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1.
Natl Vital Stat Rep ; 70(2): 1-51, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33814033

RESUMO

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.


Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Grupos de Populações Continentais/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Idade Gestacional , Hispano-Americanos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Estado Civil/etnologia , Estado Civil/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
2.
PLoS Biol ; 19(3): e3001100, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33690708

RESUMO

The issues facing academic mothers have been discussed for decades. Coronavirus Disease 2019 (COVID-19) is further exposing these inequalities as womxn scientists who are parenting while also engaging in a combination of academic related duties are falling behind. These inequities can be solved by investing strategically in solutions. Here we describe strategies that would ensure a more equitable academy for working mothers now and in the future. While the data are clear that mothers are being disproportionately impacted by COVID-19, many groups could benefit from these strategies. Rather than rebuilding what we once knew, let us be the architects of a new world.


Assuntos
/epidemiologia , Mães/estatística & dados numéricos , Pesquisadores/estatística & dados numéricos , Sexismo/estatística & dados numéricos , Ensino/estatística & dados numéricos , /economia , Feminino , Humanos , Mães/psicologia , Poder Familiar/psicologia , Poder Familiar/tendências , Sexismo/psicologia , Sexismo/tendências
3.
Eur J Epidemiol ; 36(2): 197-211, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33649879

RESUMO

With the development of multiple effective vaccines, reducing the global morbidity and mortality of COVID-19 will depend on the distribution and acceptance of COVID-19 vaccination. Estimates of global vaccine acceptance among pregnant women and mothers of young children are yet unknown. An understanding of the challenges and correlates to vaccine acceptance will aid the acceleration of vaccine administration within these populations. Acceptance of COVID-19 vaccination among pregnant women and mothers of children younger than 18-years-old, as well as potential predictors, were assessed through an online survey, administered by Pregistry between October 28 and November 18, 2020. 17,871 total survey responses from 16 countries were obtained. Given a 90% COVID-19 vaccine efficacy, 52.0% of pregnant women (n = 2747/5282) and 73.4% of non-pregnant women (n = 9214/12,562) indicated an intention to receive the vaccine. 69.2% of women (n = 11,800/17,054), both pregnant and non-pregnant, indicated an intention to vaccinate their children. Vaccine acceptance was generally highest in India, the Philippines, and all sampled countries in Latin America; it was lowest in Russia, the United States and Australia. The strongest predictors of vaccine acceptance included confidence in vaccine safety or effectiveness, worrying about COVID-19, belief in the importance of vaccines to their own country, compliance to mask guidelines, trust of public health agencies/health science, as well as attitudes towards routine vaccines. COVID-19 vaccine acceptance and its predictors among women vary globally. Vaccination campaigns for women and children should be specific for each country in order to attain the largest impact.


Assuntos
/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Intenção , Internacionalidade , Pessoa de Meia-Idade , Mães/psicologia , Mães/estatística & dados numéricos , Gravidez , Gestantes/psicologia , Adulto Jovem
4.
Ugeskr Laeger ; 183(11)2021 03 15.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33734073

RESUMO

The COVID-19 pandemic may not only increase mortality due to the virus but also due to the indirect effects. The disease continues to ravage health and economic metrics globally, which is likely to increase maternal and under five-year child mortality in low- and middle-income countries. This review highlights key areas of concern for maternal and under five-year child mortality due to the indirect effects of the COVID-19 pandemic in low- and middle-income countries.


Assuntos
/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Mortalidade Materna , Mães/estatística & dados numéricos , Pandemias , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Desnutrição/epidemiologia , Serviços de Saúde Materna , Saúde Mental , Pobreza , Gravidez , Complicações Infecciosas na Gravidez
5.
Epidemiol Psychiatr Sci ; 30: e6, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33416045

RESUMO

AIMS: There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. METHODS: Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. RESULTS: Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). CONCLUSIONS: Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.


Assuntos
Desenvolvimento Infantil , Renda , Saúde Materna/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Mães/psicologia , Comportamento Social , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Emoções , Feminino , Humanos , Transtornos Mentais/psicologia , Mães/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Singapura , Classe Social , Fatores Socioeconômicos
6.
PLoS One ; 15(12): e0243721, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332387

RESUMO

To address the increase in overweight and obesity among mothers and children in sub-Saharan Africa, an understanding of the factors that drive their food consumption is needed. We hypothesized food consumption in Malawi is driven by a combination of factors, including season, food accessibility (area of residence, convenience of purchasing food, female autonomy), food affordability (household resources, food expenditures, household food insecurity), food desirability (taste preferences, body size preferences), demographics, and morbidity. Participants in Lilongwe and Kasungu Districts were enrolled across three types of mother-child dyads: either the mother (n = 120), child (n = 80), or both (n = 74) were overweight. Seven-day dietary intake was assessed using a quantitative food frequency questionnaire during the dry and rainy seasons. Drivers associated with intake of calories, macronutrients, and 11 food groups at p<0.1 in univariate models were entered into separate multivariate linear regression models for each dietary intake outcome. Mother-child dyads with an overweight child had a higher percent of calories from carbohydrates and lower percent of calories from fat compared to dyads with a normal weight child (both p<0.01). These mothers also had the highest intake of grains (p<0.01) and their children had the lowest intake of oil/fat (p = 0.01). Household food insecurity, maternal taste preferences, and maternal body size preferences were the most consistent predictors of food group consumption. Household food insecurity was associated with lower intake of grains, fruits, meat and eggs, oil/fat, and snacks. Maternal taste preferences predicted increased consumption of grains, legumes/nuts, vegetables, fish, and oil/fat. Maternal body size preferences for herself and her child were associated with consumption of grains, legumes/nuts, dairy, and sweets. Predictors of food consumption varied by season, across food groups, and for mothers and children. In conclusion, indicators of food affordability and desirability were the most common predictors of food consumption among overweight mother-child dyads in Malawi.


Assuntos
Inquéritos sobre Dietas/estatística & dados numéricos , Comportamento Alimentar/psicologia , Obesidade Materna/epidemiologia , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Tamanho Corporal , Pré-Escolar , Comportamento Alimentar/fisiologia , Feminino , Preferências Alimentares , Humanos , Lactente , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Mães/estatística & dados numéricos , Obesidade Materna/etiologia , Sobrepeso/etiologia , Obesidade Pediátrica/etiologia , Gravidez , Prevalência , Fatores de Risco , Estações do Ano , Fatores Socioeconômicos , Adulto Jovem
7.
Front Public Health ; 8: 587833, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330330

RESUMO

The present study focused on the psychological impact that the lockdown due to coronavirus disease-19 (COVID-19) had on families in Italy. During the COVID-19 pandemic, the Italian government imposed a strict lockdown for all citizens. People were forced to stay at home, and the length of the lockdown was uncertain. Previous studies analyzed the impact of social distance measures on individuals' mental health, whereas few studies have examined the interplay between the adults' functioning, as parents, during this period and the association with the child's adjustment. The present study tested if maternal distress/coping predicts children's behaviors during the COVID-19 lockdown, hypothesizing a mediation effect via children's emotional experience. Participants were 144 mothers (M age = 39.3, 25-52, SD = 5.6) with children aged 5-10 years (M age = 7.54, SD = 1.6, 82 boys); mothers answered to an online survey. Results indicated that mothers with higher exposure to COVID-19 showed higher levels of distress and higher display of coping attitudes, even if in the structural equation modeling model, the COVID-19 exposure was not a predictor of mothers' distress. Compared with mothers with good coping skills, mothers with higher stress levels were more likely to attribute negative emotions to their children at the expense of their positive emotions. Moreover, children's emotions acted as mediators between maternal distress/coping and children's adaptive/maladaptive behaviors. In conclusion, it is important to support parents during pandemic emergence, by providing them with adequate information to manage the relationship with their children, to reduce their level of distress and to enhance their coping abilities.


Assuntos
Adaptação Psicológica , Mães/psicologia , Mães/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Estresse Psicológico , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
BMC Public Health ; 20(1): 1912, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317498

RESUMO

BACKGROUND: Childhood obesity remains a significant public health problem. To date, most research on the causes and correlates of obesity has focused on a small number of direct predictors of obesity rather than testing complex models that address the multifactorial nature of the origins of obesity in early development. We describe the rationale and methods of iGrow (Infant Growth and Development Study) which will test multiple pathways by which (a) prenatal maternal psychobiological risk predicts infant weight gain over the first 6 months of life, and (b) this early weight gain confers risk for obesity at age 2. Infant hormonal and psychobiological risk are proposed mediators from prenatal risk to early weight gain, though these are moderated by early maternal sensitivity and obesogenic feeding practices. In addition, higher maternal sensitivity and lower obesogenic feeding practices are proposed predictors of adaptive child self-regulation in the second year of life, and all three are proposed to buffer/reduce the association between high early infant weight gain and obesity risk at age 2. METHODS: iGrow is a prospective, longitudinal community-based study of 300 diverse mothers and infants to be followed across 5 data waves from pregnancy until children are age 2. Key measures include (a) maternal reports of demographics, stress, well-being, feeding practices and child characteristics and health; (b) direct observation of maternal and infant behavior during feeding, play, and distress-eliciting tasks during which infant heart rate is recorded to derive measures of vagal withdrawal; (c) anthropometric measures of mothers and infants; and (d) assays of maternal prenatal blood and infant saliva and urine. A host of demographic and other potential confounds will be considered as potential covariates in structural equation models that include tests of mediation and moderation. Efforts to mitigate the deleterious effects of COVID-19 on study success are detailed. DISCUSSION: This study has the potential to inform (1) basic science about early life processes casually related to childhood obesity and (2) development of targeted intervention and prevention approaches that consider mother, infant, and family risks and resources.


Assuntos
Comportamento Alimentar , Mães/psicologia , Obesidade Pediátrica/epidemiologia , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Comportamento do Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Mães/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Projetos de Pesquisa , Fatores de Risco , Ganho de Peso
9.
MMWR Morb Mortal Wkly Rep ; 69(39): 1385-1390, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33001877

RESUMO

Homicide is the 13th leading cause of death among infants (i.e., children aged <1 year) in the United States (1). Infant homicides occurring within the first 24 hours of life (i.e., neonaticide) are primarily perpetrated by the mother, who might be of young age, unmarried, have lower educational attainment, and is most likely associated with concealment of an unintended pregnancy and nonhospital birthing (2). After the first day of life, infant homicides might be associated with other factors (e.g., child abuse and neglect or caregiver frustration) (2). A 2002 study of the age variation in homicide risk in U.S. infants during 1989-1998 found that the overall infant homicide rate was 8.3 per 100,000 person-years, and on the first day of life was 222.2 per 100,000 person-years, a homicide rate at least 10 times greater than that for any other time of life (3). Because of this period of heightened risk, by 2008 all 50 states* and Puerto Rico had enacted Safe Haven Laws. These laws allow a parent† to legally surrender an infant who might otherwise be abandoned or endangered (4). CDC analyzed infant homicides in the United States during 2008-2017 to determine whether rates changed after nationwide implementation of Safe Haven Laws, and to examine the association between infant homicide rates and state-specific Safe Haven age limits. During 2008-2017, the overall infant homicide rate was 7.2 per 100,000 person-years, and on the first day of life was 74.0 per 100,000 person-years, representing a 66.7% decrease from 1989-1998. However, the homicide rate on first day of life was still 5.4 times higher than that for any other time in life. No obvious association was found between infant homicide rates and Safe Haven age limits. States are encouraged to evaluate the effectiveness of their Safe Haven Laws and other prevention strategies to ensure they are achieving the intended benefits of preventing infant homicides. Programs and policies that strengthen economic supports, provide affordable childcare, and enhance and improve skills for young parents might contribute to the prevention of infant homicides.


Assuntos
Maus-Tratos Infantis/legislação & jurisprudência , Criança Abandonada/legislação & jurisprudência , Homicídio/estatística & dados numéricos , Adulto , Feminino , Homicídio/prevenção & controle , Humanos , Lactente , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
10.
Rev Med Suisse ; 16(712): 2050-2054, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112519

RESUMO

Mother-to-child transmission (MTCT) is almost inexistent in Switzerland nowadays. This success has been achieved with systematic screening of HIV in pregnant women, provision of antiretroviral treatment (ART), elective cesarean-section (CS), neonatal antiretroviral prophylaxis (ARP) and avoidance of breastfeeding. Elective CS and neonatal ARP are no longer recommended when the viral load (VL) is suppressed. Recent studies have shown that the risk of HIV MTCT through breastfeeding is extremely rare if not zero when the mother is treated, has a suppressed VL and is correctly followed-up. It is time to be open to discuss the risks and benefits of breastfeeding with HIV-infected pregnant women and to enter in a shared decision-making process, as recommended by the new Swiss guidelines. Close monitoring is mandatory in case of breastfeeding.


Assuntos
Aleitamento Materno , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Aleitamento Materno/efeitos adversos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Mães/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Suíça/epidemiologia
11.
BMC Public Health ; 20(1): 1559, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066763

RESUMO

BACKGROUND: Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS: A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS: Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION: Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Áreas de Pobreza , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Mães/estatística & dados numéricos , Prevalência , Fatores de Risco , Fatores Socioeconômicos
12.
J Pregnancy ; 2020: 8395142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32953178

RESUMO

Background: Episiotomy is the most common obstetric procedure, performed when the clinical circumstances place the patient at a high risk of high-degree laceration. However, episiotomy should be done with judicious indication to lower perineal laceration with fewer complications. Despite its adverse effects, the magnitude of episiotomy is increasing due to different factors. Therefore, this study is aimed at determining the recent magnitude of episiotomy and at identifying associated factors among women who gave delivery in Arba Minch General Hospital, Southern Ethiopia. Methods: An institution-based cross-sectional study was conducted from December 15, 2018, to January 30, 2019. A systematic random sampling technique was used to select study participants. A semistructured questionnaire was used to collect data. This was supplemented with a review of the labor and delivery records. Binary and multivariable logistic regression analyses were performed to identify factors associated with the magnitude of episiotomy. P value ≤ 0.05 was used to determine the level of statistically significant variables. Results: The magnitude of episiotomy was found to be 272 (68.0%) with 95%CI = 64.0-72.5. Women who attended secondary education [AOR = 10.24, 95%CI = 2.81-37.34], women who attended college and above [AOR = 4.61, 95%CI = 1.27-16.71], birth weight ≥ 3000 g [AOR = 4.84, 95%CI = 2.66-8.82], primipara [AOR = 4.13, 95%CI = 2.40-7.12], being housewife occupants [AOR = 3.43, 95%CI = 1.20-9.98], married women [AOR = 2.86, 95%CI = 1.40-5.84], and body mass index < 25 kg/m2 [AOR = 2.85, 95%CI = 1.50-5.44] were independent variables found to have significant association with episiotomy. Conclusion: The magnitude of episiotomy was 68.0% which is higher than the recommended practice by WHO (10%). The study participants' occupational status, marital status, educational status, parity, birth weight, and BMI were significantly associated with the magnitude of episiotomy in the study area. Therefore, to reduce the rate of episiotomy, it is better to have periodic training for birth attendants regarding the indication of episiotomy.


Assuntos
Episiotomia/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Trabalho de Parto , Lacerações/prevenção & controle , Mães/estatística & dados numéricos , Adolescente , Adulto , Peso ao Nascer , Índice de Massa Corporal , Estudos Transversais , Escolaridade , Episiotomia/efeitos adversos , Etiópia/epidemiologia , Feminino , Humanos , Ocupações , Paridade , Gravidez , Risco , Cônjuges , Inquéritos e Questionários , Adulto Jovem
13.
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
14.
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
15.
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
16.
Int Breastfeed J ; 15(1): 82, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928250

RESUMO

BACKGROUND: The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. This review aims to summarise how to manage breastfeeding during COVID-19. The summary was used to create guidelines for healthcare professionals and mothers. METHODS: Current publications on breastfeeding during the COVID-19 pandemic were reviewed to inform guidelines for clinical practice. RESULTS: Current evidence states that the Coronavirus is not transmitted via breastmilk. Breastfeeding benefits outweigh possible risks during the COVID-19 pandemic and may even protect the infant and mother. General infection control measures should be in place and adhered to very strictly. CONCLUSIONS: Breastfeeding should be encouraged, mothers and infant dyads should be cared for together, and skin-to-skin contact ensured throughout the COVID-19 pandemic. If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Guidelines, based on this current evidence, were produced and can be distributed to health care facilities where accessible information is needed.


Assuntos
Aleitamento Materno , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Betacoronavirus/fisiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Humanos , Leite Humano/química , Mães/estatística & dados numéricos , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
17.
PLoS One ; 15(9): e0238370, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886687

RESUMO

Maternal health and nutritional status before and during gestation may affect neonates' immune system and energy balance as they develop. The objective of this study was to associate certain clinical markers of maternal adiposity (body mass index and gestational weight gain) and neonatal adiposity (birth weight, abdominal circumference, and waist/height index) with the levels of pro- and anti-inflammatory cytokines in umbilical cord blood at birth: IL-1ß, IL-1Rα, IL-4, IL-6, IL-10, IFN-γ, and TNF-α. An exploratory cross-sectional study was conducted with a convenience sample of women from one hospital recruited shortly before giving birth through scheduled cesarean section. Of 31 the pregnant women who agreed to participate and met the inclusion criteria, twenty-nine newborns from these women were analyzed. Three cases of tobacco smoking during pregnancy were identified as an unexpected maternal risk factor and were included in the analysis. Typical of the population treated at this hospital, ten of our participants had diabetes during pregnancy, and nine of them had a pre-pregnancy BMI> 25. Non-parametric statistical analyses and a generalized linear model with gamma scale response with a log link were performed. Results: Correlation analyses, differences in medians, and a prediction model all showed positive and significant results between cytokine levels in cord blood and neonatal abdominal circumference, birth weight, and waist-height index. For maternal variables, smoking during pregnancy showed significant associations with cytokine levels in cord blood. Conclusion: This study found a variety of associations suggesting that increased neonatal adiposity increases pro-inflammatory cytokine levels at birth.


Assuntos
Adiposidade , Peso ao Nascer , Índice de Massa Corporal , Citocinas/sangue , Obesidade/imunologia , Obesidade/fisiopatologia , Ganho de Peso , Adulto , Estudos Transversais , Citocinas/imunologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Gravidez , Fatores de Risco , Adulto Jovem
18.
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
19.
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
20.
BMC Public Health ; 20(1): 1221, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778085

RESUMO

BACKGROUND: Between 2010 and 2018, measles-related mortality had halved in India mainly with effective measles vaccination campaigns and widespread coverage across the states and population subgroups. Despite the commendable vaccination coverage, 2.9 million children in India missed the first dose of measles vaccine (MCV1) in 2017, and many of those vaccinated were not vaccinated at the recommended age (i.e. between 9 and 12 months). This study analyzed pattern and correlates of MCV1 coverage and MCV1 administration at recommended age among children aged 12-23 months in India. METHODS: We used the official data from the recent round of National Family Health Survey (NFHS-4), a nationally representative cross-sectional household survey in India conducted in 2015-16. Descriptive statistics and logistic regression analysis were applied to ascertain the influence of specified socio-demographic variables affecting measles vaccination coverage in India. RESULTS: The study revealed the distinct variations in coverage of MCV1 between the districts of India. There were also major challenges with age recommended vaccination, with about 15% of eligible children not vaccinated within the recommended age range, attributable to several socio-demographic factors. Significantly, antenatal care utilization of mothers strongly influenced MCV1 coverage and age recommended MCV1 coverage in India. The study also identified that children who missed MCV1 had one or more adverse health risks such as malnutrition, anemia and diarrhea disease. CONCLUSIONS: A socio-economic gradient exists in India's MCV1 coverage, mediated by antenatal visits, education of mothers, and highlighted socio-demographic factors. Infection with measles was significantly correlated with greater anthropometric deficits among the study cohort, indicating a wider range of benefits from preventing measles infection. Eliminating morbidity and mortality from measles in India is feasible, although it will require efficient expanded program on immunization management, enhanced health literacy among mothers, continuing commitment from central state and district political authorities.


Assuntos
Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Mães/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Programas de Imunização , Esquemas de Imunização , Índia/epidemiologia , Lactente , Masculino , Sarampo/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
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