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2.
PLoS One ; 15(9): e0239515, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970726

RESUMO

Optimal breastfeeding practices can ensure healthy growth and development of infants, which in the long term can impact the country's economic development. Nevertheless, Myanmar has yet to achieve the WHO's target of 70% for early initiation of breastfeeding, and the country's target of 90% for exclusive breastfeeding. The purpose of this study was to assess the associations between early initiation of breastfeeding and exclusive breastfeeding and bio-demographic, socio-economic and behavioral factors in Myanmar. Using the 2015-2016 Myanmar Demographic and Health Survey, the analysis of early initiation of breastfeeding was based on a sample of 1,506 under-2 children and the analysis of exclusive breastfeeding was based on a sample of 376 children aged 0-5 months. Multiple logistic modeling, with heteroskedasticity-adjusted standard errors, was used. The prevalence rates of early initiation of breastfeeding and exclusive breastfeeding in the study were 67.9% and 52.2% respectively. Having a vaginal delivery (AOR = 2.5; 95% CI = 1.7-3.7) and having frequent (≥ 4) antenatal visits (AOR = 2.4; 95% CI = 1.5-3.8) were associated with higher odds of early initiation of breastfeeding. Having a postnatal checkup (AOR = 0.5; 95% CI = 0.3-0.9) and having an infant that was perceived to be small at birth (AOR = 2.5; 95% CI = 1.1-5.7, for infants perceived to be large at birth) were significantly associated with decreased odds of exclusive breastfeeding. In order to promote optimal breastfeeding practices, this study suggested that delivery and quality of health services during pregnancy need to be strengthened in Myanmar.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Aleitamento Materno/tendências , Adulto , Parto Obstétrico , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Mianmar/epidemiologia , Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Fatores Socioeconômicos
3.
PLoS One ; 15(9): e0239278, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941500

RESUMO

BACKGROUND: Education on exclusive breastfeeding (EBF) practices is usually given in the form of health talks by health workers (HWs). The need for HWs to be well-informed about cultural practices and misconceptions that act as barriers to EBF has been documented in literature. This information can guide HWs in developing interventions such as health talks which are culturally sensitive. However, this has not been explored from the perspectives of HWs in Ghana. In this paper, we report mothers' and grandmothers' misconceptions and cultural practices that are barriers to EBF in two rural districts in Ghana from the perspectives of Community Health Workers and Community Health Volunteers. METHODS: We used qualitative data collected in the Kwahu Afram Plains South and North Districts of Ghana through nine focus group discussions (FGDs) among HWs and followed the data saturation principle. All FGDs were audio-taped, transcribed verbatim and translated from local dialects to English. The emerging themes were used in writing a narrative account, guided by the principles of the thematic analysis. RESULTS: Our main findings included mothers' and grandmothers' perceptions that HWs themselves do not practice EBF. Mothers had the perception that grandmothers did not practice EBF but their children grew well, and gestures of babies suggested their readiness to start eating. Misconceptions revealed included beliefs that breastmilk is watery in nature and does not satisfy infants. Another misconception was that babies gain weight faster when not exclusively breastfed but fed on infant formulas. A custom of giving corn flour mixed with water or light porridge during the first few days after birth to welcome newborns was also reported. CONCLUSIONS: The reports of the HWs revealed that several socio-cultural factors and misconceptions of mothers and grandmothers negatively influence EBF practices of mothers. Findings from this study highlight the need for HWs to provide culturally appropriate counselling services on breastfeeding not only to mothers but also to grandmothers and fathers in order to promote EBF and reap its benefits.


Assuntos
Aleitamento Materno/psicologia , Avós/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Mães/psicologia , Adulto , Aleitamento Materno/estatística & dados numéricos , Características Culturais , Feminino , Gana , Humanos , Masculino , Mães/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Mal-Entendido Terapêutico
4.
PLoS One ; 15(9): e0239446, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970729

RESUMO

INTRODUCTION: Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women. METHODS: This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women's individual, household and community level characteristics. RESULTS: Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women's non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman's husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28-3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40-0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65-2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women's age, education or rural-urban residence display no statistically significant relationship with EIBF. CONCLUSION: Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Inquéritos Epidemiológicos , Adolescente , Adulto , Cesárea , Estudos Transversais , Feminino , Humanos , Indonésia , Recém-Nascido , Pessoa de Meia-Idade , Relações Mãe-Filho , Razão de Chances , Gravidez , Fatores Socioeconômicos , Cônjuges/psicologia , Adulto Jovem
5.
PLoS One ; 15(9): e0238735, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886727

RESUMO

BACKGROUND: The optimal frequency, duration, and form of professional lactation support needed to continue exclusive breastfeeding (EBF) for six months have not yet been specifically identified. This study investigates the association between six-month EBF and the frequency, duration, and form (face-to-face vs. telephone contact) of professional lactation support in a cohort of Lebanese mothers, and explores barriers to EBF during the first six months postpartum. METHODS: An observational study was nested in a breastfeeding support randomized controlled trial. Secondary analysis of data from 159 trial participants who received professional lactation support was conducted. (1) Six-month EBF with professional lactation support frequency, duration, and form was investigated using bivariate and multivariate regression analyses. (2) Barriers to breastfeeding were explored using content analysis of narrative data collected about breastfeeding mothers by the lactation experts. RESULTS: Six-month EBF was achieved by 57/159 (35.8%) participants. Professional lactation support was received by more mothers continuing six months of EBF (100% vs. 83.3%, p = 0.001). In crude analysis, those mothers had a higher number of overall contacts with lactation experts (mean ± SD of 9.5 ± 2.9 vs. 7.0 ± 4.4, p = 0.001), and longer duration of face-to-face contacts (mean ± SD of 261.9 ± 209.1 vs. 201.0 ± 117.4 minutes, p = 0.035). In adjusted analysis, frequencies of overall and of telephone contacts with the lactation experts were positively associated with six-month EBF (OR = 1.15; 95% CI: 1.04 to 1.27, p = 0.007; OR = 1.12; 95% CI: 1.00 to 1.26, p = 0.05; respectively). Participants discontinuing EBF early were described as inexperienced, lacking breastfeeding knowledge, concerned about milk insufficiency, and showing negative attitudes towards night feeds. CONCLUSION: Need-based telephone contact augmenting face-to-face professional lactation support may positively influence six-month EBF. Early identification of mothers at risk for early discontinuation of EBF can help tailor interventions specific to their concerns.


Assuntos
Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Lactação , Mães/psicologia , Mães/estatística & dados numéricos , Apoio Social , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Líbano , Estudos Retrospectivos , Sono , Fatores de Tempo
6.
Artigo em Inglês | MEDLINE | ID: mdl-32957434

RESUMO

COVID-19 also affects pregnant and breastfeeding women. Hence, clinicians and policymakers require reliable evidence on COVID-19 epidemiology and consequences in this population. We aimed to assess the susceptibility of pregnant women to SARS-CoV-2 and women's perceived impact of the pandemic on their breastfeeding practices, medical counseling and social support. We performed a cross-sectional study using an online survey in primary care in Belgium. Pregnant and breastfeeding women and women who breastfed in the preceding four weeks were eligible to participate. The survey was distributed through social media in April 2020. In total, 6470 women participated (i.e., 2647 pregnant and 3823 breastfeeding women). Overall, 0.3% of all respondents reported to have tested positive for SARS-CoV-2, not indicating a higher susceptibility of pregnant women to contracting COVID-19. More than 90% refuted that the pandemic affected their breastfeeding practices, nor indicated that the coronavirus was responsible for breastfeeding cessation. Half of the women even considered giving longer breastmilk because of the coronavirus. In contrast, women's medical counseling and social support were negatively affected by the lockdown. Women without previous breastfeeding experience and in the early postpartum period experienced a higher burden in terms of reduced medical counseling and support. In the future, more consideration and alternative supportive measures such as tele-visits by midwives or perinatal organizations are required for these women.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Atenção Primária à Saúde/organização & administração , Bélgica/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Estudos Transversais , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Gravidez , Complicações Infecciosas na Gravidez/psicologia
7.
Am J Perinatol ; 37(S 02): S46-S53, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898882

RESUMO

OBJECTIVE: We aimed at reviewing the currently available guidelines and scientific recommendations regarding the neonatal in-hospital management and feeding in the light of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: We systematically searched the guideline databases, Medline, Embase, and nationale/international neonatal societies websites as of June 19, 2020, for guidelines on neonatal management and feeding during the COVID-19 pandemic, at the same time assessing the methodological quality using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS: Eleven guidelines were included. The Chinese and American recommendations suggest separation of the mother and her neonate, whereas in French, Italian, UK, Canadian, and World Health Organization consensus documents the rooming-in is suggested, with Centers for Disease Control and Prevention guidelines suggesting to decide on a case-by-case basis. All the guidelines recommend breastfeeding or feeding with expressed maternal milk; the only exception is the Chinese recommendations, these last suggesting to avoid breastfeeding. CONCLUSION: This review may provide a useful tool for clinicians and organizers, highlighting differences and similarities of the existing guidelines on the management and feeding strategies in the light of the COVID-19 pandemic. KEY POINTS: · This study compares guidelines on management and nutrition of a newborn born to a mother with SARS-CoV-2 infection.. · Existing guidelines on neonatal management and nutrition during the SARS-CoV-2 pandemic show many differences.. · The majority of recommendations are mainly based on experts' opinion and are not evidence-based..


Assuntos
Aleitamento Materno/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Leite Humano , Pandemias , Organização Mundial da Saúde
8.
J Pregnancy ; 2020: 2097285, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32908703

RESUMO

Introduction: Practicing exclusive breastfeeding (EBF) in an infant's first six months of life is recommended by the World Health Organization because of its proven effectiveness as a method to support the infant's short- and long-term physical and cognitive development. However, many countries, including Cambodia, face contextually driven challenges in meeting this optimum standard of breastfeeding. The recent declining EBF rate in Cambodia is a concerning indicator of the impact of these challenges. Methods: We used existing data from the 2014 Cambodian Demographic and Health Survey (CDHS) to analyze 717 Cambodian mother-infant pairs. CDHS 2014 used a two-stage stratified cluster sampling approach to select samples. A multivariable logistic regression analysis was used to assess determinants of EBF, taking into account the sampling weight in the analysis. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated, and significance level was considered at p value < 0.05. Results: Our findings indicate that among mothers with infants under six months, EBF was more likely if they resided rurally (AOR = 2.28; 95% CI 1.23-4.23) and if they delivered at a public hospital (AOR = 2.64; 95% CI 1.28-5.47). On the other hand, mothers of middle wealth index practiced EBF less than mothers of low wealth index (AOR = 0.58; 95% CI 0.34-0.99). And as expected, our analysis confirmed that the older the infants grew, the less likely they were to be exclusively breastfed than those younger than one month old (2-3 months: AOR = 0.49; 95% CI 0.26-0.92; 4-5 months: AOR = 0.25; 95% CI 0.15-0.43). Conclusion: The findings emphasize the need to address these determinants adequately by appropriate interventions to halt the declining trend of EBF practice. We recommend a multifaceted approach to improve EBF rates in Cambodia. Advocacy around EBF at public hospitals should continue, and private hospital staff should receive training to provide EBF counselling and support to mothers.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Aleitamento Materno/tendências , Mães/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Camboja/epidemiologia , Aconselhamento , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , População Rural , Classe Social , Apoio Social , Adulto Jovem
9.
PLoS One ; 15(9): e0239062, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970700

RESUMO

Exclusive breastfeeding (EBF) for the first six months of life is effective in preventing infant morbidity and mortality. However, 36% of Ugandan children below 6 months are not breastfed exclusively despite its active promotion. This study determined the prevalence and factors associated with exclusive breastfeeding among mothers working in the informal sector in Kampala district. A community based cross-sectional study targeting 428 interviews with mothers with children aged 0-5 months was conducted. Analysis was done using modified Poisson regression in Stata version 14. The prevalence of exclusive breastfeeding was 42.8%. The factors associated with exclusive breastfeeding included: attending antenatal care at least 4 times (APR = 1.24; 95% CI: 1.01-1.51), intention to exclusively breastfeed for 6 months (APR = 1.26; 95% CI: 1.01-1.57) or longer (APR = 1.38; 95% CI: 1.06-1.76), proper breastfeeding practices (APR = 4.12; 95% CI: 2.88-5.90), age of the infant (APR = 0.78; 95% CI: 0.65-0.94) and (APR = 0.48; 95% CI: 0.39-0.60) for children aged 2-3 and 4-5 months respectively and working in a lower position (APR = 0.68; 95% CI: 0.55-0.83). Mothers should be encouraged to attend antenatal care where they learn about the benefits of exclusive breastfeeding to children below 6 months hence enabling them to make informed decisions about exclusive breastfeeding. The government of Uganda should ensure maternity leave benefits of the employment act are enforced in the informal sector to allow women to practice EBF.


Assuntos
Aleitamento Materno , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Setor Informal , Masculino , Mães , Gravidez , Cuidado Pré-Natal , Uganda , Adulto Jovem
10.
PLoS One ; 15(9): e0238730, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915827

RESUMO

BACKGROUND: The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly. AIM: To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices. METHODS: A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates. RESULTS: The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036). CONCLUSION: There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in Lebanon, thus increasing breastfeeding rates and positively impacting the health of infants and mothers.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Mães/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Líbano , Masculino , Cuidado Pós-Natal , Organização Mundial da Saúde
11.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47781

RESUMO

Estudo do Ministério da Saúde aponta que mais da metade das crianças brasileiras continua sendo amamentada no primeiro ano de vida, e mais de 45% das menores de seis meses recebem leite materno exclusivo.


Assuntos
Aleitamento Materno/tendências , Aleitamento Materno/estatística & dados numéricos , Brasil
13.
PLoS One ; 15(8): e0237190, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760148

RESUMO

BACKGROUND: There is growing evidence that peer support programs may be effective in supporting breastfeeding mothers. A randomised controlled trial (RCT) (the RUBY study) that tested peer support in the Australian context found that infants of first-time mothers who received proactive telephone peer support were more likely to be receiving breastmilk at six months of age. METHODS: This qualitative sub-study of the RUBY RCT explores the experiences and views of peer volunteers who delivered the intervention. Focus groups were conducted with 17 peers from the RUBY RCT between November 2015 and March 2016. All had provided peer support to at least one mother. RESULTS: We found that volunteers identified strongly with the mothers' need for support when establishing breastfeeding. Key components of the support were strengthening the mothers' self-belief through affirmation and sharing experiential knowledge. Volunteers found the role rewarding and personally therapeutic although some women reported challenges initiating and maintaining contact with some mothers. Data were analysed using a hybrid approach to thematic analysis combining inductive and deductive techniques. CONCLUSIONS: Breastfeeding peer support programs are reliant on recruitment of motivated volunteers who can provide empathetic mother-to-mother support. This study provides important information regarding volunteers' experiences that may support the upscaling of breastfeeding peer support for new mothers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831.


Assuntos
Aleitamento Materno/psicologia , Sistemas de Apoio Psicossocial , Adulto , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Telefone , Voluntários/psicologia , Voluntários/estatística & dados numéricos
14.
Cochrane Database Syst Rev ; 8: CD013679, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32813276

RESUMO

BACKGROUND: The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES: To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS: We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS: The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Saúde da Criança/normas , Comunicação , Necessidades e Demandas de Serviços de Saúde , Saúde do Lactente/normas , Saúde Materna/normas , Aleitamento Materno/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Parto Obstétrico/normas , Feminino , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Saúde Materna/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Envio de Mensagens de Texto
15.
Chemosphere ; 255: 127003, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32679629

RESUMO

In this study, we assessed the presence of 14 phthalate metabolites in the urine of 104 lactating mothers from Valencia (Spain) who took part in the human biomonitoring project BETTERMILK. Nine of the metabolites studied showed detection frequencies >80%, whereas the rest of the metabolites presented low detection frequencies (<5%). The concentrations ranged from

Assuntos
Monitoramento Biológico , Aleitamento Materno/estatística & dados numéricos , Exposição Materna/estatística & dados numéricos , Ácidos Ftálicos , Adulto , Coleta de Dados , Dietilexilftalato , Exposição Ambiental/análise , Poluentes Ambientais/metabolismo , Feminino , Humanos , Lactação , Mães , Embalagem de Produtos , Medição de Risco , Espanha
16.
Medicine (Baltimore) ; 99(28): e20815, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664074

RESUMO

BACKGROUND: The high rate of cesarean section is an important factor affecting breastfeeding in China. To improve the nation's current situation of breastfeeding, promoting breastfeeding in women undergoing cesarean section is essential. OBJECTIVE: To explore the effects of health belief model-based interventions on breastfeeding knowledge, breastfeeding behaviors, and breastfeeding satisfaction of Chinese cesarean women. METHODS: A total of 346 cesarean section women were enrolled in the randomized controlled trial conducted at a center in Chengdu, China, between July 1, 2018 and August 31, 2018. While the control group (n = 173) received conventional breastfeeding guidance only, the intervention group (n = 173) received additional interventions based on the health belief model. Questionnaires were distributed to assess breastfeeding knowledge, breastfeeding behavior, and breastfeeding satisfaction at discharge, 42 days postpartum, and 4 months postpartum, respectively. RESULTS: At discharge from hospital, the breastfeeding knowledge score of the intervention group was higher than that of the control group (Z = -11.753, P < .001). The exclusive breastfeeding rates in the intervention group at the time of discharge, 42 days postpartum, and 4 months postpartum were 67.3%, 60.7%, and 52.9%, respectively, while those of the control group were 41.2%, 41.6%, and 40.4%, respectively. The differences were statistically significant (χ = 23.353, P < .001; χ = 11.853, P < .001; χ = 4.805, P = .03). The breastfeeding satisfaction of the intervention group was also higher than the control group at the time of discharge, 42 days postpartum and 4 months postpartum (t = 4.955, P < .001; t = 3.051, P = .002; Z = -3.801, P < .001). CONCLUSION: The health belief model-based interventions can effectively increase breastfeeding knowledge for Chinese cesarean women and improve their breastfeeding behaviors and breastfeeding satisfaction within 4 months after delivery. CLINICAL TRIAL REGISTRATION: ChiCTR1900026006 .


Assuntos
Aleitamento Materno/psicologia , Cesárea/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adulto , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , China/etnologia , Cultura , Feminino , Humanos , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/tendências , Satisfação do Paciente/etnologia , Satisfação do Paciente/estatística & dados numéricos , Período Pós-Parto/fisiologia , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
17.
PLoS One ; 15(7): e0236080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667942

RESUMO

BACKGROUND: Exclusive breastfeeding (EBF) means that an infant should be breastfed only for the first six months of life to achieve optimal child development and to prevent infant morbidity and mortality. The aim of this analysis was to determine the individual-, household-, and community-level factors associated with EBF practice in Bangladesh. METHODS: A total of 1,440 women-child pairs data were analysed extracted from 2011 and 2014 Bangladesh Demographic and Health Survey. Multilevel logistic regression models were used separately for individual-, household-, and community level factors to identify the different level of factors associated with EBF practice. RESULTS: Around 61% women in Bangladesh practiced EBF with significant variation across several individual-, household-, and community-level factors. At the individual level, higher odds of EBF practice was found among mothers' received higher number of antenatal care and lower age of child. Mothers' higher education and engagement in formal jobs were found negatively associated with EBF practice. At the community level, higher odds of EBF was found among women live in Barishal, Dhaka, and Rajshahi divisions, and resided in the community with moderate level of female education, higher level of fertility, and higher use of antenatal and delivery care. CONCLUSIONS: One in every three children in Bangladesh do not breastfeed exclusively which needs special attention for the policymakers. In this case, educated women engaged in income generating activities and women did not use antenatal care should be given priority. At the community level, priority should be given for the women's resides in the community with lower level of antenatal and delivery healthcare services use.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Mães/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Bangladesh , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez
18.
BJOG ; 127(11): 1324-1336, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32531146

RESUMO

BACKGROUND: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified? OBJECTIVE: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction. SEARCH STRATEGY: Two biomedical databases were searched between September 2019 and June 2020. SELECTION CRITERIA: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported. DATA COLLECTION AND ANALYSIS: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission. MAIN RESULTS: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated. CONCLUSIONS: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother. TWEETABLE ABSTRACT: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.


Assuntos
Alimentação Artificial/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Fórmulas Infantis , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Complicações Infecciosas na Gravidez/epidemiologia , Betacoronavirus , Extração de Leite , China/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Leite Humano , Relações Mãe-Filho , Pandemias , Gravidez , Fatores de Risco
19.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32518168

RESUMO

BACKGROUND: In-hospital formula feeding (IHFF) of breastfed infants is associated with shorter duration of breastfeeding. Despite evidence-based guidelines on when IHFF is appropriate, many infants are given formula unnecessarily during the postpartum hospital stay. To account for selection bias inherent in observational data, in this study, we estimate liberal and conservative bounds for the association between hospital formula feeding and duration of breastfeeding. METHODS: Infants enrolled in the Minnesota Special Supplemental Nutrition Program for Women, Infants, and Children were selected. Breastfed infants given formula were matched with infants exclusively breastfed (n = 5310) by using propensity scoring methods to adjust for potential confounders. Cox regression of the matched sample was stratified on feeding status. A second, more conservative analysis (n = 4836) was adjusted for medical indications for supplementation. RESULTS: Hazard ratios (HR) for weaning increased across time. In the first analysis, the HR across the first year was 6.1 (95% confidence interval [CI] 4.9-7.5), with HRs increasing with age (first month: HR = 4.1 [95% CI 3.5-4.7]; 1-6 months: HR = 8.2 [95% CI 5.6-12.1]; >6 months: HR = 14.6 [95% CI 8.9-24.0]). The second, more conservative analysis revealed that infants exposed to IHFF had 2.5 times the hazard of weaning compared with infants who were exclusively breastfed (HR = 2.5; 95% CI 1.9-3.4). CONCLUSIONS: IHFF was associated with earlier weaning, with infants exposed to IHFF at 2.5 to 6 times higher risk in the first year than infants exclusively breastfed. Strategies to reduce IHFF include prenatal education, peer counseling, hospital staff and physician education, and skin-to-skin contact.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Fórmulas Infantis , Desmame , Hospitalização , Humanos , Recém-Nascido , Fatores de Tempo
20.
PLoS Genet ; 16(6): e1008790, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32525877

RESUMO

Recent discoveries from large-scale genome-wide association studies (GWASs) explain a larger proportion of the genetic variability to BMI and obesity. The genetic risk associated with BMI and obesity can be assessed by an obesity-specific genetic risk score (GRS) constructed from genome-wide significant genetic variants. The aim of our study is to examine whether the duration and exclusivity of breastfeeding can attenuate BMI increase during childhood and adolescence due to genetic risks. A total sample of 5,266 children (2,690 boys and 2,576 girls) from the Avon Longitudinal Study of Parents and Children (ALSPAC) was used for the analysis. We evaluated the role of breastfeeding (exclusivity and duration) in modulating BMI increase attributed to the GRS from birth to 18 years of age. The GRS was composed of 69 variants associated with adult BMI and 25 non-overlapping SNPs associated with pediatric BMI. In the high genetic susceptible group (upper GRS quartile), exclusive breastfeeding (EBF) to 5 months reduces BMI by 1.14 kg/m2 (95% CI, 0.37 to 1.91, p = 0.0037) in 18-year-old boys, which compensates a 3.9-decile GRS increase. In 18-year-old girls, EBF to 5 months decreases BMI by 1.53 kg/m2 (95% CI, 0.76 to 2.29, p<0.0001), which compensates a 7.0-decile GRS increase. EBF acts early in life by delaying the age at adiposity peak and at adiposity rebound. EBF to 3 months or non-exclusive breastfeeding was associated with a significantly diminished impact on reducing BMI growth during childhood. EBF influences early life growth and development and thus may play a critical role in preventing overweight and obesity among children at high-risk due to genetic factors.


Assuntos
Índice de Massa Corporal , Aleitamento Materno/estatística & dados numéricos , Obesidade/genética , Adiposidade/genética , Adolescente , Aleitamento Materno/métodos , Feminino , Predisposição Genética para Doença , Humanos , Lactente , Masculino , Obesidade/epidemiologia , Obesidade/prevenção & controle , Polimorfismo de Nucleotídeo Único , Adulto Jovem
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