Hand Washing Practice and Food Insecurity are Associated With Undernutrition of Breastfeeding Mothers in Rural Ethiopia: A Cross-sectional Study.

Background: Breastfeeding mothers are prone to undernutrition. However, factors contributing to maternal undernutrition are not exhaustively understood. Hence, this study aimed to determine prevalence of undernutrition among breastfeeding mothers and identify associated factors. Methods: A cross-sectional study was conducted among 606 breastfeeding mothers from selected rural districts in Oromia and Sidama regional states of Ethiopia. Data were collected through an interviewer-administered questionnaire. Nutritional status was assessed using body mass index (BMI) and mid-upper-arm-circumference (MUAC). Logistic regression analysis was used to identify factors associated with maternal undernutrition. Results: One out of ten breastfeeding mothers was found undernourished as determined by BMI (12.6%) and MUAC (10.7%). Mothers who did not practice hand washing after cleaning children's bottom were 2 and 3 times more likely to be undernourished compared to their counters, as measured by BMI (AOR = 2.29, P = .002) and MUAC (AOR = 3.03, P < .001), respectively. Mothers living in mildly or moderately food insecure households (AOR = 2.37, P = .019) were more than two times more likely to be undernourished as determined by MUAC. Mothers who breastfed children in the age range of 9 to 11 (AOR = 2.79, P = .025) or 12 to 23 (AOR = 2.57, P = .018) months were more than two and half times more likely to be undernourished as determined by BMI. Conclusions: Maternal undernutrition is a medium-level public health problem in rural districts of Oromia and Sidama regional states in Ethiopia. The lack of hand washing practice after cleaning a child's bottom, household food insecurity and higher child age increased the odds of maternal undernutrition. Mothers should prioritize and improve their nutritional care as the age of their breastfed child increases. Nutrition programs in rural districts of Ethiopia should also aim to improve personal hygiene practices and food insecurity integrated with implementation researches to evaluate program's impact on nutritional status of breastfeeding mothers.

Assessment of the Baby-Friendly Hospital Initiative showed suboptimal knowledge and a low exclusive breastfeeding rate in Ogun State, Nigeria.

AIM: Implementing the Baby-Friendly Hospital Initiative (BFHI) programme has been fraught with challenges globally. The study aimed to assess the implementation of the BFHI and breastfeeding practices in healthcare facilities in Ogun State, Nigeria. METHODS: It was a questionnaire-based cross-sectional study carried out between August and October 2019 among 100 healthcare workers and 110 mothers from health facilities in Ijebu-Ode Local Government Area of Ogun State, Nigeria. RESULTS: Nearly two-thirds (61.0%) of the healthcare workers were community health workers while the others were nurses. Less than a quarter (23.8%) of the healthcare workers had ever attended breastfeeding educational programmes since they started working. About half of the healthcare workers had good knowledge, attitude and practice of BFHI. Nurses had a significantly better practice of BFHI than community health workers. Understaffing was a major limitation to the implementation of BFHI. The mothers had an exclusive breastfeeding rate of 47%. CONCLUSION: The knowledge, attitude, and practice of BFHI were suboptimal and the exclusive breastfeeding rate among the mothers was low. There is a need to improve staff strength, training and re-training of staff, as well as regular monitoring and evaluation of healthcare facilities on the implementation of BFHI.

The pattern of herbal medicines use for breastfeeding mother in Jogonalan, Klaten, Indonesia: a mini survey.

BACKGROUND AND OBJECTIVES: Indonesian society extensively uses herbal medicine due to its abundant natural resources that have been utilized for generations for health purposes. Herbal medicine is also employed by specific community groups, such as breastfeeding mothers, to address issues like low milk production. However, there has yet to be much research conducted on its usage patterns in the Jogonalan District, Klaten Regency, Indonesia. It is crucial to understand this aspect to gain an overview of herbal medicine utilization in the community, thus preserving local's healthy traditional culture and traditions and continuing their development. This study aims to describe the pattern of herbal medicine usage among breastfeeding mothers in the Jogonalan District, Klaten Regency, Central Java Province, Indonesia. METHODS: The quantitative descriptive study conducted as a mini survey to breastfeeding mothers who used herbs, visited minimal three (3) times in integrated service posts for babies/toddlers in the Jogonalan sub-district and agree to overcome the research. Calculating the frequency distribution was used to analyze the study's findings. The advantages and disadvantages of these results are evaluated in relation to the findings of earlier investigations. RESULTS AND CONCLUSIONS: The respondents were dominated housewives (84.4%), aged 20-35 years (71.1%), had secondary education (60.0%), and multiparous (66.7%). The daily use of uyub-uyub as a breast milk enhancer dominates the pattern of herbal medicine use. Papaya leaves, turmeric, and aromatic ginger are further herbal remedies. Nursing mothers' health and fitness and breastfed children's health is other advantages. The only adverse effects reported by three respondents (6.7%) were nausea and dizziness. Breastfeeding mothers can safely utilize evidence-based herbal medicines by increasing their knowledge, consulting with health professionals, and using them under supervision to preserve their use.

An assessment of Individual, community and state-level factors associated with inadequate iodised salt consumption among pregnant and lactating women in Nigeria.

BACKGROUND: Iodine deficiency is the most common cause of thyroid disease, and in its severe form can result in cretinism; the impairment of the brain development of a child. Pregnant and breastfeeding women's daily iodine requirement is elevated due to physiological changes in iodine metabolism, requiring up to double the iodine intake of other women. Although Nigeria was the first African country to be declared iodine sufficient in 2007, recent evidence has shown that only about seven in ten households consume salt with adequate iodine content (≥ 15 ppm), with variation across states. The study aimed to assess the Individual- and household-, community- and state-level factors associated with inadequate iodised salt consumption among pregnant women and breastfeeding mothers in Nigeria. METHODS: This study utilised the Multiple Indicator Cluster Survey to assess factors associated with inadequate iodised salt consumption among 4911 pregnant women and breastfeeding mothers in Nigeria. The descriptive analysis was presented using frequencies and percentages. The prevalence of adequate and inadequate iodised salt consumption with their 95% confidence interval were computed. Several multi-level mixed effect log-binomial logistic regressions were used to explore the factors associated with inadequate iodised salt consumption. The Loglikelihood, Akaike Information Criterion and Bayesian Information Criterion were used to assess the goodness of fit of the models. All analyses were adjusted for the complex survey design and analysed using Stata 15.0 at p < 0.05. RESULTS: The prevalence of inadequate iodised salt consumption among pregnant and breastfeeding mothers was 35.2% (95% CI: 33.1-37.5). Inadequate consumption of iodised salt was highest among pregnant and breastfeeding women aged 45-49 years (48.2%; 95%CI: 37.8-58.8), as well as those with non-formal education (52.7%; 95%CI: 47.7-57.6) and no education (34.6%; 95%CI: 31.3-38.1). Our findings revealed that pregnant and breastfeeding women living in the poorer, middle, richer and richest quintiles were 32%, 47%, 35% and 62% less likely to consume salt with inadequate iodine compared to those in the poorest households. Those with non-formal education were 1.8 times (95%CI: 1.36-2.42) more likely to consume salt with deficient iodine than those without education. Pregnant and breastfeeding mothers residing in moderately and most deprived communities were 3.5 (95%CI: 2.57-4.73) and 4.7 times (95%CI: 3.38-6.55) more likely to consume salt with inadequate iodine than those from least deprived communities. Women in the Northwestern region and those from the Southwestern region were 4.0 and 3.5 times, respectively, more likely to consume salt with inadequate iodine compared to pregnant and breastfeeding women residing in the North-Central region. CONCLUSIONS: The study has shown that inadequate consumption of iodised salt dominates among older pregnant and breastfeeding women. Also, women with non-formal education have higher prospects of consuming salt with lesser iodine. There is a need to enhance women's economic opportunities and empowerment as well as sensitisation on their nutritional requirements during pregnancy and breastfeeding. Both formal and non-formal educational initiatives on nutrition are extremely important and should be prioritised by the Nigerian government in its efforts to encourage the consumption of iodised salt among pregnant and lactating mothers. Additionally, health promotion interventions that seek to advocate iodised salt intake must be prioritised by the actors in the health sector.

Mother's Experience with COVID-19 in Breastfeeding: A Phenomenological Study.

Background: The COVID-19 pandemic has disrupted mothers' and children's access to essential health services. Concerns about the transmission of COVID-19 to infants resulted in strict procedures, which then caused delays in initial contact and breastfeeding. This delay then impacted the well-being of mothers and babies. Purpose: This study aimed to explore the experience of mothers with COVID-19 in breastfeeding. This study was qualitative research with a phenomenological approach. Methods: Participants were mothers with a confirmed history of COVID-19 during the breastfeeding period either in 2020, 2021, or 2022. Semi-structured in-depth interviews were conducted with 21 mothers. Data were analyzed using thematic analysis. Results: Three themes were obtained: breastfeeding during the mother was confirmed COVID-19, changes in the mother's condition, and social support received by the mother. Based on this theme, it can be seen that mothers are temporarily separated from their newborns, which causes breastfeeding difficulties. Mothers confirmed to have COVID-19 in 2020 and 2021 appear to have more significant concerns about transmitting COVID-19, as indicated by the mother's decision not to breastfeed and to undergo separate isolation with the baby. Conclusion: Mothers need support to continue to breastfeed. The benefits obtained from breastfeeding are far more significant than efforts to prevent transmission by separating mother and baby, so mothers should be encouraged to continue breastfeeding.

Acrylamide in human breast milk - the current state of knowledge.

Human milk is a first choice in infant nutrition. It not only provides all the nutrients necessary for the proper infant`s development but also contains bioactive factors that provide natural protection against infections. Unfortunately, chemical contaminants can pass to breast milk and pose a health risk for the breastfed infant's health. Acrylamide is a typical process contaminant and in food it is formed as a result of the Maillard reaction. Numerous studies have shown that acrylamide is a neurotoxic and carcinogenic compound. So far there have been published only three studies on the acrylamide content in human milk. In two of them, the acrylamide level in most of the tested samples did not exceed the value of 0.5 µg/L. In the third study, the authors assessed the circulation of acrylamide in the body of two breastfeeding women after consuming products with high acrylamide content. Depending on the time elapsed after the meal, the acrylamide content ranged from 3.17 µg/L to 18.8 µg /L. These studies show that the breastfeeding mothers' diet may have a significant influence on the level of acrylamide in their milk. However, it seems that the acrylamide content in breast milk is also influenced by the time of breast milk collection, including the time elapsed after the mother's meal. To assess the exposure of breastfed infants to acrylamide in human milk, more data is needed on the acrylamide content in human milk at different stages of lactation and using standard protocols for human milk sampling.

The association of maternal dietary quality and the antioxidant-proxidant balance of human milk.

BACKGROUND: Human milk composition varies over time within an individual mother as well as between lactating mothers due to several factors including maternal health, diet, and nutritional status. Therefore, improving nutrition status during gestation and breastfeeding is crucial for improving the health of both mothers and infants. Diet can enhance the oxidant-antioxidant balance of human milk. This study aimed to investigate the association between human milk oxidant-antioxidant balance with dietary patterns of lactating mothers identified by using principal component analysis. METHOD: This cross-sectional study included 350 breastfeeding women between the ages of 20 to 35 years. The dietary intakes of the women in the study were estimated using a validated food frequency questionnaire, which included 65 food items. The oxidant-antioxidant balance of milk samples was assessed using the ferric reducing antioxidant power (FRAP), 2, 2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Ellman's assay. The milk concentration of total protein, calcium, and triglyceride was also measured using commercial kits. RESULT: Two predominant dietary patterns were recognized that we defined as a healthy and unhealthy pattern. There were higher levels of DPPH and thiol in the milk from mothers in the third tertile (highest adherence) of a healthy dietary pattern compared to the first tertile (lowest adherence; p < 0.05). Milk calcium and thiol were significantly lower in the third tertile of mothers with an unhealthy dietary pattern versus the first tertile (P < 0.05). In multivariate multinomial logistic regression analyses adjusted for mother's age, body mass index (BMI), energy intake, and infant's sex, adherence to a healthy dietary pattern was associated with higher levels of milk DPPH (OR = 1.32, 95% confidence interval (CI): 1.01, 1.80) and milk thiol (OR = 1.21, 95% CI: 1.10, 1.50). On the other adherence to the unhealthy dietary pattern was correlated with low levels of milk thiol (OR = 1.29; 95%CI: 1.09, 1.59) and milk calcium (OR = 1.28; 95%CI: 1.11, 1.55). CONCLUSION: Our findings demonstrated that adherence to a healthy dietary pattern, identified by higher consumption of green vegetables, other vegetables, and fruits is associated with a higher milk oxidant-antioxidant status in breastfeeding mothers.

The effect of intra-vaginal oxytocin on sexual function in breastfeeding mothers: a randomized triple-blind placebo-controlled trial.

BACKGROUND: Considering the importance of sexual function, high prevalence of sexual dysfunction (especially dyspareunia caused by atrophic vaginitis) in breastfeeding women, and lack of effective interventions, the present research aimed to determine the effect of oxytocin (OXT) vaginal gel on sexual function (primary outcome), sexual satisfaction, and depression (secondary outcomes) in the breastfeeding women. METHODS: This randomized triple-blind controlled trial was conducted on 64 breastfeeding women who referred to health centers in the city of Tabriz, Iran, in 2020-21. Participants were equally assigned to intervention/control groups using block randomization. 200 IU of OXT vaginal gel was given to the participants in the intervention group daily for eight week and the same protocol was carried out for the control group with placebo. Standard questionnaires of Female Sexual Function Index (FSFI), Edinburgh Postpartum Depression Scale (EPDS) and Sexual satisfaction scale for women (SSSW) were completed at baseline and 8 weeks after intervention. ANCOVA test was used to compare post-intervention mean score of the groups, adjusted for the baseline values. RESULTS: After intervention, there was no statistically significant difference between groups in terms of mean total score of FSFI (Adjusted Mean Difference (AMD): 1.14; 95% Confidence Interval (95% CI): -1.28 to 9.16; P= 0.349) and sexual satisfaction (AMD: 5.01; 95% CI: -0.53 to 10.56; P= 0.075). However, there was statistically significant difference between the groups in terms of mean scores of sexual contentment (AMD: 1.56; 95% CI: 0.29 to 2.83; P = 0.017) and depression (AMD: -1.90; 95% CI: -1.27 to -2.54; P < 0.001). One participant in the OXT group and one participant in the placebo group reported mild uterine contraction and one person in the placebo group reported vaginal burning sensations. CONCLUSIONS: No evidence was found for the effects of OXT gel in the improvement of FSFI, even though, OXT significantly improved sexual satisfaction in the domain of contentment, and improved the symptoms of depression in comparison to the placebo group. However, a definite conclusion requires more research in this regard. TRIAL REGISTRATION: the Iranian Registry of Clinical Trials (IRCT), code: IRCT20120718010324N55 , Date of registration: 27/05/2020, URL: https://en.irct.ir/user/trial/44986/view .

A systematic review of qualitative research on barriers and facilitators to exclusive breastfeeding practice in sub-Saharan African countries.

BACKGROUND: Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers' perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers' perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding. METHODS: A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies' quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically. RESULTS: After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study's limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers' understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761. CONCLUSIONS: This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.

Profiles of Human Milk Oligosaccharides and Their Relations to the Milk Microbiota of Breastfeeding Mothers in Dubai.

The composition of human breast milk is affected by several factors, including genetics, geographic location and maternal nutrition. This study investigated the human milk oligosaccharides (HMOs) of breastfeeding mothers living in Dubai and their relations with the milk microbiota. A total of 30 breast milk samples were collected from healthy Emirati and UAE-expatriates at Latifa Hospital. HMO profiling was performed using UHPLC-MS. Microbiota profiles were determined by sequencing amplicons of the V3-V4 region of the 16S rRNA gene. HMO concentrations were significantly higher in Emirati, and dropped with the lactation period in both groups of mothers. The Le (a-b+)-secretor (Le+Se+) type was the most abundant in Dubai mothers (60%), followed by the Le(a-b-)-secretor (Le-Se+) type (23%). Bifidobacterium and Lactobacillus were considerably lower in Dubai-based mothers, while Pseudomonas and Delftia (Hydrogenophaga) were detected at a higher abundance compared to mothers from other countries. Atopobium was correlated with sialyl-lacto-N-tetraose c, Leptotrichia and Veillonella were correlated with 6'-sialyl-lactose, and Porphyromonas was correlated with lacto-N-hexaose. The study highlights the HMO profiles of breastfeeding mothers in Dubai and reveals few correlations with milk microbial composition. Targeted genomic analyses may help in determining whether these differences are due to genetic variations or to sociocultural and environmental factors.

Human milk contamination by nine organochlorine pesticide residues (OCPs).

Organochlorine pesticides (OCPs) are widely used around the world as insecticides, herbicides, fungicides, nematicides, and rodenticides. Despite banned in Brazil, the usage remains occurring in many countries. The persistence and extreme mobility of OCPs contribute to the contamination of the environment and the human body. The OCPs bioaccumulation in adipose tissue triggers the excretion into human milk during breastfeeding. Hence, the present study determined eighteen OCPs residues in the breast milk of mothers from the Western Region of Bahia State, Brazil. Nine different residue species were found, including beta-Hexachlorocyclohexane (9.24 ± 0.00 ng g-1 fat), delta- Hexachlorocyclohexane (22.15 ± 10.48 ng g-1 fat), Heptachlor (58.08 ± 74.13 ng g-1 fat), Aldrin (142.65 ± 50.65 ng g-1 fat), Dieldrin (774.62 ± 472.68 ng g-1 fat), Endosulfan I (408.44 ± 245.51 ng g-1 fat), Dichloro-diphenyl-dichloro-ethylene (29.17 ± 22.42 ng g-1 fat), Dichloro-diphenyl-trichloro-ethane (28.87 ± 0.00 ng g-1 fat) and Methoxychlor (1699.67 ± 797.43 ng g-1 fat). The Methoxychlor presence in all samples may reveal a recent exposure, while Dieldrin and Endosulfan I analyses can point to distant past exposure.

Observing baby or sexual videos changes the functional synchronization between the prefrontal and parietal cortices in mothers in different postpartum periods.

During the postpartum period (PP), mothers are more sensitive to sensory stimuli related to babies and less sensitive to those with sexual significance. The processing of emotional stimuli requires synchronization among different cerebral areas. This study characterized the cortical electroencephalographic (EEG) correlation in mothers from 1½ to 3 months (PP1), 4 to 5½ months (PP2) and over 6½ months, postpartum (PP3) while observing two videos: one of a baby (BV) and one with sexual content (SV). EEGs were recorded from the frontopolar, dorsolateral and parietal cortices. All three groups rated the BV as pleasant, but only PP3 reported higher sexual arousal with the SV. While watching the BV, PP1 showed a higher correlation among all cortical areas; PP2 manifested a decreased correlation between the prefrontal and parietal cortices, likely associated with the lower emotional modulation of the BV; and PP3 presented a higher synchronization among fewer cortical areas, probably related to longer maternal experience. These cortical synchronization patterns could represent adaptive mechanisms that enable the adequate processing of baby stimuli in new mothers. These data increase our knowledge of the cerebral processes associated with distinct sensitivities to the emotional stimuli that mothers experience during the PP.

Congenital Cytomegalovirus and Zika Infections.

Congenital infections affecting newborn infants can have potentially devastating clinical outcomes. They are usually caused by viruses that infect mothers during pregnancy and are transmitted to the fetus or newborn during the prenatal, perinatal or postnatal periods. Congenital cytomegalovirus (cCMV) is the most common congenital infection affecting up to 2.5% of all live births. Even though most infected infants are asymptomatic at birth, cCMV is an important cause of neurodevelopmental impairment and represents the main cause of non-hereditary sensorineural hearing loss. Also, congenital Zika infection has emerged in recent years as a cause of microcephaly and neurodevelopmental delays. Currently, universal screening is not recommended for either infection in pregnant women or newborn infants. Therefore, screening for both conditions is based on multiple factors such as maternal immune status, exposure, and clinical manifestations of the infant. Use of antiviral medications on symptomatic cCMV has shown improvement in outcomes, in contrast with congenital Zika for which there are no therapeutic options available. Even though both viruses can be present in breast milk, there are no recommendations against breastfeeding in full-term infants. Close follow-up for affected infants is necessary to monitor for developmental delays and sensory impairments to implement interventional therapies at the earliest time possible.

Biomonitoring of bisphenols A, F, S and parabens in urine of breastfeeding mothers: Exposure and risk assessment.

In the present study we used human biomonitoring to assess the internal exposure and the risk to four parabens and three bisphenols in 103 Spanish breastfeeding mothers participating in the BETTERMIILK project. Urinary methylparaben (MP), ethylparaben (EP), propylparaben (PP) and butylparaben (BP) presented detection frequencies ranging from 12% (BP) to 92% (MP), while bisphenol A (BPA), bisphenol F (BPF) and bisphenol S (BPS) were detected in 76% (BPA) and 20% (BPF, BPS) of the mothers. Average paraben concentrations (geometric mean) ranged from 0.021 ng mL-1 (BP) to 17.7 ng mL-1 (MP), whereas bisphenols had geometric means concentrations from 0.042 ng mL-1 (BPF) to 0.927 ng mL-1 (BPA). Except for BPA, the estimated daily intakes (EDI) were calculated in order to interpret urinary levels in a risk assessment context. The obtained EDIs ranged from 0.00042 mg/kg/day for PP to 0.0434 mg/kg/day for MP and EP. A hazard quotient (HQ) was calculated for BPA (0.0049) and parabens (0.001-0.004), showing no risk in the studied population. Sociodemographic characteristics, food consumption, and usage patterns of personal care products (PCPs) were investigated as possible determinants of exposure. Use of makeup and skincare products were associated with higher concentrations of MP and PP, respectively. Regarding dietary habits, MP was also associated with the consumption of packaged and bakery products.

Antibiotics use, knowledge and practices on antibiotic resistance among breastfeeding mothers in Kaduna state (Nigeria).

This project explores the relationship between sociodemographic status and antibiotic use, practices and knowledge about the concept of antibiotic resistance among breastfeeding mothers. A pre-tested questionnaire was administered to breastfeeding mothers in six public hospitals in Kaduna state of Nigeria. Socio-demographic characteristics using univariate analysis were compared with antibiotic use, knowledge and practices. Multivariable logistic regression models were performed to know the potential predictors of a better knowledge and understanding about antibiotics resistance. A total of 321 breastfeeding mothers took part in the survey with 25.27% believing that antibiotics are used to treat fever, common cold, bacterial and viral infections and 43.7% declaring not having heard of the term before, 45.7% do not believe that antibiotics taken by the mother could affect the baby and 74.58% believe that antibiotics resistance is when their body becomes resistant to antibiotics. Multivariable models showed that the unemployed and those with lower levels of education are more prone to antibiotics misuse. This study demonstrates that breastfeeding mothers have a lack of adequate knowledge and understanding regarding the use of antibiotics and antibiotic resistance. Maternal misuse while breastfeeding could contribute to the development of antibiotic resistance, mainly in the intestinal microbiota in children.

A double-blind, randomized, placebo-controlled trial of saffron stigma (Crocus sativus L.) in mothers suffering from mild-to-moderate postpartum depression.

INTRODUCTION: Numerous adverse effects of antidepressants as well as the attitudes of breastfeeding mothers, who prefer to consume herbal medicine rather than chemical drugs, encouraged us to assess the effects of saffron (Crocus sativus L.) on mothers suffering from mild-to-moderate postpartum depressive disorder. METHODS: A double-blind, randomized, and placebo-controlled trial was conducted on 60 new mothers who had a maximum score of 29 on the Beck Depression Inventory-Second Edition (BDI-II). They were randomly assigned to the saffron (15 mg/Bid) or placebo group. The primary outcome was a change in the BDI-II scores 8 weeks after treatment compared to the baseline. The response and remission rates were considered to be secondary outcome measures. RESULTS: Saffron had a more significant impact on the BDI-II scores than the placebo. The mean BDI-II scores decreased from 20.3 ±â€¯5.7 to 8.4 ±â€¯3.7 for the saffron group (p < .0001) and from 19.8 ±â€¯3.2 to 15.1 ±â€¯5.4 for the placebo group (p < .01). In the final assessment, 96% of the saffron group were in remission compared to 43% of the placebo group (p < .01). The complete response rates were 6% for the placebo group and 66% for the saffron group. CONCLUSION: When administered to treat minor PPD in breastfeeding mothers, saffron had a more significant impact on the BDI-II than the placebo.

Biomonitoring of mercury in hair of breastfeeding mothers living in the Valencian Region (Spain). Levels and predictors of exposure.

This study focused on the evaluation of the levels of total mercury in hair among 120 breastfeeding mothers aged 20 to 45 -. The concentrations of Hg ranged from 0.07 to 6.87 µg/g with a geometric mean (GM) of 1.22 µg/g. This GM is six times higher than the average internal exposure of mothers from other 17 European countries (0.225 µg/g). Near 70% of mothers presented levels of Hg above the USA EPA internal exposure guideline of 1 µg/g, and 27% exceeded the EFSA health-based guidance value of 1.9 µg/g. The multivariate regression analysis revealed that age, smoking and fish consumption (sword fish, small fat fish, small lean fish) were the major predictors of mercury in hair.

Qualitative exploration of psychological reactions and coping strategies of breastfeeding mothers living with HIV in the Greater Accra Region of Ghana.

BACKGROUND: Exploring the psychological reactions of breastfeeding mothers living with Human Immunodeficiency Virus (HIV) is an important step which may improve guidelines for counselling. The purpose of this study was to explore the psychological reactions and coping strategies of breastfeeding mothers living with HIV in the Greater Accra Region of Ghana. METHODS: Qualitative descriptive exploratory design was used to explore the psychological experiences and coping strategies of 13 breastfeeding mothers living with HIV in a main referral public hospital, at the greater Accra Region of Ghana. An interview guide was designed and piloted before it was used to collect data between November, 2014 and February, 2015. Data was content analyzed for themes and subthemes to emerge. RESULTS: The two major themes that emerged included psychological reactions and coping strategies. Some of the subthemes were fear, anxiety, blame, hope, denial, prayer and trust in positive situations of life. CONCLUSION: The women used denial, prayer and hope in ART, among others to cope with their emotions. This highlights the need for HIV counsellors to detect signs of denial since it can lead to non-adherence to ART as well as relapse. Health workers should therefore put the coping strategies in context during counselling of mothers in this category.

Determination of GHB levels in breast milk and correlation with blood concentrations.

The sodium salt of GHB or sodium oxybate is approved and registered in some countries as a therapeutic substance (Xyrem(®)) for the treatment of narcolepsy-associated cataplexy. This study was designed to measure the GHB endogenous levels in blood and breast milk of 20 breastfeeding women. In addition, blood and breast milk samples of a 32-year-old narcoleptic nursing mother, who was on sodium oxybate treatment, were simultaneously collected at 0.5, 1, 3, 4 and 5h following a 4.5g GHB dose and analyzed, in order to establish the safety interval of time to breastfeed. A GC-MS method for the detection and quantification of GHB in blood and breast milk was developed and fully validated. The geometric mean of endogenous GHB levels in blood and breast milk detected at time 0 were 0.57mg/L; 95% Reference Interval (RI): 0.21-1.52mg/L and 0.36mg/L; 95% RI: 0.13-1.03mg/L, respectively. The geometric mean of the concentration of GHB in milk was 37% less (95% RI: from 14 to 53%) compared to that found in the blood. The analysis of blood and breast milk samples collected from the 32 years-old female showed the following results: GHB blood concentration 0.5h after medication intake was 80.10mg/L, reaching the peak 1h after the drug administration (108.34mg/L) and it steadily decreased to reach a level of 1.75mg/L, 5h after the medication intake. The GHB concentration found in breast milk followed the same pattern as for the blood, with the highest concentration being 23.19mg/L, 1h after sodium oxybate administration and the lowest 0.99mg/L, 5h after the medication's intake. The comparison between blood and breast milk GHB levels in the 32-year-old woman, showed significant lower GHB levels in milk at 0.5, 1 and 3h, ranging from 71 to 80% less. It is interesting to note that only at 4 and 5h the difference between blood and breast milk GHB levels fell within the 95% RI (14-53%) of endogenous levels. Taking into consideration the absence of reference values for endogenous GHB in milk, we suggest the following reference interval: 0.13-1.03mg/L. We would recommend, following these preliminary data, that nursing mothers under sodium oxybate treatment should breastfeed at least 5h after the last GHB administration. However, further studies are necessary in order to confirm these findings.

Experience of non-breastfeeding mothers: Norms and ethically responsible risk communication.

BACKGROUND: Breastfeeding is currently strongly recommended by midwives and paediatricians, and the recommendations are based on documents provided by the World Health Organization and public health authorities worldwide. RESEARCH QUESTION: The underlying question is, how are non-breastfeeding mothers affected emotionally when informed that breastfeeding is the safest and healthiest option? RESEARCH DESIGN: The method used is an anonymous web-based qualitative survey exploring the narratives of non-breastfeeding mothers, published on Thesistools.com. The aim is to achieve qualitative knowledge about the emotions of non-breastfeeding mothers. PARTICIPANTS AND RESEARCH CONTEXT: Participants were based in Sweden, the United Kingdom and the Netherlands and were selected through a purposeful sample. ETHICAL CONSIDERATIONS: The online survey anonymizes responses automatically, and all respondents had to tick a box agreeing to be quoted anonymously in scientific articles. The study conforms to research ethics guidelines. FINDINGS: Respondents describe how they were affected, and the following themes emerged in studying their descriptions: depression, anxiety and pain, feeling failed as a mother and woman, loss of freedom/feeling trapped, relief and guilt. DISCUSSION: The themes are discussed against the background of the ethics of care and a theory of ethically responsible risk communication. CONCLUSION: Three conclusions are made. First, the message should become more empathetic. Second, information should be given in an attentive dialogue. Third, information providers should evaluate effects in a more inclusive way.