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1.
Epidemiol Psychiatr Sci ; 29: e174, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33070789

RESUMO

AIMS: Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). METHODS: We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. RESULTS: We identified 21 trials with 28 284 mother-child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13-1.71, ten trials, N = 4749 mother-child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02-0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. CONCLUSIONS: These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.


Assuntos
Aleitamento Materno/psicologia , Transtornos Mentais/psicologia , Saúde Mental/estatística & dados numéricos , Relações Mãe-Filho/psicologia , Criança , Filho de Pais Incapacitados , Países em Desenvolvimento , Feminino , Humanos , Masculino , Saúde Materna , Apego ao Objeto , Pobreza
3.
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
4.
Artigo em Inglês | MEDLINE | ID: mdl-32867111

RESUMO

The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers' capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women's control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers' real opportunities for achieving healthy child growth.


Assuntos
Aleitamento Materno , Transtornos do Crescimento , Mães , População Rural , Aleitamento Materno/psicologia , Criança , Pré-Escolar , Feminino , Grupos Focais , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Transtornos da Nutrição do Lactente , Recém-Nascido , Masculino , Folhas de Planta , Tanzânia
5.
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
6.
Artigo em Inglês | MEDLINE | ID: mdl-32752026

RESUMO

Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.


Assuntos
Aleitamento Materno , Aplicativos Móveis , Mães , Poder Psicológico , Ásia , Aleitamento Materno/psicologia , Feminino , Humanos , Lactente , Gravidez , Vietnã
7.
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
8.
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
9.
Recurso na Internet em Inglês | LIS - Localizador de Informação em Saúde | ID: lis-47574

RESUMO

Em entrevista para o Boletim da Organização Mundial de Saúde, o pesquisador Dr. João Aprígio Guerra de Almeida, coordenador da Rede Global de Bancos de Leite Humano, secretário executivo do Programa Ibero-Americano de Bancos de Leite Humano, fala sobre as origens da Rede Brasileira de Bancos de Leite Humano, os aspectos psicossociais da amamentação e o impacto desta iniciativa no Brasil e em outros países.


Assuntos
Bancos de Leite , Leite Humano , Aleitamento Materno/psicologia , Promoção da Saúde , Mortalidade Infantil
10.
BMC Public Health ; 20(1): 875, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503486

RESUMO

BACKGROUND: Worldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers. METHODS: The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method. RESULTS: Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming 'spoilt'. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers' ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace. CONCLUSION: Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support feeding and childcare if global nutrition and development goals are to be met.


Assuntos
Aleitamento Materno/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Mulheres Trabalhadoras/psicologia , Local de Trabalho/psicologia , Adulto , Emprego/métodos , Emprego/psicologia , Feminino , Grupos Focais , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Gravidez , Pesquisa Qualitativa , África do Sul
11.
Bull World Health Organ ; 98(6): 380-381, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514211

RESUMO

João Aprígio Guerra de Almeida speaks to Andréia Azevedo Soares about the origins of Brazil's human milk bank network and the psychosocial aspects of breastfeeding.


Assuntos
Aleitamento Materno/psicologia , Bancos de Leite/organização & administração , Brasil , Feminino , Humanos , Apoio Social
12.
Rev Assoc Med Bras (1992) ; 66(4): 541-546, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32578793

RESUMO

OBJECTIVE: These recommendations aim to provide guidance on breastfeeding for mothers with suspected or confirmed Covid-19. METHODS: We performed a review of the recent medical literature on breastfeeding mothers with suspected or confirmed Covid-19, focusing on the neonatal period. RESULTS: We analyzed 20 recent publications on breastfeeding, Covid-19, and its transmission through breastmilk. We presented possible options for breastfeeding and their consequences for the mother and the child. CONCLUSION: All maternal decisions in relation to breastfeeding are justifiable since the infection by Covid-19 is still poorly known. However, puerperal women and their families must be very well informed to make a conscious choice based on the information available in the literature so far.


Assuntos
Aleitamento Materno , Infecções por Coronavirus/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pneumonia Viral/transmissão , Betacoronavirus , Aleitamento Materno/efeitos adversos , Aleitamento Materno/psicologia , Extração de Leite , Infecções por Coronavirus/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mães/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto
13.
BMC Womens Health ; 20(1): 94, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370804

RESUMO

BACKGROUND: Breastfeeding is one of the most important interfering factors in infants' health. Monitoring mothers' performance and providing them with the feedback helps to increase their self-efficacy, interest in learning, and level of performance. The present research evaluates the effect of prenatal counseling on the breastfeeding self-efficacy and frequency of breastfeeding problems in mothers with previous unsuccessful breastfeeding. METHODS: This randomized controlled clinical trial was conducted on 108 pregnant women with unsuccessful breastfeeding in Tabriz health centers during 2017-2018. The participants were randomly assigned to intervention and control groups. The intervention group had four prenatal counseling sessions and the controls only received routine care. Then, the mothers who gave birth to their children received a counseling session up to 4 months after the delivery. The Breastfeeding Self-Efficacy (BSES) questionnaire and the frequency of breast feeding problems checklist on the 15th day, and 2nd and 4th month were completed both by the intervention and control groups. RESULTS: The mean (SD) of breastfeeding self-efficacy was 119.3 (10.5), 128.3 (8.3) and 133.8 (10.3) in the intervention group and 105.3 (16.1), 105.7 (19.7) and 109.4 (24.7) in the control group on the 15th day, 2nd and 4th month after the delivery, respectively. There was a significant difference in terms of breastfeeding self-efficacy between intervention and control group on the 15th day (p <  0.001), and 2nd (p <  0.001) and 4th (p <  0.001) month after the delivery. The frequency of breastfeeding problems on the 15th (p = 0.008), 2nd (p <  0.001) and 4th (p <  0.001) after the delivery was significantly different in most cases of the intervention group when compared to the controls. CONCLUSION: The results indicated that prenatal counseling can increase mothers' breastfeeding self-efficacy and solves most breastfeeding problems during postpartum period. TRIAL REGISTRATION: IRCT20100109003027N19.


Assuntos
Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Aconselhamento , Conhecimentos, Atitudes e Prática em Saúde , Mães/educação , Gestantes/educação , Cuidado Pré-Natal/métodos , Autoeficácia , Adulto , Criança , Feminino , Humanos , Lactente , Mães/psicologia , Mães/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Período Pós-Parto , Gravidez
14.
PLoS One ; 15(5): e0231755, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365108

RESUMO

OBJECTIVE: A primary objective of this study was to identify specific facilitators and challenges around exclusive breastfeeding (EBF) in our community in India, from the perspective of breastfeeding mothers and their support networks. METHODS: We conducted eight focus groups incorporating 75 women and their support networks in the Belagavi District, Karnataka State, India. We used a directed content analysis to guide the analysis. RESULTS: The specific facilitator that emerged as a theme, broad support for and knowledge about breastfeeding on the individual, family and community levels, was a seeming contraction to the identified specific challenge, the paradox of the common practice of supplemental feeds. CONCLUSIONS: Despite voicing strong support for and knowledge about EBF, participants were familiar with a variety of supplemental feeding practices in their communities. In place of universal condemnation of all supplemental feeding, policy makers might consider strategies to address the most potentially dangerous of these practices.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Sistemas de Apoio Psicossocial , Adulto , Atitude do Pessoal de Saúde , Aleitamento Materno/psicologia , Escolaridade , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia/epidemiologia , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido , Mães/psicologia , Sistema de Registros , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
15.
J Clin Nurs ; 29(15-16): 2872-2885, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32421233

RESUMO

BACKGROUND: Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2 months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants. AIMS AND OBJECTIVES: To explore maternal experiences with feeding moderate (320/7 - 336/7  weeks' gestational age) and late preterm infants (340/7 - 366/7  weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory. METHODS: We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 320/7 - 346/7  weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes. RESULTS: Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding. CONCLUSION: Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.


Assuntos
Aleitamento Materno/psicologia , Mães/psicologia , Autoeficácia , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Masculino , Pesquisa Qualitativa
18.
BMC Public Health ; 20(1): 440, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245371

RESUMO

BACKGROUND: KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period. METHODS: Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13- < 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points. RESULTS: At KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January-August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion exclusively breastfeeding was 44.6 and 50.5% (p = 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p = 0.02). There were reductions in mixed breastfeeding among all infants (23.2% vs 16.3%; p = 0.016). Although there was no change in the proportion of carers who reported not breastfeeding (31.9% vs 32.8%; p = 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p = 0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (adjusted odds ratio [AOR] 3.76; 95% CI 3.1-4.6), as were HIV positive mothers (AOR 2.1; 95% CI 1.7-2.6). CONCLUSION: Despite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Adolescente , Adulto , Aleitamento Materno/psicologia , Estudos Transversais , Feminino , Humanos , Lactente , Modelos Logísticos , Mães/psicologia , Análise Multivariada , Razão de Chances , África do Sul , Inquéritos e Questionários , Adulto Jovem
19.
Medicine (Baltimore) ; 99(16): e19643, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311936

RESUMO

BACKGROUND: Women with gestational diabetes mellitus (GDM) face big challenges of breastfeeding. In order to improve breastfeeding self-efficacy and breastfeeding rate of them, we formulated perinatal individualized interventions based on self-efficacy theory and conducted a randomized controlled trial to verify the effectiveness. METHODS: We conducted a randomized controlled trial. The perinatal individualized interventions based on the self-efficacy theory including 4 phases were led by the International Board Certified Lactation Consultant (IBCLC). Women allocated to the control group received usual care for lactation support during the antenatal and postnatal period. Data collection occurred at admission, discharge, 6 weeks postpartum, 4 months postpartum, and 6 months postpartum. RESULTS: We enrolled 226 women with GDM, 113 in the intervention group and 113 in the control group. The scores of breastfeeding self-efficacy in the intervention group were significantly higher than those in the control group at discharge, at 6 weeks, 4 months, and 6 months postpartum (P < .05). We found higher rates of exclusive and any breastfeeding in the intervention group at discharge (Exclusive: 25.2% vs 13.5%, P < .05; Any: 94.4% vs 89.4%, P > .05), at 6 weeks postpartum (Exclusive: 75.5% vs 62.5%, P < .05; Any: 100.0% vs 96.2%, P > .05), at 4 months postpartum (Exclusive: 68.9% vs 43.3%, P < .05; Any: 94.3% vs 83.7%, P < .05) and at 6 months postpartum (Exclusive: 55.8% vs 36.9%, P < .05; Any: 88.5% vs 64.1%, P < .05). CONCLUSION: Perinatal individualized breastfeeding education based on the self-efficacy theory had positive effects on breastfeeding self-efficacy and breastfeeding rate of women with GDM.


Assuntos
Aleitamento Materno/psicologia , Diabetes Gestacional/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Autoeficácia , Adulto , Aleitamento Materno/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Período Pós-Parto , Gravidez , Teoria Psicológica , Inquéritos e Questionários
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