2.92) were statistically significant associated factors with the recommended way of infant feeding practice. CONCLUSIONS AND RECOMMENDATIONS: Hence, the current study area is the capital city of the Ethiopia, where a relatively educated population lived in, there was an opportunity for better income, and appropriate infant feeding practice among HIV-positive mothers was found slightly higher than even the overall national target (70%) that was planned by 2020. Therefore, different stakeholders should develop strategic plan to excel females' education coverage and thereby their knowledge and attitude toward infant feeding to fully eradicate mother-to-child transmission of diseases.

Weaning, food allergens and potential risk factors for delayed introduction: a cross-sectional study.

Much evidence supports that the early introduction of allergenic foods in weaning is useful to prevent food allergies later in life. Real life is often different, with factors related to mothers and infants. Our study aimed to deepen the timing of introducing the foods responsible for most allergic reactions during the weaning and why parents delay their introduction. 110 mothers participated in the study, compiling a questionnaire. Exclusive breastfeeding was associated with a delayed introduction of allergenic foods at 4 months (r = 0.433, p < 0.01) and 1 year (r = 0.486, p < 0.01). Large-for-gestational age at birth was inversely associated with a delayed introduction of allergenic foods (r=-0.204, p < 0.05). This study demonstrates that introducing many allergens is delayed during the weaning. Parents with infants fed with exclusive breastfeeding could need more information about the correct time of introduction of potential allergens in the weaning.