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This study aimed to estimate and compare dietary exposure to bisphenol A (BPA) in exclusively breastfed (EBF) and breastfed plus formula-fed (BF + FF) infants. A total of 70 mothers and their 0–6 month-old infants (40 in the EBF group and 30 in BF + FF group) were included in the study. After the questionnaire form was applied to the mothers, maternal breast milk, infant formula, and infant urine were collected from mother-infant dyads. Total BPA levels in breast milk, infant formula, and infant urine samples were analyzed by the high-pressure liquid chromatography (HPLC). While BPA was detected in 92.5% of the breast milk samples in the EBF group (mean ± SD = 0.59 ± 0.29 ng/mL), BPA was detected in all of the breast milk samples in the BF + FF group (mean ± SD= 0.72 ± 0.37 ng/mL) (p < 0.05). Similarly, 100% of the infant formula samples in the BF + FF group had detectable levels of BPA (mean ± SD = 7.54 ± 1.77 ng/g formula). The mean urinary BPA levels in the EBF infants (4.33 ± 1.89 µg/g creatinine) were not statistically different from the BF + FF infants (5.81 ± 0.11 µg/g creatinine) (p > 0.05). The average daily BPA intake in EBF infants (0.18 ± 0.13 µg/kg body weight (bw)/day) was found to be significantly higher than in BF + FF infants (0.12 ± 0.09 µg/kg bw/day) (p < 0.05). The estimated dietary intakes of BPA for infants in both groups were below the temporary tolerable daily intake (t-TDI) (4 µg/kg bw/day). Consequently, BPA intake of EBF and BF + FF infants were within safe daily limits during the first six months of life. [ABSTRACT FROM AUTHOR]

Much evidence supports that the early introduction of allergenic foods in weaning is useful to prevent food allergies later in life. Real life is often different, with factors related to mothers and infants. Our study aimed to deepen the timing of introducing the foods responsible for most allergic reactions during the weaning and why parents delay their introduction. 110 mothers participated in the study, compiling a questionnaire. Exclusive breastfeeding was associated with a delayed introduction of allergenic foods at 4 months (r = 0.433, p < 0.01) and 1 year (r = 0.486, p < 0.01). Large-for-gestational age at birth was inversely associated with a delayed introduction of allergenic foods (r=-0.204, p < 0.05). This study demonstrates that introducing many allergens is delayed during the weaning. Parents with infants fed with exclusive breastfeeding could need more information about the correct time of introduction of potential allergens in the weaning. [ABSTRACT FROM AUTHOR]

Breast milk is the perfect food during infancy. Adequate support from family and health systems can be helpful to continue breastfeeding. This study aimed to determine the status of breastfeeding challenges and its relationship with social support and socio-demographic factors. In this correlational-descriptive study, 348 breastfeeding mothers were recruited using cluster random sampling from health care centers in Tabriz, Iran in 2022. Socio-demographic, breastfeeding challenges and social support questionnaires were used for data collection. Data were analyzed for descriptive and inferential statistics (Pearson correlation tests, independent t-test, one-way ANOVA and general linear model) using SPSS version 16. Difficulty in completing household tasks and breastfeeding at the same time (32.5 percent) was the most common challenge reported by mothers. There was an inverse and significant correlation between perceived social support and experiencing challenges (r = −0.199؛ p =.001). Based on the adjusted general linear model, with increasing social support, the score of breastfeeding challenges decreased (B = −0.165; 95 percent CI: −0.07–0.25, p <.001). Considering the relationship between perceived social support and the challenges experienced during breastfeeding, it can be concluded that adequate support from family along with training and guidance from health care providers can lead women to have better breastfeeding experiences and overcome breastfeeding problems. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to explore and describe the infant feeding experiences of mothers of children aged 3 to 24 months, living in two selected informal settlements in Tshwane, South Africa. Design: This exploratory qualitative study gathered data via six focus-group discussions (FGDs). These were facilitated using a semi-structured questionnaire guide with probes. Data were then transcribed, coded and thematically analysed. Setting: The study was conducted in the two selected informal settlements in the west of Tshwane, South Africa. Subjects: Biological mothers (n = 28) of infants and young children aged 3 to 24 months, living in the selected informal settlements participated. The mothers had to be living with their child with some responsibility for their daily care and feeding. Results: Three themes with six sub-themes were identified following thematic analysis. First was the mothers' experience of infant feeding, which included their interpretations and practices of exclusive breastfeeding and complementary feeding. Second, mothers received infant feeding support from their elders based on common beliefs. The support received from healthcare workers was sometimes perceived negatively. However, healthcare workers based at healthcare facilities were important sources of exclusive breastfeeding and complementary feeding information. Third were the setting-related factors that negatively affected the mothers' ability to access nutritious food for themselves and their infants. These included household food insecurity, plus environmental and household factors affecting food storage and preparation. Conclusion: Mothers experienced several challenging circumstances affecting their infant feeding efforts. These findings highlight the need to strengthen targeted infant feeding counselling and support for mothers living in resource-constrained environments. [ABSTRACT FROM AUTHOR]

This study examined the demographic and sociocultural influences on the level of exclusive breastfeeding (EBF) practices in Enugu state. The major instrument for data collection was a uniform set of structured questionnaire and in-depth interviews with the husbands, grandmothers/mothers-in-law, health workers, women leaders, and traditional/community leaders. Data were analyzed using frequencies, percentages and chi-squared test. Qualitative data were analyzed with ATLAS.ti. The study established that the prevalence level of EBF practice was relatively low (27%) in all the local government areas in the state. The result also showed that several sociocultural factors affected EBF practice. Some of them were: influence of TBAs (91%); poor nutrition in family menu (82%); campaign/marketing of artificial feed (78.3%), unfavorable conditions in the work place (66.8%); belief that lack of water can kill a baby (64.6%) and influence of grandmothers/mothers-in-law (64.2%). The results further revealed that age, occupation, parity, and educational qualification of the mothers influences the level of EBF practice. The findings also revealed that majority of mothers practice mixed feeding in the name of EBF practice. It is suggested that more efforts are needed in giving proper and adequate education and skilled counseling on EBF practice and sociocultural factors associated with the practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand the agencies of migrant mothers in their interaction with health professionals promoting compliance with exclusive breastfeeding (EB). This qualitative study conducted interviews with breastfeeding migrant and Chilean women and health professionals from the Chile Crece Contigo Program in Chile. The results indicated that migrant women who did not practice EB took actions to resist pressure from health professionals considered a form of agency; however, this did not necessarily free them from social judgment. In addition, these actions were associated with a lack of promotion of parental co-responsibility and access to social and economic resources. [ABSTRACT FROM AUTHOR]

To assess whether oral domperidone compared to placebo increases the rate of exclusive breastfeeding for 6 months among post-lower segment cesarean section (LSCS) mothers. This double-blind Randomized Controlled Trial, conducted in a tertiary care teaching hospital in South India, included 366 post-LSCS mothers with delayed initiation of breastfeeding or with subjective feelings of not having enough milk. They were randomized to two groups - Group A: Standard lactation counseling and oral Domperidone and Group B: Standard lactation counseling and a placebo. The primary outcome was an exclusive breastfeeding rate at 6 months. Exclusive breastfeeding rates at 7 days and 3 months and serial weight gain of an infant were assessed in both groups. Exclusive breastfeeding rate at 7 days was statistically significant in the intervention arm. The exclusive breastfeeding rates at 3 months and 6 months were higher in the domperidone arm compared to placebo but not statistically significant. Oral Domperidone along with effective breastfeeding counseling showed an increasing trend of exclusive breastfeeding rate at 7 days and at six months. Appropriate breastfeeding counseling and postnatal lactation support are important in enhancing exclusive breastfeeding. The study was prospectively registered with CTRI – Reg no. CTRI/2020/06/026237 [ABSTRACT FROM AUTHOR]

Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon. [ABSTRACT FROM AUTHOR]

Breast milk and breastfeeding bring considerable benefits to infants. A caveat in breastfeeding promotion efforts is the lack of emphasis on exclusive breastfeeding (EBF) for the first six months of a baby's life. This research examined the relative effectiveness of descriptive and injunctive messaging on promoting 6-month EBF by employing a 3 (norms: descriptive norms vs. injunctive norms vs. no norms) X 2 (positive outcome recipient: baby vs. mother) factorial design and tested hypotheses with expecting women. Participants showed strong intention to exclusively breastfeed across experimental conditions. The results revealed that the descriptive normative message was more effective in promoting EBF than the control condition, whereas the injunctive normative message had no advantage over the control condition. Moreover, perceived outcome expectations for the baby and the mother attenuated the relationship between perceived descriptive norms and EBF intention. Theoretical and practical implications regarding how norms messaging can promote EBF are discussed. [ABSTRACT FROM AUTHOR]

Although studies have investigated relationships between autism spectrum disorder (ASD) and breastfeeding duration, information concerning these children's nursing styles is limited. This study investigated nursing personality and features and ASD. One hundred forty-one children aged 24–72 months diagnosed with ASD and 128 healthy children were included. Information concerning the family's sociodemographic characteristics and the child's developmental stages was obtained through forms prepared by the authors and from hospital records. The Childhood Autism Rating Scale (CARS) was used to determine symptom severity in ASD. Development levels of children with ASD were determined using the Denver Developmental Screening Test 2nd Edition (DDST II). Mothers of children with ASD reported higher rates of unintended pregnancies (p = 0.029) [2.380*(1.093–5.182)]. Children with ASD exhibited less nursing strike (NS) behavior (p = 0.042) [0.388(0.156–0.967)] and less eye contact during breastfeeding (ECDB) (p = 0.009) [2.300(1.236–4.282)]. NS reduced the risk of ASD 2.6-fold, while absence of ECDB increased the risk 2.3-fold, and unintended pregnancy increased the risk 2.4-fold. Higher CARS scores were determined in children with ASD with vaginal delivery histories (p = 0.041) and histories of incubation (p = 0.025). Lack of ECDB was associated with decreased social and gross motor scores at DDST-II (p = 0.005). Babies with ASD began breastfeeding at least as early as typically developing peers and for similar lengths of time. However, babies with ASD exhibited less NS behavior and less eye contact during breastfeeding. Babies with ASD perceive no emotional cues even in the first months, and may therefore not exhibit NS behavior. [ABSTRACT FROM AUTHOR]

427 women were included in this observational cohort study to determine the rate of exclusive (EB), mixed (MB) and artificial breastfeeding (AB) and the personal reasons and social factors influencing this decision. An initial survey was conducted within the first 36 h postpartum and a second wave was carried out 3 months after delivery. 55.74% (238) of the patients intended to EB, 32.55% (139) AB and 11.71% (50) MB. After 3 months, a high percentage in group EB (75.23%) maintained EB. The main reason for switching to AB was the absence of milk or weight loss of the newborn. In conclusion, EB is the preferred form for feeding newborns. When these women returned to their workplace, most of them wanted to continue with EB. Women with higher academic degrees chose more often EB. What is already known on this subject? The benefits of exclusive breastfeeding are well known. However, in modern western societies, it is not easy to combine breastfeeding with day-to-day activity. Work activity, age or previous parity are some of the factors that may influence the election of the type of lactation. What do the results of this study add? Exclusive breastfeeding is the preferred method for feeding newborns immediately postpartum and 3 months later. Work activity does not seem to influence or to switch the choice. However, the level of education could be a determinant of adherence to exclusive breastfeeding. What are the implications of these findings for clinical practice and/or further research? Assessing the factors that favour adherence to exclusive breastfeeding might be a useful tool to its promotion. This study warrants further multivariate analyses on the same topic and additional studies in other social contexts. [ABSTRACT FROM AUTHOR]

Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city. A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators. Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding. Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums. [ABSTRACT FROM AUTHOR]

Introduction: Although exclusive breastfeeding is very beneficial for children's and mothers' health, a limited number of infants are exclusively breastfed for 6 months.Aim: This randomized controlled intervention study aims to determine the effect of breastfeeding training on mothers' knowledge, behaviors, and exclusive breastfeeding for 6 months.Materials and Methods: The participants were selected randomly for training (n = 60) and control groups (n = 60) among the pregnant women admitted to the obstetrics and gynecology polyclinics of a baby-friendly hospital. The training group received breastfeeding training during the prenatal and postnatal periods. The data were collected using a questionnaire during admission and at the postpartum 1st and 24th weeks through face-to-face interviews. The study was completed with 34 and 30 mother-infant pairs in the training and control groups, respectively. Analyzed using the chi-square, Student t, Mann-Whitney U, and Wilcoxon t-tests.Results: The difference between the number of correct answers in pre- and posttest was higher in the training group (four questions) than in the control group (two questions) (p < .001). The number of mothers exclusively breastfeeding for 6 months was significantly higher in the training group (26.5%) than in the control group (3.3%) (p = .015). The median of the exclusive breastfeeding period was longer in the training group (5 months) than in the control group (4 months) (p = .013).Conclusion: Training and supporting pregnant women and breastfeeding mothers on breastfeeding increased their knowledge, the period of exclusive breastfeeding, and the rate of 6-month exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding counseling and mother support provision positively affect the duration of exclusive breastfeeding and infant growth and development. This study aimed to determine the effect of prenatal counseling on the frequency of exclusive breastfeeding and infant weight gain in mothers with previous unsuccessful breastfeeding. Methods: This was a randomized clinical trial on 108 pregnant women who visited the healthcare centers in Tabriz-Iran from November 2017 to May 2018. Participants were randomly allocated either to an intervention or a control group. The intervention group received four breastfeeding counseling sessions in the third trimester, whereas the control group merely received routine care. Counseling was offered to mothers until day 15, 2 months and the end of the month 4 postpartum, in case of experiencing any problem. A researcher-made breastfeeding performance checklist was completed by the groups on three occasions (p <.05 considered as the significance level). Findings: The frequency of exclusive breastfeeding in the intervention group was 75.9, 72.2, and 72.2% on day 15, and 2 and 4 months postpartum, respectively. It was 31.5, 16.7, and 16.7% in the control group, respectively. The probability of exclusive breastfeeding on day 15, month 2, and month 4 was significantly higher in the intervention group. The mean infant weight on day 15 postpartum was significant in the intervention group (mean difference = 112.2; 95% confidence interval = 29.8–194.5; p =.008). No statistically significant difference was observed between the groups in terms of infant weight gain in months 2 (p =.221) and 4 (p =.128) postpartum. Result: The results of the study showed that pregnancy counseling increases the frequency of exclusive breastfeeding in mothers. [ABSTRACT FROM AUTHOR]

In the era of widespread antiretroviral therapy (ART), consequences of being HIV-exposed is unclear for children, especially in rural communities. A population sample of consecutive births (470/493) in the Eastern Cape of South Africa (SA) were recruited and reassessed at five points over the first 24 months. Maternal and child outcomes between mothers living with and without HIV were assessed using multiple linear and logistic regressions. At birth, 28% of the sample was mothers living with HIV and five additional mothers seroconverted. All mothers living with HIV reported taking ART. The rate of depressed mood and IPV was similar across serostatus. However, mothers living with HIV significantly decreased their alcohol use after learning about their pregnancy and were more likely to exclusively breastfeed when compared to mothers without HIV. Despite maternal HIV status, children had similar growth across the first 24 months of life. Future work is needed to assess if these developmental trajectories will persist. [ABSTRACT FROM AUTHOR]

Breastfeeding is important for growth, development and survival of HIV exposed infants. Exclusive breastfeeding reduces the risk of morbidity, mortality and increases HIV free survival of infants. Evidence on risk factors for inappropriate breastfeeding in Northern Uganda is limited. This study determined the risk factors for non-exclusivity of breastfeeding in the first 14 weeks of life. This prospective cohort study was conducted among 466 mother-infant pairs between August 2018 and February 2020 in Lira district, Northern Uganda. HIV infected pregnant women were enrolled and followed up at delivery, 6- and 14- weeks postpartum. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related, HIV-related characteristics and exclusive breastfeeding. Data were analysed using Stata version 14.0 (StataCorp, College Station, Texas, USA.). We estimated adjusted risk ratios using modified Poisson regression models. The proportion of HIV exposed infants that were exclusively breastfed reduced with increasing age. Risk factors for non-exclusive breastfeeding included infants being born to HIV infected women who: were in the highest socioeconomic strata (adjusted risk ratio = 1.5, 95%CI: 1.01– 2.1), whose delivery was supervised by a non-health worker (adjusted risk ratio = 1.6, 95%CI: 1.01– 2.7) and who had not adhered to their ART during pregnancy (adjusted risk ratio = 1.3, 95%CI: 1.01– 1.7). HIV infected women: with highest socioeconomic status, whose delivery was not supervised by a health worker and who did not adhere to ART were less likely to practice exclusive breastfeeding. We recommend ART adherence and infant feeding counselling to be emphasised among HIV infected women who are at risk of having a home delivery, those with poor ART adherence and those of higher socioeconomic status. We also recommend integration of these services into other settings like homes, community and work places instead of limiting them to hospital settings. HIV: Human Immunodeficiency Virus; ART: Antiretroviral therapy; HEI: HIV exposed infant; PMTCT: Prevention of mother-to-child transmission of HIV; MTCT: Mother-to-child transmission of HIV; AFASS: Acceptable, Feasible, Affordable, Sustainable and Safe; LRRH: Lira regional referral hospital; CI: confidence interval; ARR: Adjusted risk ratio; SD: Standard deviation; PCA: Principal component analysis [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to study the impact of a Human Milk Bank (HMB) on neonatal mortality, incidence of necrotizing enterocolitis (NEC) and rate of exclusive breastfeeding. Methods: This pre-post intervention study was conducted in a tertiary care teaching institute in south India. Data regarding neonatal mortality, incidence of NEC, and exclusive breastfeeding rates were collected for a period of 6 months before and after establishing a modern HMB and compared. Results: The number of deliveries, live births, and incidence of preterm and VLBW neonates during pre- and post-HMB periods were comparable. Neonatal mortality was 11.32/1000 live births pre-HMB compared with 10.77/1000 live births post HMB. The incidence of NEC was 1.26% of live births pre-HMB compared with 1.07% post-HMB. Exclusive breastfeeding rate pre-HMB was 34% compared with 74% post HMB (p < .001). Conclusion: There is a decreasing trend in neonatal mortality and incidence of NEC after establishing a HMB. Human milk banking significantly improved exclusive breastfeeding rate in the population studied. [ABSTRACT FROM AUTHOR]

Sick children can be a reason a mother is absent from work or does not work optimally. This study aims to look at the relationship between exclusive breastfeeding practices and frequency of sick children and the productivity of health-care provider mothers. This quantitative study was done using a sample of 160 health-care provider mothers from hospitals in cities and districts in Samarinda, Indonesia. Data analysis was approached using Chi-square test for categorical variables. There is a significant relationship between the practice of exclusive breastfeeding and the frequency of sick children and the productivity of health-care provider mothers (p = 0.002). The results showed that the scores of OR on the frequency variable of sick children and maternal-productivity variables are 3.22 and 2.99, respectively. The practice of exclusive breastfeeding can reduce the frequency of sick children and the productivity of health-care provider mothers. The health-care provider mothers play a role in promoting exclusive breastfeeding and as role models in providing support for the application of the Baby-Friendly Hospital Initiative with "Ten Steps to Successful Breastfeeding". There is a need for regulations regarding maternity and breastfeeding leave regardless of employment status. [ABSTRACT FROM AUTHOR]

This study aimed to identify the factors that influence the success of exclusive breastfeeding in twins. This cross-sectional study was conducted on 184 mothers who had twins aged 6–23 months in Malang Raya, East Java, Indonesia and used the consecutive sampling technique. The data was collected through distributing questionnaires containing questions related to knowledge about exclusive breastfeeding, breastfeeding self-efficacy, and the support of family and certified health workers. Multinomial regression statistical test results show that the most influential factor for the success of exclusive breastfeeding with twins was breastfeeding self-efficacy (OR 0.111; 95% CI 0.033–0.387). A high level of breastfeeding self-efficacy can increase a mother's confidence to be able to provide exclusive breastfeeding for twins. This study suggests that nurses can provide breastfeeding counselling to improve breastfeeding self-efficacy. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effects of maternal nutritional supplementation (MNS) in conjunction with a breastfeeding support program on birth outcomes and breastfeeding performance.Methods: A total of 228 singleton Vietnamese mothers aged 20-35 years at 26-29 weeks of gestation with pre-pregnancy body mass index (BMI) < 25.0 kg/m2 were randomized to the intervention (n = 114), receiving MNS (252 kcal/day) daily up to 12 weeks postpartum and four breastfeeding education and support sessions or to the control (n = 114), receiving standards of care.Results: The intervention was 2.09 times more likely to exclusively breastfeed over the 12 weeks than the control (95%CI: 1.05-4.13, p = .0358), after controlling for potential confounders. Infant's breast milk intake was significantly higher in the intervention than the control among mothers with baseline mid-upper arm circumference (MUAC) < 50th (p = .0251). Infants in the intervention had significantly higher birth weight (p = .0312), birth weight-for-age (p = .0141) and birth head circumference-for-age (p = .0487), and higher head circumference-for-age z-score (p = .0183) development over the postnatal period, compared with the control.Conclusions: Use of MNS and breastfeeding support improve birth outcomes and exclusive breastfeeding (EBF) rate in Vietnamese mothers. Additionally, it promotes breast milk production among mothers with lower baseline MUAC. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding is embedded in National Health Law and Regulation in Indonesia and is vigorously promoted by health workers, breastfeeding counsellors and religious leaders. This article explores the transformation of state legislation into breastfeeding promotions that are imbued with moralising assumptions directed at expectant women, new mothers and their partners. Drawing on an 18-month ethnographic study, the rhetoric of breastfeeding promotion messages is contrasted with the narratives of urban middle-class mothers in Yogyakarta. This article highlights the challenges women experience in their attempts to breastfeed and the divergence between the moralising rhetoric of breastfeeding promotions and women’s imperfect lived realities. It demonstrates how dominant health promotion messages construct breastfeeding as a moral issue, insist women are obligated to breastfeed their infants, and fail to acknowledge women’s choice, reproductive agency and bodily autonomy. Such messaging assumes the right of infants to be breastfed, and emphasises the developmental problems likely to befall children who are not breastfed. Gendered expectations that all mothers will assume their breastfeeding role selflessly and dutifully are also embedded in breastfeeding promotion messages. We conclude that breastfeeding promotion messages need to be more inclusive and less moralising in their substance and delivery to better serve Indonesian women. Women are likely to feel more supported and less alienated by breastfeeding promotion messages that recognise the possibility of common breastfeeding challenges, such as difficulty establishing successful breastfeeding, the baby blues, the likelihood of suffering discomfort from breastfeeding in public, and issues with the premature cessation of breastfeeding. [ABSTRACT FROM PUBLISHER]

This study investigates factors that influence exclusive breastfeeding practice. Focus group discussions involving 60 nursing mothers from selected rural areas of Enugu State, Nigeria, was adopted. Thematic analysis was adopted in analyzing data collected. Findings show that nursing mothers in the study area are yet to fully accept the 6 months’ practice of exclusive breastfeeding. Issues relating to culture, economic hardship, and support networks were revealed to exercise gross influence on practice of exclusive breastfeeding. The study concluded that professional support from social workers is very vital to achieving conformity to the practice. This can be done through awareness creation that would accommodate support networks, while adopting exclusive breastfeeding campaign models that have proven successful in other African nations. [ABSTRACT FROM PUBLISHER]

The study determined the influence of sociocultural practices on food and nutrition security of children and women in Karamoja subregion, located in northeastern Uganda. Sixteen focus group discussions were conducted among 133 participants. Data were analyzed using qualitative content analysis. Findings indicate that cultural norms, myths, and taboos restrict consumption of animal-sourced foods and some green vegetables by women. Sociocultural practices promoted prelacteal feeding, affecting the implementation of World Health Organization’s recommendations for exclusive breast feeding. In conclusion, sociocultural practices influence food and nutrition security, exposing women and children to the risk of malnutrition and associated consequences. [ABSTRACT FROM PUBLISHER]

Introduction: Adequate antenatal counseling combined with postnatal lactation support is likely to improve exclusive breastfeeding rates.Objective: To assess the impact of a postnatal video based health education program in promoting exclusive breastfeeding among primiparous mothers.Methods: This interventional study was done in a tertiary care teaching hospital, south India. Primiparous mothers in one postnatal ward (group A) received routine lactation counseling. A similar group of primiparous mothers in another postnatal ward (group B) were administered a video based health education program on exclusive breastfeeding in the local language Tamil in addition to the routine lactation counseling. The exclusive breastfeeding rates of these two groups of mothers were compared. Their knowledge and perceptions after intervention were also compared using a pretested questionnaire.Results: Among 878 primiparous mothers, 94% fed colostrum and 43% initiated breastfeeding within one hour of delivery. Correct attachment was noted with 96% and 13% had lactation issues. Group B had marginally better exclusive breastfeeding rate at six months but not statistically significant. Mothers in group B had a statistically significant better knowledge score post-intervention compared to those in Group A. Use of gripe water was more in group A compared to group B.Conclusion: The video based health education program when combined with routine lactation counseling improved the knowledge regarding exclusive breastfeeding among postnatal primiparous mothers better than with routine lactation counseling alone. However, both interventions had similar effect on exclusive breastfeeding rate at six months. [ABSTRACT FROM AUTHOR]

Background:Childhood undernutrition remains a highly influential risk factor in terms of the global burden of disease. Increasing evidence links infant and young child feeding (IYCF) practices to undernutrition. However, the results are inconsistent, and more country-specific studies are needed. Objectives:To determine the associations between IYCF practices and nutritional outcomes among children aged 0–23 months using a nationally representative dataset. Methods:The study used data from the 2011 Nepal Demographic and Health Survey, and the data were analysed for children aged 0–23.9 months who had corresponding data for the outcome variables of interest (n = 890). Multiple linear and logistic regressions were undertaken and adjusted for the complex design of the survey, controlling for child, maternal, household and community characteristics. Results:Of the 890 children included in the study, 83% received age-appropriate breastfeeding but only 48% were breastfed within 1 hour of birth. Exclusive breastfeeding under 6 months of age was associated with a higher weight-for-age Z-score (WAZ) and a lower probability of wasting, but the estimated effects were of borderline significance. A significant negative association was found between continued breastfeeding at 1 year and WAZ and weight-for-height Z-score (WHZ). Timely introduction of complementary feeding in children aged 6–8 months was associated with a higher WAZ [effect size (ES) 0.6,P < 0.01] and higher WHZ (ES 0.6,P < 0.05). Higher dietary diversity index (DDI) was associated with higher height-for-age Z-score (ES 0.1,P < 0.05 for each DDI point). Children who achieved minimum meal frequency had a higher WAZ (ES 0.3,P < 0.05). Conclusion:This is the first study to relate the wide ranges of IYCF indicators with child nutritional outcomes in Nepal, and it underscores the need to improve age-appropriate complementary feeding practices with a sustained focus on exclusive breastfeeding to reduce undernutrition in infants and young children. [ABSTRACT FROM PUBLISHER]

Objective: To assess the association of maternal anxiety with nonadherence to exclusive breastfeeding.Methods: This questionnaire-based study was conducted at a tertiary care teaching hospital in South India mothers with infants less than 6 months of age and not exclusively breastfeeding were interviewed and their demographic and clinical details were noted. The Iowa Infant Feeding Attitude Scale (IIFAS) and Hospital Anxiety and Depression Scale (HADS) were administered to these mothers.Results: A total of 85 mother-infant dyads were included. The mean age of the mothers was 26 years and 57% were from urban areas. Among the additional feeds given, cow's milk was the commonest (57.6%), followed by gripe water (28.2%) and formula feeds (16.5%). The mean HADS anxiety subscale score was 12.2 (±5.3) and HADS depression subscale score was 9.5 (±3.8). The mean score on IIFAS was 58.4 (±3.6) suggesting a relatively favorable attitude toward breastfeeding. On linear regression analysis, higher HADS depression score, lower birth weight and lower per capita income were independent predictors of poorer attitudes toward breastfeeding.Conclusion: Maternal anxiety may be an independent risk factor for nonadherence to exclusive breastfeeding for the initial six months. [ABSTRACT FROM AUTHOR]

Background: Undernutrition is highly prevalent among infants in Uganda. Optimal infant feeding practices may improve nutritional status, health, and survival among children. Objective: Our study evaluates the socioeconomic distribution of exclusive breastfeeding (EBF) and growth outcomes among infants included in a trial, which promoted EBF by peer counselors in Uganda. Design: Twenty-four clusters comprising one to two communities in Uganda were randomized into intervention and control arms, including 765 mother-infant pairs (PROMISE-EBF trial, 200608, Clinical- Trials.gov no. NCT00397150). Intervention clusters received the promotion of EBF by peer counselors in addition to standard care. Breastfeeding and growth outcomes were compared according to wealth quintiles and intervention/control arms. Socioeconomic inequality in breastfeeding and growth outcomes were measured using the concentration index 12 and 24 weeks postpartum. We used the decomposition of the concentration index to identify factors contributing to growth inequality at 24 weeks. Results: EBF was significantly concentrated among the poorest in the intervention group at 24 weeks postpartum, concentration index -0.060. The control group showed a concentration of breastfeeding among the richest part of the population, although not statistically significant. Stunting, wasting, and underweight were similarly significantly concentrated among the poorest in the intervention group and the total population at 24 weeks, but showing non-significant concentrations for the control group. Conclusion: This study shows that EBF can be successfully promoted among the poor. In addition, socioeconomic inequality in growth outcomes starts early in infancy, but the breastfeeding intervention was not strong enough to counteract this influence. [ABSTRACT FROM AUTHOR]

Objectives: Breastfeeding is one of the primary strategies used to enhance infant nutrition and improving child survival worldwide. The intention of globally increasing the rate of exclusive breastfeeding (EBF) to at least 50% of infants in the first six months of life was stated in the 2014 International Conference on Nutrition Rome Declaration on Nutrition and the Post-2015 Development Agenda. This study aimed to explore the infant-feeding practices of mothers and caregivers of infants aged ≤ 6 months in four provinces in South Africa. Setting and subjects: This cross-sectional study was conducted in four provinces in South Africa. In total, 40 health facilities were randomly selected in the four provinces and visited, including metropolitan and non-metropolitan health facilities over the geographical area of the provinces. The sample size comprised mothers and/or caregivers of babies aged ≤ 6 months. Design: Fixed-format interviews were used in this cross-sectional study on 580 mothers and/or caregivers. The mothers completed 24-hour recall based on the Food and Agriculture Organization of the United Nations dietary diversity list, consisting of 12 different food groups, to assess dietary intake and diversity. Results: The EBF rate for infants up to the age of six months was 12%. Mothers who delivered full-term babies were most likely to initiate breastfeeding within the first hour of delivery. More than a third of the mothers had ceased breastfeeding by one month (40%, n = 23). The introduction of complementary food took place in 17% of infants during this first month. The minimum standards of dietary diversity were met by one infant only. Different reasons found to influence mothers' feeding practices included needing to return to work (29%) or their studies (12%), the mothers' health status (25%), and perceptions of an “insufficient” milk supply (13%). Conclusion: Therefore, new strategies should address these gaps in knowledge with key breastfeeding awareness messages and a special focus on community involvement and participation. There is also a need for the whole nutrition fraternity, including government, academia and development industries, to intervene by developing more innovative approaches to increase the rate of EBF in South Africa. [ABSTRACT FROM AUTHOR]

Background: For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food. Aims and Objectives: A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0–<6 months with regard to food intake. Methods: Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and <6 months were selected for analysis (n = 196). An ANCOVA test was performed on age of the infant with mothers' height and weight as covariates. Results: Prevalence of stunting (infants' length-for-age Z-score (LAZ) <−2SD) was 39%, wasting (WLZ <−2SD) 2%, and underweight (WAZ <−2SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (−1·13, 0·12) and WAZ (−0·41, 0·13) than infants not being exclusively breastfed (−1·59, 0·11, and −0·97, 0·11, respectively). There was no overall significant association between breastfeeding practice and WLZ. Conclusion: Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educateHIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding toHIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context ofHIVinprogramsettings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) ofHIVprograms in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context ofHIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to describe the attitudes of human immunodeficiency virus (HIV)-infected women and other role players towards the World Health Organization (WHO) 2010 infant feeding guidelines. Design: This was formative evaluation research, carried out from September-November 2011. Setting: The study was conducted at Mulago Hospital, Kampala, Uganda. Subjects: Focus group discussions (FGDs) were held among five groups: HIV-infected pregnant women (9), HIV-infected postpartum mothers (10), HIV-infected peers (10), male partners (10), family members of the pregnant women (10) and key informants (12). Outcome measures: Descriptive data were collected through FGDs and key informant interviews. Results: With the exception of male partners, the majority of FGD participants and key informants who were health workers held a positive attitude towards exclusive breastfeeding. The introduction of complementary foods at six months while HIV-infected lactating mother continued to breastfeed was supported by all of the health workers, but by only a minority of participants from each focus group discussion. The majority of FGD participants and the health workers were in favour of an HIV-infected lactating mother taking antiretroviral (ARV) drugs during the breastfeeding period, rather than the infant. Conclusion: Three conclusions can be drawn from this study. Firstly, general attitudes towards the WHO 2010 infant feeding guidelines on exclusive breastfeeding were positive. Secondly, there were still fears about an HIV-infected mother introducing complementary foods at six months while continuing to breastfeed. Thirdly, all of the FGD participants and the majority of the health workers recommended that the mother should take ARV drugs in the lactating period. [ABSTRACT FROM AUTHOR]

With the global trend of increasing asthma and allergic disorders there is strong interest regarding early life nutrition as a potentially modifiable risk factor for lung disease. This systematic review includes 10 studies that assessed the effect of breastfeeding on lung growth and function. The review found breastfeeding to be beneficial for lung function, with the most consistent effect on increased forced vital capacity. There was no clear evidence that the relationship between breastfeeding and lung function was mediated through other factors. Furthermore, the findings from the few studies that investigated if maternal asthma modified the effect of breastfeeding on lung function were inconsistent. Further research is needed to determine the specific details such as duration and type (exclusive vs partial) of breastfeeding that leads to improved lung function. [ABSTRACT FROM AUTHOR]

Exclusive and safe formula feeding can eliminate the risk of vertical HIV transmission due to breastfeeding. Therefore, many countries advise all HIV-positive women to avoid breastfeeding their infants. However, little research explores the experiences of women attempting to exclusively formula feed in countries with free and universal access to highly active antiretroviral therapy (HAART). This article examines the success of Brazil in supporting HIV-positive women as engage in exclusive formula feeding (EFF). We conducted in-depth interviews with 30 HIV-positive women receiving care at the primary facility for HIV/AIDS in Salvador, Brazil about their attitudes and practices related to EFF as well as challenges with adhering to EFF. All interviews were recorded, professionally transcribed and translated, and then analyzed. Our results showed that one woman reported both breastfeeding and formula feeding her infant; all others reported EFF. Postpartum counseling regarding the risk of HIV transmission through breastfeeding was the primary motivation for EFF. Challenges included difficulty reconciling their perceptions that breastfeeding is an important maternal responsibility, trouble accepting that breastfeeding can cause potential to harm their infants, confronting HIV-related stigma associated with EFF, and unexpected financial burdens due to EFF. We conclude that HIV-positive women adhered to national guidelines recommending EFF; this phenomenon has likely contributed to declining rates of vertical transmission in Brazil. Despite this success, many women experienced challenges with EFF. Greater support services may enhance Brazil's success in empowering HIV-positive women and eliminating vertical HIV transmission via breastfeeding. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the factors related to exclusive breastfeeding among postpartum Thai women with a history of gestational diabetes mellitus. Background: Postpartum women with diabetes are more likely to have delayed lactogenesis. Strict glycaemic control may affect lactation. Methods: A cross-sectional analytic research was designed to carry out the study. One hundred and fifty participants were included in the study. Data were collected in two phases using the Exclusive Breastfeeding questionnaire. Data were analysed using Pearson correlation, independent t-test and binary logistic regression. Results: The significant factors related to the 6-month exclusive breastfeeding were maternal age, employment, parity, body mass index, duration of newborn's admission in NICU and exclusive breastfeeding intention. Conclusion: These findings indicate that effective nursing interventions need to be implemented for promoting exclusive breastfeeding among postpartum women with diabetes. [ABSTRACT FROM AUTHOR]

This study assessed trends in equity of access to reproductive health services and service utilization in terms of coverage of family planning, antenatal care and skilled birth attendance in Thailand. Two health indicators were measured: the prevalence of low birthweight and exclusive breastfeeding. Equity was measured against the combined urban–rural areas and geographic regions, women's education level and quintiles of household assets index. The study used data from two nationally representative household surveys, the 2006 and 2009 Reproductive Health Surveys. Very high coverage of family planning (79.6%), universal antenatal care (98.9%) and skilled birth attendance (99.7%), with very small socioeconomic and geographic disparities, were observed. The public sector played a dominant role in maternity care (90.9% of all deliveries in 2009). The private sector also had a role among the higher educated, wealthier women living in urban areas. Public sector facilities, followed by drug stores, were a major supplier of contraception, which had a high use rate. High coverage and low inequity were the result of extensive investment in the health system by successive governments, in particular primary health care at district and sub-district levels, reaching universality by 2002. While maintaining these achievements, methodological improvements in measuring low birthweight and exclusive breastfeeding for future reproductive health surveys are recommended. Cette étude a analysé l'évolution de l'équité de l'accès aux services de santé génésique et l'utilisation des services avec la couverture de la planification familiale, les soins prénatals et l'assistance qualifiée à l'accouchement en Thaïlande. Deux indicateurs sanitaires ont été examinés : la prévalence de l'insuffisance pondérale à la naissance et l'allaitement exclusivement au sein. L'équité a été mesurée par rapport aux données combinées des régions géographiques et des zones urbaines-rurales, au niveau d'instruction des femmes et aux quintiles de la richesse des ménages. L'étude a utilisé les informations de deux enquêtes auprès des ménages représentatives à l'échelon national : les enquêtes de santé génésique de 2006 et 2009. Elle a observé une très vaste couverture de la planification familiale (79,6%), la généralisation des soins prénatals (98,9%) et de l'assistance qualifiée à l'accouchement (99,7%), avec très peu de disparités géographiques et socio-économiques. Le secteur public jouait un rôle prédominant dans les soins obstétricaux (90,9% des accouchements en 2009). Le secteur privé apportait aussi sa contribution pour les femmes les plus instruites et vivant dans les zones urbaines. Les centres du secteur public, suivis des pharmacies, représentaient une source majeure d'approvisionnement en contraception orale, largement utilisée. La couverture élevée et les faibles inégalités résultent d'investissements considérables réalisés par les gouvernements successifsdans le système de santé, en particulier les soins de santé primaires au niveau du district et du sous-district, qui sont devenus universels en 2002. Tout en maintenant ces progrès, il est recommandé d'apporter desaméliorations méthodologiques aux mesures de l'insuffisance pondérale à la naissance et de l'allaitement exclusif pour les futures enquêtes de santé génésique. Este estudio evaluó las tendencias en equidad de acceso a los servicios de salud reproductiva e infantil y en el uso de estos con relación a la cobertura de planificación familiar, atención antenatal y atención calificada del parto en Tailandia. Se midieron dos indicadores de salud: prevalencia de bajo peso al nacer y lactancia exclusiva. Se midió la equidad contra las zonas urbanas-rurales y las zonas geográficas, el nivel de escolaridad de las mujeres y los quintiles del índice de bienes. Se utilizaron datos de dos encuestas domiciliarias nacionalmente representativas: las Encuestas de Salud Reproductiva de 2006 y 2009. Se observó una cobertura muy alta de los servicios de planificación familiar (79.6%), atención antenatal universal (98.9%) y atención calificada del parto (99.7%), con muy pequeñas diferencias socioeconómicas y geográficas. El sector público desempeñó una función dominante en la atención obstétrica (el 90.9% de todos los partos en 2009). El sector privado también desempeñó un rol entre las mujeres más cultas y con mayores recursos financieros que viven en las zonas urbanas. Las unidades de salud del sector público, seguidas por las farmacias, fueron uno de los principales proveedores de anticonceptivos, cuya tasa de prevalencia de uso fue elevada. La alta cobertura y la baja inequidad fueron el resultado de extensas inversiones en el sistema de salud por parte de sucesivos gobiernos, en particular en la atención primaria a nivel distrital y sub-distrital, alcanzando universalidad para el año 2002. A la vez que se mantienen estos logros, se recomienda mejorar la metodología para medir el bajo peso al nacer y la lactancia exclusiva para futuras encuestas de salud reproductiva. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to assess nursing staff knowledge, attitudes and practices regarding the Baby-Friendly Hospital Initiative (BFHI); to assess the knowledge of maternity obstetric unit (MOU) managers regarding BFHI principles and their attitude towards BFHI implementation; and to describe the barriers and constraints to the implementation of BFHI principles. Study design: Cross-sectional descriptive survey. Setting: The study was done in eight non-BFHI-accredited primary care maternity obstetric units in Cape Town. Subjects: The subjects were eight MOU managers and a random sample of 45 nursing staff. Outcomes measures: Knowledge, attitude and practices regarding BFHI and barriers to BFHI implementation were assessed by an intervieweradministered questionnaire. Results: The study demonstrated acceptable awareness and knowledge of the recommended BFHI principles. A total of 56.6% of the staff could define rooming-in, 47.2% could define the components of the BFHI, and 52.8% could name three baby-friendly care practices and routines. Eighty-nine per cent of the nursing staff were able to demonstrate correct positioning of the baby for breastfeeding, and 91.1% could demonstrate the correct attachment of the baby to the breast. Only 8.9% of the nursing staff were able to adequately demonstrate the correct hand milk-expressing technique, 35.6% knew about the correct management of painful nipples and 22.2% knew how to manage engorgement. Only 40% could adequately describe the safe preparation of infant formula. The enrolled nursing assistants (ENA) were significantly less knowledgeable than the other cadres of nurses. The majority of the nurses had a positive attitude toward BFHI principles and practices. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to determine the effects of breastfeeding education/support offered at home on day 3 postpartum on breastfeeding duration and knowledge. Methods. The study included a total of 60 women who gave birth at Zübeyde Hanım Maternity Hospital located in Aydın, Turkey. In addition to a standard breastfeeding education in the first few hours after delivery, which was provided to all women in this 'baby-friendly initiative' (BFI) hospital, the mothers in the intervention group received breastfeeding education at home on day 3 postpartum from supporters. Results. Both groups were comparable in terms of maternal and neonatal characteristics. The breastfeeding education/support offered during a home visit on day 3 postpartum was associated with a significant increase in the percentage of exclusively breastfed infants both at 2 weeks and 6 weeks, and at 6 months, and was also associated with a significant increase in exclusive breastfeeding and in total breastfeeding duration. In addition, increased breastfeeding knowledge scores were observed in the intervention group at 2 weeks and at 6 weeks after delivery, when compared with the respective scores in the control group. Conclusion. Breastfeeding education offered at home on day 3 postpartum was effective in increasing the breastfeeding duration and breastfeeding knowledge. [ABSTRACT FROM AUTHOR]

The Baby-Friendly Hospital Initiative (BFHI) is a global effort to improve the role of maternity services and to enable mothers to breastfeed their infants, thus ensuring the best start in life for their infants. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF). It has been shown, however, that the selective implementation of only some of the steps may be ineffective and discouraging to successful BF practices. An initial study was therefore conducted to assess the extent of the implementation of the Ten Steps in both public and private maternity facilities. Poor performance for some steps led to a follow-up study to investigate the knowledge and attitudes of health care workers (HCWs) and mothers alike and to evaluate the exclusive BF (EBF) practices of mothers attending private BF clinics. Both studies followed descriptive, cross-sectional designs and were set in the Cape Metropole in the Western Cape. Twenty-six maternity facilities participated in the initial study, for which observation lists were completed and verified by interviewer-administered questionnaires to both HCWs and mothers. Eighteen private BF clinics participated in the follow-up study, which included observations and interviewer-administered questionnaires to 25 HCWs and 64 mothers. During the initial study, lower mean scores were noted for Steps 1, 2, 6 and 10. The overall implementation of the Ten Steps was average. The findings highlighted the importance of the establishment and implementation of BF policies, of appropriate and continuous BF training and better referral systems to ensure initiation and establishment of early BF, EBF practices and support on an ongoing basis to ensure the best start in life for infants. [ABSTRACT FROM AUTHOR]

Background: Real differences in the duration of post-partum amenorrhoea for similar breastfeeding practices are observed in different populations. Aim: The present study investigated the role of energetics in the regulation of fertility among lactating women with high levels of physical activity and poor nutritional status. Subjects and methods: From 1996 to 1998, we carried out a longitudinal survey on the factors regulating fertility in lactating women. All women in our sample (n=150) had poor nutritional status and high levels of physical activity, and most of them were illiterate. Half of them were tea workers, and the other half were housewives of male tea workers. They lived in the same villages inside the tea plantation, and were highly comparable. Results: Survival analysis revealed a very significant longer median duration of post-partum amenorrhoea for tea workers (636 days) compared with non-workers (375 days) although the tea workers cannot breastfeed during the working day. These durations are much longer than those of the WHO multinational study, carried out with a similar protocol, where the medians ranged between 122 and 282 days. Conclusion: We suggest that our findings highlight the effect of energetics on the regulation of fertility in lactating women. [ABSTRACT FROM AUTHOR]

Objective: Currently there are no recommendations for vitamin/mineral supplementation for lactating women but supplementation may be important, particularly for those women who choose to restrict milk intake during lactation. The objective of this study was to assess nutrient adequacy for lactating women and compare their dietary intake, including supplements, between those who restrict milk and those who do not.Methods: A cohort of 175 healthy exclusively breast-feeding women (19-45 yrs) recruited from prenatal classes were divided into milk restrictors (RS) defined as milk intake < or = 250 ml/day and non-restrictors (NRS) (>250 ml/day) and followed for six months postpartum. Participants provided repeated 24-hr dietary recalls, detailed use of vitamin/mineral supplements and reasons for restricting milk.Statistical Analyses: Observed intakes were adjusted to remove day-to-day variability. Nutrient intakes were estimated for macronutrients and vitamins C, D, thiamin, riboflavin, niacin, and minerals, calcium and zinc, with and without vitamin/mineral supplements. Chi-square was used to compare the number of RS and NRS with intakes less than the Estimated Average Requirement (EAR).Results: Milk restriction was practiced by 23% of the sample. Sixty per cent of RS reported protein intakes Conclusions: Milk restriction compromised protein and nutrient intakes in lactating women who restricted milk to <250 mL. Vitamin/mineral supplements helped exclusively breastfeeding milk restrictors improve their vitamin D and calcium intakes. Milk restriction is not recommended during lactation and where unavoidable, nutrients provided by milk should be compensated for by other foods or supplements. [ABSTRACT FROM AUTHOR]

Child feeding practices and food choice is a concern of every member of the family, especially the mother, but it is influenced by many factors. To understand the influences on mothers choice of complementary foods a cross sectional study was undertaken among 201 rural and urban mothers with infants between the ages of 0-18 months in the Ilesa area of Osun State. The analysis of data from logistic regression analysis show that income, place of birth, nurses recommendations, price of the food and the age of mothers were the main factors influencing the choice of complementary foods by mothers. The relevance of the findings is helpful in designing nutrition education intervention for mothers. [ABSTRACT FROM AUTHOR]