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1.
Sante Publique ; HS1(S1): 113-122, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374090

RESUMO

INTRODUCTION: The WHO and UNICEF have declared exclusive breast-feeding one of the essential tools in the fight against neonatal mortality. Both international bodies finalized a 40-hour training program to provide counseling in feeding, to teach a body of care-givers to bring qualified assistance to the breast-feeding mothers and to help them to overcome their difficulties. However, in the field and in maternities such as those where the study took place (Boucle du Mouhoun region in the northwest of Burkina Faso), although technical recommendations are generally adopted and respected, exclusive breastfeeding makes it difficult for mothers to find their way. The aim of this study is to examine the blockages existing at the maternity ward and in families which prevent the practice of exclusive breastfeeding from becoming widespread. A qualitative approach was used through open interviews with various socio-professional medical categories and community members. METHOD: Fourteen observations were made in the families. Twenty-four observations were made on the care of the newborn at home. Thirty-eight interviews with health and administrative staff and nine interviews with healers using traditional knowledge were also conducted. RESULTS: The results show that exclusive breastfeeding is complicated to implement particularly in rural areas because of the use of medicinal plants in the form of washing and gavage. Moreover, the information is not given to mothers of families at the appropriate time. CONCLUSION: In conclusion, we suggest that maternities be thought out and designed in partnership with the health workers who use them.

2.
Int Breastfeed J ; 15(1): 36, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375834

RESUMO

BACKGROUND: The total neonatal mortality in Tanzania remains high reaching as much as 44,900 deaths per year, particularly among low birthweight (LBW) babies. This makes Tanzania the fourth African country with the highest number of annual neonatal deaths. Studies have shown the advantages of breast milk for LBW babies and the effectiveness of interventions from healthcare workers (HCWs) to encourage mothers to achieve exclusive breastfeeding (EBF). Although these interventions can substantially reduce mortality in this vulnerable group, they remain insufficient in practice particularly in resource-limited countries. Therefore, there is an urgent need to establish the most appropriate interventions for mothers with LBW babies, particularly in these countries. To help address this need, we evaluated the breastfeeding care and education given to mothers with LBW babies by HCWs during hospitalization in Tanzania. METHODS: A qualitative study using semi-structured interviews with mothers of LBW babies at an urban hospital in Tanzania was conducted. We assessed their understanding of breastfeeding at discharge. All the interviews were conducted in local Swahili and then translated to English. Data were analyzed using content analysis. RESULTS: Among the 19 mothers interviewed, only four breastfed their baby within an hour after birth. Nine mothers received no support from HCWs when they breastfeed their baby for the first time. Ten mothers received no education on EBF, and there were mothers who misunderstood the EBF definition. Eight answered that they had difficulty breastfeeding their baby at discharge. Four mothers were dissatisfied with the care and education given by HCWs, and six mothers provided suggestions for improvements. Although six mothers had a high reliance on HCWs, they had difficulty asking HCWs questions because of their authoritative attitude and behavior. CONCLUSIONS: Mothers with LBW babies need special support to increase their ability to breastfeed and ensure EBF continuance. To address the gaps between the currently provided breastfeeding interventions and the ideal breastfeeding interventions, improvements in the quality and quantity of breastfeeding care and education are required. Training HCWs to systematize standard interventions, confirming mothers' understanding, and ensuring a comfortable environment for mothers are absolutely needed.

3.
BMC Pediatr ; 20(1): 214, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404193

RESUMO

BACKGROUND: Vitamin A supplementation (VAS) in the postpartum period improves the vitamin A concentration of breast milk and vitamin A status is an important predictor of childhood survival. It is also known that Vitamin A Deficiency (VAD) is more prevalent in HIV-infected women. This study investigated the association between vitamin A supplements provided to HIV-positive women in the postpartum period and mortality and morbidity of their breastfed infants in sub-Saharan Africa (SSA) where the prevalence of VAD and HIV is high. METHODS: This cross-sectional study was conducted based on the secondary data of 838 HIV-positive women (309 vitamin A supplement and 529 non-supplemented) extracted from the datasets of 43 Demographic and Health Surveys (DHS) conducted in 26 SSA countries between 2003 and 2015. The data of HIV-positive women who gave a live birth in the preceding 6 months of the survey and who were breastfeeding their infants at the time of the survey or who breastfed their deceased infants until the time of death, were included in the analysis. The association of postpartum VAS with early infant mortality (death in the first 6 months of birth) and morbidity secondary to fever, diarrhoea and cough with respiratory difficulties in the preceding 2 weeks was assessed by mixed-effects logistic regression model and interpreted using adjusted odds ratio (AOR) with the 95% confidence intervals (CI). RESULTS: About one-third (36.9%) of the HIV-positive women received VAS soon after the recent delivery. The early infant mortality rate per 1000 live births in vitamin A supplemented group was 100 (95% CI: 67-133) and the corresponding level for non-supplemented group was 125 (95% CI: 97-154). Yet, in the multivariable model adjusted for seven potential confounders, the association was not significant (AOR = 1.10: 95% CI, 0.57-2.13). Similarly, postpartum VAS was not significantly associated with the occurrence of cough with difficult breathing (AOR = 0.65: 95% CI, 0.39-1.10), diarrhoea (AOR = 0.89: 95% CI, 0.50-1.58) and fever (AOR = 1.19: 95% CI 0.78-1.82) in their breastfed infants. CONCLUSION: VAS provided to HIV-positive women in the immediate postpartum period does not have significant association with the mortality and morbidity of their breastfed infants.

4.
Int Breastfeed J ; 15(1): 27, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303233

RESUMO

BACKGROUND: WHO guidelines recommend breastfeeding for mothers living with HIV adherent to antiretroviral therapy in countries where formula is not accessible. In Canada and the US, guidelines for mothers living with HIV recommend exclusive formula feeding. Awareness of national infant feeding guidelines and socio-cultural factors influence infant feeding choices that may result in an increased risk of vertical transmission of HIV. The purpose of this paper is to present factors associated with awareness of guidelines among Black mothers living with HIV. Data were derived from a survey conducted as part of a recent international study that examined infant feeding practices among Black women living with HIV in Ottawa, Canada; Port Harcourt, Nigeria; and Miami, Florida. METHODS: Participants (n = 690) from Port Harcourt (n = 400), Miami (n = 201), and Ottawa (n = 89) were surveyed on their awareness of infant feeding guidelines for mothers living with HIV. Data were collected between November, 2016 and March, 2018. RESULTS: Participants' mean ages were 34.3 ± 5.9 years. Across all sites, 15.4% (95% CI 13.2, 7.7) of mothers were NOT aware of their country's infant feeding guidelines. Cultural beliefs (OR = 0.133, p = 0.004, 95% CI 0.03, 0.53) and functional social support influenced infant feeding choices (OR = 1.1, p = 0.034, 95% CI 1.01, 1.20) and were statistically significant predictors of guideline awareness (Χ2 = 38.872, p < .05) after controlling for age, years of formal education, marital status, and country of residence. As agents of functional social support, family members and health workers (e.g., nurses, physicians, social workers, other health care workers) influenced participants' awareness of infant feeding guidelines and guided them in their infant feeding choices. CONCLUSIONS: Among participants, awareness of national infant feeding guidelines was associated with functional social support and cultural beliefs influenced infant feeding choices. Therefore, culturally adapted messaging via social supports already identified by mothers, including family relationships and health workers, is an appropriate way to enhance awareness of infant feeding guidelines. Ultimately, contributing to the global health goals of maternal health and reduced infant mortality.

5.
Cochrane Database Syst Rev ; 4: CD013141, 2020 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-32266712

RESUMO

BACKGROUND: Recently conducted randomised controlled trials (RCTs) suggest that late commencement of parenteral nutrition (PN) may have clinical benefits in critically ill adults and children. However, there is currently limited evidence regarding the optimal timing of commencement of PN in critically ill term and late preterm infants. OBJECTIVES: To evaluate the benefits and safety of early versus late PN in critically ill term and late preterm infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (5 April 2019), MEDLINE Ovid (1966 to 5 April 2019), Embase Ovid (1980 to 5 April 2019), EMCare (1995 to 5 April 2019) and MEDLINE via PubMed (1966 to 5 April 2019). We searched for ongoing or recently completed clinical trials, and also searched the grey literature and reference lists of relevant publications. SELECTION CRITERIA: We included RCTs comparing early versus late initiation of PN in term and late preterm infants. We defined early PN as commencing within 72 hours of admission, and late PN as commencing after 72 hours of admission. Infants born at 37 weeks' gestation or more were defined as term, and infants born between 34 and 36+6 weeks' gestation were defined as late preterm. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials, extracted the data and assessed the risk of bias. Treatment effects were expressed using risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous data. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: Two RCTs were eligible for inclusion. Data were only available from a subgroup (including 209 term infants) from one RCT in children (aged from birth to 17 years) conducted in Belgium, the Netherlands and Canada. In that RCT, children with medium to high risk of malnutrition were included if a stay of 24 hours or more in the paediatric intensive care unit (PICU) was expected. Early PN and late PN were defined as initiation of PN within 24 hours and after day 7 of admission to PICU, respectively. The risk of bias for the study was considered to be low for five domains and high for two domains. The subgroup of term infants that received late PN had significantly lower risk of in-hospital all-cause mortality (RR 0.35, 95% confidence interval (CI) 0.14 to 0.87; RD -0.10, 95% CI -0.18 to -0.02; number needed to treat for an additional beneficial outcome (NNTB) = 10; 1 trial, 209 participants) and neonatal mortality (death from any cause in the first 28 days since birth) (RR 0.29, 95% CI 0.10 to 0.88; RD -0.09, 95% CI -0.16 to -0.01; NNTB = 11; 1 trial, 209 participants). There were no significant differences in rates of healthcare-associated blood stream infections, growth parameters and duration of hospital stay between the two groups. Neurodevelopmental outcomes were not reported. The quality of evidence was considered to be low for all outcomes, due to imprecision (owing to the small sample size and wide confidence intervals) and high risk of bias in the included studies. AUTHORS' CONCLUSIONS: Whilst late commencement of PN in term and late preterm infants may have some benefits, the quality of the evidence was low and hence our confidence in the results is limited. Adequately powered RCTs, which evaluate short-term as well as long-term neurodevelopmental outcomes, are needed.

6.
J Hum Lact ; : 890334420906837, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32142401

RESUMO

In the late 19th century, physicians in the United States and Europe grew concerned about an increasingly visible subset of infant mortality: sudden infant death. Over the next 100 years, physicians worked variably to combat the problem, modifying and refining their conceptions of sudden infant mortality many times over the process. Physicians' overlapping revisions of sudden infant mortality ultimately helped to produce the categorization of Sudden Infant Death Syndrome (SIDS), and their ensuing, fluctuating efforts to resolve this problem shed light on social and medical perceptions of the roles that biology, the environment, and infant care practices played in sudden infant death. SIDS's official medical classification was a watershed; not only did the formal medical label establish its "authenticity" as a medical phenomenon, but the label also asserted the inexplicability of (at least some) sudden infant death episodes while simultaneously conveying that affected parents were deserving victims of a tragic loss. In the modern history of sudden infant death in the United States, breastfeeding, in particular, was understood variably as a possible cause for unnecessary infant mortality in the decades surrounding 1900; inconsequential to the occurrence of SIDS in the mid 1900s; and finally as an important and healthful way to reduce the risk for SIDS beginning in the late 1900s.

7.
Nutrients ; 12(3)2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32164187

RESUMO

Undernutrition is associated with 45% of total infant deaths, totalling 2.7 million globally per year. The vast majority of the burden is felt in low- and middle-income countries (LMICs). This review aims to assess the effectiveness of infant and young child feeding (IYCF) interventions. We searched multiple databases including Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE. Title/abstract screening and full-text screening and data extraction filtered 77 studies for inclusion. Breastfeeding education interventions (n = 38) showed 20% increase in rates of early initiation of breastfeeding, 102% increase in exclusive breastfeeding (EBF) at 3 months and 53% increase in EBF at 6 months and 24% decreases in diarrheal diseases. Complementary feeding education intervention (n=12) showed a 0.41 standard deviation (SD) increase in WAZ, and 0.25 SD in HAZ in food secure setting. Complementary food provision with or without education (n=17) showed a 0.14 SD increase in HAZ and 36% decrease in stunting. Supplementary food interventions (n=12) showed a significant 0.15 SD increase in WHZ. Subgroup analyses showed healthcare professional led interventions were largely more effective, especially on breastfeeding outcomes. We believe this is a comprehensive review of the existing literature on IYCF studies in LMICs. Though breastfeeding education is well supported in its effectiveness on breastfeeding practices, limited evidence exists for growth outcomes. Supplementation interventions seem to have better effects at improving growth. However, more research is required to reach more substantial conclusions.

8.
J Glob Health ; 10(1): 010501, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32082545

RESUMO

Background: Reductions in neonatal mortality remain stagnant, despite gains in health care access and utilization. Nutrition interventions during antenatal care (ANC) and in the immediate postpartum period are associated with improved neonatal outcomes. Adjusting coverage estimates for the quality of care provided yields greater insight into health system performance and potential population health benefits of accessing care. In this cross-sectional study, we adjust maternity care coverage measures for quality of nutrition interventions to determine the impact on infant birth weight and breastfeeding. Methods: We used household data from the Malawi 2013-2014 Multiple Indicator Cluster Survey to assess use of maternal health services and direct observations of ANC and delivery from the 2013 Service Provision Assessment to measure nutrition interventions provided. We adjusted coverage measures combining self-reported utilization of care with the likelihood of receipt of nutrition interventions. Using adjusted log-linear regression, we estimated the associations of these nutrition quality-adjusted metrics with infant birthweight and immediate breastfeeding. Results: Health facility data provided over 2500 directly observed clinical encounters and household data provided 7385 individual reports of health care utilization and outcomes. Utilization of ANC and facility-delivery was high. Women received nutrition-related interventions considerably less often than they sought care: over the course of ANC women received a median of 1.6 interventions on iron, 1 instance of nutrition counseling, and 0.06 instances of breastfeeding counseling. Nutrition quality-adjusted ANC coverage was associated with a reduced risk of low birthweight (adjusted relative risk [ARR] 0.87, 95% confidence interval (CI) = 0.79, 0.96) and increased likelihood of immediate breastfeeding (ARR = 1.04, 95% CI = 1.02, 1.07); nutrition quality-adjusted post-delivery care was also associated with greater uptake of immediate breastfeeding (ARR = 1.08, 95% CI = 1.02, 1.14). Based on these models, delivering nutrition interventions consistently within the existing level of coverage would decrease population prevalence of low birthweight from 13.7% to 10.8% and increase population prevalence of immediate breastfeeding from 75.9% to 86.0%. Conclusions: Linking household survey data to health service provision assessments demonstrates that despite high utilization of maternal health services in Malawi, low provision of nutrition interventions is undermining infant health. Substantial gains in newborn health are possible in Malawi if quality of existing services is strengthened.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição Materna , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Malaui , Gravidez , Qualidade da Assistência à Saúde
9.
Hum Nat ; 31(1): 43-67, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31898017

RESUMO

Variation in the durations of exclusive breastfeeding (exBF) and any breastfeeding (anyBF) is associated with socioecological factors. This plasticity in breastfeeding behavior appears adaptive, but the mechanisms involved are unclear. With this concept in mind, we investigated whether durations of exBF and anyBF in a rural Maya population covary with markers of a form of socioecological change-market integration-and whether individual factors (individual learning, physiological plasticity) and/or learning from others in the community (social learning, norm adherence) mediate these changes. Using data from 419 mother-child pairs from two Guatemalan Maya villages, we fit a bivariate linear mixed model. The model compared exBF and anyBF among children from households of varying degrees of market integration whose mothers follow what we inferred to be local infant-feeding norms. It controlled for other factors expected to affect breastfeeding durations. We found evidence that exBF is associated with whether mothers follow their population's infant feeding norms, but no evidence that exBF is associated with the household's level of market integration. Conversely, anyBF is significantly associated with the household's market integration, but not with the villages' inferred norms. Because deviations from exBF norms are likely to result in infant mortality and reduced fitness, we hypothesize that the incentive to conform is relatively strong. Relatively greater individual plasticity in anyBF allows mother-child pairs to tailor it to socioecological conditions. Deviations from anyBF norms may be tolerated because they may provide later-life health/fitness payoffs, while posing few risks to infant survival.

10.
BMC Pediatr ; 20(1): 40, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996186

RESUMO

BACKGROUND: In Canada alone, almost 3000 VLBW infants are born and treated annually with almost 1200 going onto death or survival with severe brain injury, chronic lung disorders, aggressive retinopathy of prematurity, late-onset sepsis, or significant necrotizing enterocolitis. Lactoferrin is an antimicrobial, antioxidant, anti-inflammatory iron-carrying, bifidogenic glycoprotein found in all vertebrates and in mammalian milk, leukocytes and exocrine secretions. Lactoferrin aids in creating an environment for growth of beneficial bacteria in the gut, thus reducing colonization with pathogenic bacteria. It is hypothesized that oral bovine lactoferrin (bLF), through its antimicrobial, antioxidant and anti-inflammatory properties, will reduce the rate of mortality or major morbidity in very low birth weight preterm infants. METHOD: Lactoferrin Infant Feeding Trial_Canada (LIFT_Canada) is a multi-centre, double-masked, randomized controlled trial with the aim to enroll 500 infants whose data will be combined with the data of the 1542 infants enrolled from Lactoferrin Infant Feeding Trial_Australia/New Zealand (LIFT_ANZ) in a pooled intention-to-treat analysis. Eligible infants will be randomized and allocated to one of two treatment groups: 1) a daily dose of 200 mg/kg bLF in breast/donor human milk or formula milk until 34 weeks corrected gestation or for a minimum of 2 weeks, whichever is longer, or until discharge home or transfer, if earlier; 2) no bLF with daily feeds. The primary outcome will be determined at 36 weeks corrected gestation for the presence of neonatal morbidity and at discharge for survival and treated retinopathy of prematurity. The duration of the trial is expected to be 36 months. DISCUSSION: Currently, there continues to be no clear answer related to the benefit of bLF in reducing mortality or any or all of the significant neonatal morbidities in very low birth weight infants. LIFT_Canada is designed with the hope that the pooled results from Australia, New Zealand, and Canada may help to clarify the situation. TRIAL REGISTRATION: Clinical Trials.Gov, Identifier: NCT03367013, Registered December 8, 2017.

12.
JPEN J Parenter Enteral Nutr ; 44(1): 92-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31062377

RESUMO

BACKGROUND: Oropharyngeal administration of mother's colostrum in early days has an immunoprotective effect in preterm infants. OBJECTIVES: Our aim was to study the effect of oropharyngeal administration of mother's milk (OPAMM) on decreasing the incidence of nosocomial sepsis. METHODS: In a pilot prospective randomized study on preterm (<32 weeks gestation and 1500 g weight) infants, we compared OPAMM practice (applying 0.2 mL of mother's colostrum or milk prior to gavage feeding until full oral feeding is reached) with regular gavage feeding. The primary outcome was incidence of culture-proven nosocomial sepsis. Secondary outcomes included bacterial colonization of the gastrointestinal tract, feeding intolerance, time to reach full feeding, incidence of necrotizing enterocolitis, ventilator-associated pneumonia, duration of respiratory support, incidence of bronchopulmonary dysplasia (BPD), length of hospital stay, and neonatal mortality. RESULTS: The outcomes of 200 neonates (100 in each group) were analyzed. OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis (8% vs 13%, P = 0.35). Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch, borderline lower incidence of ventilator-associated pneumonia, shorter duration of oxygen therapy, less episodes of feeding intolerance, reached full feeding earlier, and had a shorter length of hospital stay. OPAMM practice did not affect the incidence of necrotizing enterocolitis, BPD, or neonatal mortality. CONCLUSION: OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding, and early hospital discharge in preterm very low-birth-weight infants.

13.
J Pediatr ; 218: 11-15, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31753326

RESUMO

OBJECTIVE: To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth. STUDY DESIGN: Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. RESULTS: Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. CONCLUSION: Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts.

14.
J Pediatr Nurs ; 50: e62-e68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31862130

RESUMO

PURPOSE: The infant mortality rate in Pakistan is one of the highest in the world with most cases attributed to diarrheal or respiratory diseases. Exclusive breastfeeding for the first 6 months of life is recommended by the World Health Organization to achieve optimal growth and health, however, in Pakistan the rate of exclusive breastfeeding by mothers is <40%. The aim of this study was to investigate the relationship of exclusive breastfeeding, diarrhea, acute respiratory infections and fever among infants under the age of 6 months. DESIGN AND METHODS: The cross-sectional study analyzed secondary data from the 2017-18 Pakistan Demographic and Health-Survey. The sampling frame for the current study consisted of last-born children who were under the age of 6 months. The study sample consisted of 1033 infants under the age of 6 months. RESULTS: The prevalence of exclusive breastfeeding was 53.6%. Compared to infants who were not breastfed exclusively, infants who were had lower odds of diarrhea, acute respiratory infection, and fever. The observed association was independent of potential confounders. CONCLUSIONS: Exclusive breastfeeding reduces the odds of childhood illnesses. Plausible explanations for the observed association may be related to human milk's contents including necessary nutrients to fulfill an infant's needs within first months of life. Additionally, continued exposure to breastfeeding also reduces exposure to other contaminated foods to ensure adequate nutrition for the infant. PRACTICE IMPLICATIONS: The findings have important implications for educating families and healthcare providers about the benefits of exclusive breastfeeding for optimal child health outcomes.

15.
Cad. Saúde Pública (Online) ; 36(3): e00189717, 2020. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1089441

RESUMO

Objetiva-se descrever as consequências no aleitamento e na alimentação que terão as crianças órfãs menores de cinco anos em decorrência da morte materna, aplicando-se softwares livres de mineração de texto. Estudo transversal com base em artigos publicados nos repositórios PubMed e BIREME nos temas de morte materna e crianças órfãs. Foram selecionados dez artigos publicados entre 2005 e 2015, de acesso livre, nos quais foram lidos apenas o título ou o resumo e que cumpriam com os critérios. Os arquivos de texto definiram o corpus para análise de conteúdo semiestruturado. Palavras-chave foram incluídas para a mineração. A análise do corpus foi feita com TagCrowd e Textalyser para encontrar os termos mais e menos frequentes, AntConc e Voyant Tools, para extrair palavras-chave na análise de contexto. Foram analisadas 67.642 palavras em dez textos semiestruturados. Os termos CHILDREN (827) e DEATH (821) foram os mais frequentes, e os menos frequentes foram BREASTFEEDING (10) e NUTRITION (4). Foram encontradas 44 concordâncias para o termo raiz BREAST* e 25 para a palavra NUTRITION em orações como: "crianças órfãs têm o aumento de risco de mortalidade por falta de amamentação, e são mais susceptíveis às infecções". As sentenças de concordância apontam que a mudança no aleitamento materno conduz a uma nutrição pobre, o que deixa o recém-nascido exposto a infecções, aumentando o risco de morte. O processamento de texto com as ferramentas livres foi rápido e permitiu extrair informações úteis e compreensíveis; a análise dos dez artigos mostrou as consequências na alimentação da criança após a morte materna, tendo efeito na morbidade e mortalidade infantil.


The study aims to describe the consequences for future feeding of orphans under five years of age, following the mother's death, applying open-access text mining software packages. This was a crosscutting study of articles indexed in PubMed and BIREME on the themes of maternal death and orphan children. We selected ten open-access articles published from 2005 to 2015 in which only the title or abstract were read and which met the selection criteria. The text files determined the corpus for analysis of the semi-structured content. Keywords were included for the mining. Analysis of the corpus used TagCrowd and Textalyser to analyze the more versus less frequent terms, and AntConc and Voyant Tools were used to extract keywords in the context analysis. A total of 67,642 words were analyzed in ten semi-structured texts. The terms CHILDREN (827) and DEATH (821) were the most frequent, while the least frequent were BREASTFEEDING (10) and NUTRITION (4). We found 44 concordances for the root term BREAST* and 25 for the word NUTRITION in phrases such as "orphan infants have increased risk of mortality due to lack of breastfeeding and are more susceptible to infections". The concordant sentences indicate that the change away from maternal breastfeeding leads to poor nutrition and leaves the child more susceptible to infections, increasing the risk of death. Text processing with open-access tools was rapid and allowed extracting useful and comprehensible information; analysis of the ten articles showed the consequences for the child's feeding after the mother's death, affecting infant morbidity and mortality.


El objetivo del trabajo fue describir las consecuencias en la lactancia y la alimentación que tendrán los niños huérfanos menores de cinco años, como consecuencia de la muerte materna, aplicando softwares libres de minería de textos. Se trata de un estudio transversal, a partir de los artículos publicados en los repositorios PubMed y BIREME, sobre los temas muerte materna y niños huérfanos. Se seleccionaron diez artículos, publicados entre 2005-2015, de acceso libre en los que se había leído solamente el título o el resumen y que cumplían con los criterios. Los archivos de texto definieron el corpus para el análisis de contenido semiestructurado. Se incluyeron palabras claves para la minería. El análisis del corpus se realizó con TagCrowd y Textalyser para el análisis de los términos más y menos frecuentes, AntConc y Voyant Tools, para extraer palabras-clave en el análisis de contexto. Se analizaron 67.642 palabras en diez textos semiestructurados. Los términos CHILDREN (827) y DEATH (821) fueron los más frecuentes, mientras que los menos frecuentes fueron BREASTFEEDING (10) y NUTRITION (4). Se encontraron 44 concordancias para el término raíz BREAST* y 25 para la palabra NUTRITION en oraciones como: "niños huérfanos tienen aumento de riesgo de mortalidad por ausencia de la lactancia, siendo más susceptibles a las infecciones". Las frases de concordancia indican que el cambio en la lactancia materna conduce a una nutrición pobre, dejando al recién nacido expuesto a infecciones e incrementándose el riesgo de muerte. El procesamiento de texto con las herramientas libres fue rápido y permitió extraer información útil y comprensible; el análisis de los diez artículos mostró las consecuencias en la alimentación del niño tras la muerte materna, teniendo un efecto en la morbilidad y mortalidad infantil.

16.
JAMA Netw Open ; 2(12): e1916722, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31800070

RESUMO

Importance: Nearly 4 in 10 expectant mothers in the United States received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy between 2011 and 2017. Despite public support for the program, empirical evidence of the success of the program varies substantially. Objective: To assess the association of WIC program participation during pregnancy by low-income expectant mothers covered by Medicaid with infant mortality by gestational age at birth and by maternal race/ethnicity in comparison with their counterparts who did not receive WIC benefits. Design, Setting, and Participants: This cohort study obtained data from January 1, 2011, to December 31, 2017, from US live birth certificates. Data were from 11 148 261 expectant mothers who delivered live births in states that have implemented the 2003 revision of the US live birth certificate and whose insurance coverage and receipt of WIC benefits were recorded on the birth certificates. Data analysis was performed from June 2019 to October 2019. Exposures: Receipt of WIC benefits during pregnancy. Main Outcomes and Measures: The first outcome was gestational age at birth: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate-to-late preterm (32-37 weeks), and normal term (≥37 weeks) births. The second outcome was death within the first year of life. Results: Among the 11 148 261 expectant mothers who delivered live births between 2011 and 2017 and were covered by Medicaid during pregnancy, the modal age at delivery was 20 to 24 years, the predominant race/ethnicity was non-Hispanic white (4 257 790 [38.2%]), and 8 145 770 (73.1%) received WIC benefits during pregnancy. The proportion of expectant mothers covered by Medicaid who also received WIC benefits decreased from 2011 to 2017 (79.3% to 67.9%; P < .001). The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy (adjusted proportional odds ratio, 0.87; 95% CI, 0.86-0.87). The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy (adjusted odds ratio, 0.84; 95% CI, 0.83-0.86). Conclusions and Relevance: This study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality.

17.
BMC Pregnancy Childbirth ; 19(1): 507, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852432

RESUMO

BACKGROUND: Early postpartum facility discharge negatively impacts mothers' proper and effective use postnatal care. Cognizant of these facts, home-based postnatal care practices have been promoted to complement facility-based care to reduce neonatal mortality. This systematic review evaluated the effectiveness and cost-effectiveness of home-based postnatal care on exclusive breastfeeding practice and neonatal mortality in low-and-middle-income countries. METHODS: Randomized trials and quasi-experimental studies were searched from electronic databases including PubMed, Popline, Cochrane Central Register of Controlled Trials and National Health Service Economic Evaluation databases. Random-effects meta-analysis model was used to pool the estimates of the outcomes accounting for the variability among studies. RESULTS: We identified 14 trials implementing intervention packages that included preventive and promotive newborn care services, home-based treatment for sick neonates, and community mobilization activities. The pooled analysis indicates that home-based postpartum care reduced neonatal mortally by 24% (risk ratio 0.76; 95% confidence interval 0.62-0.92; 9 trials; n = 93,083; heterogeneity p < .01) with no evidence of publication bias (Egger's test: Coef. = - 1.263; p = .130). The subgroup analysis suggested that frequent home visits, home visits by community health workers, and community mobilization efforts with home visits, to had better neonatal survival. Likewise, the odds of mothers who exclusively breastfed from the home visit group were about three times higher than the mothers who were in the routine care group (odds ratio: 2.88; 95% confidence interval: 1.57-5.29; 6 trials; n = 20,624 mothers; heterogeneity p < .01), with low possibility of publication bias (Coef. = - 7.870; p = .164). According to the World Health Organization's Choosing Interventions that are Cost-Effective project recommendations, home-based neonatal care strategy was found to be cost-effective. CONCLUSIONS: Home visits and community mobilization activities to promote neonatal care practices by community health workers is associated with reduced neonatal mortality, increased practice of exclusive breastfeeding, and cost-effective in improving newborn health outcomes for low-and-middle-income countries. However, a well-designed evaluation study is required to formulate the optimal package and optimal timing of home visits to standardize home-based postnatal interventions.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Utilização de Instalações e Serviços/economia , Serviços de Assistência Domiciliar/economia , Mortalidade Infantil , Cuidado Pós-Natal/economia , Adulto , Serviços de Saúde Comunitária/economia , Agentes Comunitários de Saúde/economia , Análise Custo-Benefício , Países em Desenvolvimento , Feminino , Visita Domiciliar/economia , Humanos , Renda , Lactente , Recém-Nascido , Ensaios Clínicos Controlados não Aleatórios como Assunto , Cuidado Pós-Natal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Cochrane Database Syst Rev ; 2019(11)2019 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-31697857

RESUMO

BACKGROUND: Preterm infants who are fed breast milk in comparison to infant formula have decreased morbidity such as necrotizing enterocolitis. Multi-nutrient fortifiers used to increase the nutritional content of the breast milk are commonly derived from bovine milk. Human milk-derived multi-nutrient fortifier is now available, but it is not clear if it improves outcomes in preterm infants fed with breast milk. OBJECTIVES: To determine whether the fortification of breast milk feeds with human milk-derived fortifier in preterm infants reduces mortality, morbidity, and promotes growth and development compared to bovine milk-derived fortifier. SEARCH METHODS: We searched the following databases for relevant trials in September 2018. Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 9), electronic journal reference databases including MEDLINE (1980 to 20 September 2018), PREMEDLINE, Embase (1974 to 20 September 2018), CINAHL (1982 to 20 September 2018), biological abstracts in the database BIOSIS and conference abstracts from 'Proceedings First' (from 1992 to 2011). We also included the following clinical trials registries for ongoing or recently completed trials: ClinicalTrials.gov (ClinicalTrials.gov), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP; www.whoint/ictrp/search/en/) and the ISRCTN Registry (www.isrctn.com/), and abstracts of conferences: proceedings of Pediatric Academic Societies (American Pediatric Society, Society for Pediatric Research and European Society for Paediatric Research) from 1990 in the 'Pediatric Research' journal and 'Abstracts online' (2000 to 2017). SELECTION CRITERIA: We included randomized and quasi-randomized controlled trials that compared preterm infants fed breast milk fortified with human milk-derived fortifier versus those fed with breast milk fortified with bovine milk-derived fortifier. DATA COLLECTION AND ANALYSIS: The data were collected using the standard methods of Cochrane Neonatal. Two authors evaluated trial quality of the studies and extracted data. We reported dichotomous data using risk ratios (RRs), risk differences (RDs), number needed to treat (NNT) where applicable, and continuous data using mean differences (MDs). We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: One randomized trial with 127 infants met the eligibility criteria and had low risk of bias. Human milk-based fortifier did not decrease the risk of necrotizing enterocolitis in exclusively breast milk-fed preterm infants (RR 0.95, 95% CI 0.2 to 4.54; 1 study, 125 infants, low certainty of evidence). Human milk-derived fortifiers did not improve growth, decrease feeding intolerance, late-onset sepsis, or death. AUTHORS' CONCLUSIONS: There is insufficient evidence evaluating human milk-derived fortifier with bovine milk-derived fortifier in exclusively breast milk-fed preterm infants. Low-certainty evidence from one study suggests that in exclusively breast milk-fed preterm infants human milk-derived fortifiers in comparison with bovine milk-derived fortifier may not change the risk of necrotizing enterocolitis, mortality, feeding intolerance, infection, or improve growth. Well-designed randomized controlled trials are needed to evaluate short-term and long-term outcomes.


Assuntos
Enterocolite Necrosante/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Animais , Bovinos , Alimentos Fortificados , Humanos , Lactente , Fórmulas Infantis , Recém-Nascido , Leite , Leite Humano , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/prevenção & controle
19.
Lima; Perú. Ministerio de Salud; 3 ed; 20191100. 52 p. ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1026361

RESUMO

La publicación describe los criterios conceptuales, metodológicos e instrumentales para desarrollar la consejería en lactancia materna que apoye y facilite el ejercicio del derecho de las madres a amamantar a sus niñas y niños hasta los dos años o más, con la finalidad de contribuir con la reducción de la morbi-mortalidad infantil, el desarrollo integral de la niña, el niño y la madre, y la mejora de su calidad de vida


Assuntos
Comportamento de Sucção , Aleitamento Materno , Substitutos do Leite Humano , Nutrição Materna , Promoção da Saúde
20.
Asian Pac Isl Nurs J ; 4(3): 108-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583265

RESUMO

Purpose: Early initiation of breastfeeding (EIBF) significantly decreases neonatal mortality and improves exclusive breastfeeding. The objective of the present study was to assess the effect of lactation support program (LSP) on early initiation of breastfeeding (BF) among term well infants. Methods: A "before-and-after" design was used to study the effect of the LSP on EIBF at a tertiary care institute in India over a period of two and half years. EIBF was defined as BF initiated <1 hour in vaginal delivery (VD) and <2 hours in cesarean section (CS). Impact of LSP was assessed by comparing baseline data (control group) with data after initiation of LSP (study group). Even after 1 year of initiation of LSP, EIBF in CS remained low, hence a hospital policy was implemented to alter a modifiable factor to promote EIBF in CS. Data of the study group was analyzed over two time periods, as study group A (prior to implementation of hospital policy) and study group B (following the commencement of hospital policy). Results: A total of 2,769 postnatal mothers were included for the study with 537 in the control group, 1,157 in study group A, and 1,075 in study group B. In VD, EIBF rate increased significantly from 92.6% at baseline to 99.8% and 99.6%, in study group A and study group B, respectively (p value < 0.001). In CS, EIBF rate increased from 0.4% at baseline to 1.9% and 92.7% in study group A and study group B, respectively (p < 0.001). The time of initiation of BF reduced from 1.3 (0.9) to 0.7 (0.3) hours in VD and from 4.2 (0.71) to 1.8 (0.66) hours in CS with both having a p value of < 0.001. Conclusion: Lactation support program is a simple but effective way of implementing appropriate steps towards promotion of exclusive BF.

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