Effect of Access to Workplace Supports for Breastfeeding Among Formally Employed Mothers in Kenya

Abstract Objectives We evaluated the availability of workplace breastfeeding (BF) supports, and the associations between these supports and BF practices among formally employed mothers in Kenya – where many women work in horticulture farms and legislation requiring workplace BF supports is being implemented. We hypothesized that the availability of supports would be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). Methods We conducted repeated cross-sectional surveys among formally employed mothers at 1–4 days, 6 weeks, 14 weeks, and 36 weeks (to estimate 24 weeks) postpartum at 3 health facilities in Naivasha from Sept. 2018 to Oct. 2019, 13 months after the 2017 Kenyan Health Act, which requires workplace BF support, was passed. We evaluated the associations of workplace BF supports with EBF practices using tests of proportions and adjusted logistic regression. Results Among formally employed mothers (n = 564), reported workplace supports included on-site housing (16.8%), on-site daycare (9.4%), and private lactation spaces (2.8%). Mothers who used workplace on-site childcare were more likely to practice EBF than mothers who used community- or home-based childcare at both 6 weeks (95.7% versus 82.4%, p = 0.030) and 14 weeks (60.6% versus 22.2%, p < 0.001; [aOR (95% CI) = 5.11 (2.3, 11.7)]. Likewise, mothers who visited daycares at or near workplaces were more likely to practice EBF (70.0%) compared to those who did not visit a daycare (34.7%, p = 0.005) at 14-weeks. Among all mothers, 84.6% with access to workplace private lactation spaces practiced EBF, compared to 55.6% without such spaces, p = 0.037. Mothers who live in on-site housing were twice as likely [aOR (95% CI) = 2.06 (1.25, 3.41)] to practice EBF compared to those without access to on-site housing. Conclusions Formally employed mothers in Kenya who used on-site childcare, lived in on-site housing, and had access to private workplace lactation rooms are more likely to practice EBF than mothers who lack these supports, while the use of community-based childcare in this context is associated with a lower prevalence of EBF. As the Kenya Health Act is implemented, provision of these supports and strategies to help women visit their children in daycare can enable EBF among employed mothers. Funding Sources NIH Fogarty International Center.

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Lower Prevalence of Exclusive Breastfeeding Among Employed Mothers: Results from a Cross-Sectional Survey in Naivasha, Kenya

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_082 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1010-1010

Author(s):

Scott Ickes ◽

Vanessa Oddo ◽

Ruth Nduati ◽

Donna Denno ◽

Hannah Sanders ◽

...

Keyword(s):

Early Initiation ◽

Hiv Status ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Logistic Regression Models ◽

Funding Sources ◽

Employed Mothers ◽

Formal Employment ◽

Fogarty International Center ◽

Delivery Type

Abstract Objectives We compared the prevalence of exclusive (EBF) and continued breastfeeding (BF) among formally employed, informally/self-employed, and non-employed mothers in Naivasha, Kenya, where the commercial agriculture and hospitality industries employ many women. Methods We conducted a cross-sectional survey from Sept. 2018 to Oct. 2019. Mothers of infants presenting to 3 health facilities were asked about their BF status and reasons for EBF cessation at four postpartum points: prior to discharge (n = 296), 6-weeks (n = 298), 14-weeks (n = 295), and 36-weeks (n = 297). BF status at 24-weeks was estimated at the 36-week visit. We used separate multivariable logistic regression models to compare the prevalence of early initiation (within 1-hr of birth) and EBF, between groups at each time-point, controlling for maternal age, education, HIV status, delivery setting, delivery type, and infant morbidity. We collapsed the non-employed, informal and self-employed groups into one category due to a lack of differences between these groups across all analyses. Results 65.6% of those formally employed reported early initiation of BF, compared to 75.6% without formal employment, although differences were not significant in adjusted models [OR = 0.62, 95% CI = 0.35, 1.14]. Upon hospital discharge, >96% in both groups reported practicing EBF. At 6 weeks, EBF prevalence did not significantly differ between mothers with (94.0%) and without formal employment (86.6%), [OR = 2.00, 95% CI = 0.81, 4.95]. By 14-weeks, formally employed mothers had a lower EBF prevalence compared to mothers without formal employment, 47.2% versus 78.8%, [OR = 0.19, 95% CI = 0.11, 0.33]. The lower EBF prevalence among formally employed mothers was also observed at 24-weeks (15.8% versus 48.9% [OR = 0.72, 95% CI = 0.11, 0.33]. At 36-weeks, the prevalence of continued BF was ≥98% in both groups [OR = 0.72, 95% CI = 0.11, 4.89]. The primary reasons reported for early EBF cessation were return to work (46.5%), belief that it is appropriate to feed other foods based on the child's age (33.5%), and perceived milk insufficiency (13.7%). Conclusions Formally employed mothers in Kenya experience shorter durations of EBF compared to mothers who are not formally employed by 14-weeks postpartum. These mothers may benefit from additional supports to help prolong the period of EBF. Funding Sources NIH Fogarty International Center.

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Liver fat content is independently associated with microalbuminuria in a normotensive, euglycaemic Chinese population: a community-based, cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-044237 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044237

Author(s):

Xiaoming Li ◽

Mingfeng Xia ◽

Hui Ma ◽

Yu Hu ◽

Hongmei Yan ◽

...

Keyword(s):

Logistic Regression ◽

Blood Glucose ◽

Density Lipoprotein ◽

Fat Content ◽

Lipoprotein Cholesterol ◽

Liver Fat ◽

Community Based ◽

Liver Fat Content ◽

Cross Sectional ◽

Multivariable Logistic Regression

ObjectiveNon-alcoholic fatty liver disease (NAFLD) is associated with microalbuminuria (MA) in patients with diabetes/pre-diabetes. Whether this association is mediated by blood glucose and blood pressure (BP) remains unclear. This study investigated whether liver fat content (LFC) was associated with MA in a normotensive and non-diabetic population.DesignA cross-sectional substudy.SettingsLFC was determined from the hepatic/renal echogenicity ratio at ultrasound. MA was defined as an albumin-to-creatinine ratio (ACR) of 30–300 µg/mg (early- morning urine sample). Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate LFC as a predictor of MA.ParticipantsBetween May 2010 and June 2011, this cross-sectional, community-based study enrolled residents from Shanghai (China), aged ≥40 years and with normal glucose tolerance and BP.ResultsA total of 550 residents (median age, 57 years; 174 men) were enrolled and stratified according to LFC quartiles. ACR (p<0.001) and MA prevalence (p=0.012) increased across the LFC quartiles. Multivariable logistic regression showed that the OR for MA (per SD increase in LFC) was 1.840 (95% CI 1.173 to 2.887, p=0.008) after adjustment for potential confounders including age, gender, waist-hip ratio, blood urea nitrogen, systolic and diastolic BP, fasting blood glucose, postprandial glucose, low-density lipoprotein-cholesterol, triglycerides, high-density lipoprotein-cholesterol, total cholesterol, estimated glomerular filtration rate and lipid-lowering drugs. The ROC analysis revealed that the optimal LFC cut-off value for predicting MA was 6.82%.ConclusionLFC is independently associated with MA in normotensive, euglycaemic middle-aged and elderly Chinese individuals. Screening for MA in people with NAFLD might facilitate early intervention to minimise kidney disease risk.

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Evaluating Specimen Quality and Results from a Community-Wide, Home-Based Respiratory Surveillance Study

10.1101/2020.12.07.415653 ◽

2020 ◽

Author(s):

Ashley E. Kim ◽

Elisabeth Brandstetter ◽

Naomi Wilcox ◽

Jessica Heimonen ◽

Chelsey Graham ◽

...

Keyword(s):

Online Survey ◽

Respiratory Infections ◽

Cross Sectional Study ◽

Respiratory Pathogen ◽

Respiratory Pathogens ◽

Sample Collection ◽

Community Based ◽

Cross Sectional ◽

Home Based ◽

Pathogen Screening

AbstractIntroductionWhile influenza and other respiratory pathogens cause significant morbidity and mortality, the community-based burden of these infections remains incompletely understood. The development of novel methods to detect respiratory infections is essential for mitigating epidemics and developing pandemic-preparedness infrastructure.MethodsFrom October 2019 to March 2020, we conducted a home-based cross-sectional study in the greater Seattle area, utilizing electronic consent and data collection instruments. Participants received nasal swab collection kits via rapid delivery within 24 hours of self-reporting respiratory symptoms. Samples were returned to the laboratory and were screened for 26 respiratory pathogens and a human marker. Participant data were recorded via online survey at the time of sample collection and one week later.ResultsOf the 4,572 consented participants, 4,359 (95.3%) received a home swab kit, and 3,648 (83.7%) returned a nasal specimen for respiratory pathogen screening. The 3,638 testable samples had a mean RNase P CRT value of 19.0 (SD: 3.4) and 1,232 (33.9%) samples had positive results for one or more pathogens, including 645 (17.7%) influenza-positive specimens. Among the testable samples, the median time between shipment of the home swab kit and completion of laboratory testing was 8 days [IQR: 7.0-14.0].DiscussionHome-based surveillance using online participant enrollment and specimen self-collection is a feasible method for community-level monitoring of influenza and other respiratory pathogens, which can readily be adapted for use during pandemics.

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Maternal Knowledge on Routine Childhood Immunization: A Community Based Cross-sectional Study in Rural Area of Mon State, Myanmar

Asian Journal of Research in Infectious Diseases ◽

10.9734/ajrid/2020/v3i230121 ◽

2020 ◽

pp. 1-9

Author(s):

Aung Zaw Htike ◽

San San Myint Aung ◽

Win Myint Oo

Keyword(s):

Logistic Regression ◽

Rural Area ◽

Cross Sectional Study ◽

Knowledge Level ◽

Maternal Knowledge ◽

Sectional Study ◽

Childhood Immunization ◽

Community Based ◽

Cross Sectional ◽

Routine Childhood

Aims: To determine the knowledge on routine childhood immunization and the factors associated with it among mothers in rural area of Mon State, Myanmar during 2017. Study Design: A community based cross-sectional study. Place and Duration of Study: Rural area of Mon State, Myanmar, between June and August 2017. Methodology: We included 302 mothers who had 18 to 23 months old children using multistage random sampling. Face-to-face interview was applied in data collection. Chi-square test and multivariate logistic regression analysis were utilized in data analysis. Results: More than three fourths of mothers (76.2%) had good knowledge level on routine childhood immunization. There was a significant association between maternal knowledge and immunization status of their children (p<0.001). Logistic regression showed that the husband’s occupation was significantly associated with maternal knowledge (p=0.02). Conclusion: Majority of mothers have good knowledge on routine childhood immunization. However, health education campaign should be intensified to improve their knowledge level, especially among mothers whose husbands are blue-collar workers.

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Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017–2019)

BMJ Open ◽

10.1136/bmjopen-2021-051677 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051677

Author(s):

Jean Adams ◽

David Pell ◽

Tarra L Penney ◽

David Hammond ◽

Lana Vanderlee ◽

...

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Logistic Regression Model ◽

Food Policy ◽

Perceived Effectiveness ◽

Policy Study ◽

Cross Sectional ◽

Public Acceptability ◽

Adjusted Logistic Regression ◽

The Uk

ObjectivesTo determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation.DesignRepeat cross-sectional online survey.SettingThe UK.ParticipantsUK respondents to the International Food Policy Study aged 18–64 years who provided information on all variables of interest in November–December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284).Outcome measuresSelf-reported support for, and perceived effectiveness of, the SDIL.ResultsThe adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar.ConclusionsWe found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.

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Prevalence of Onchocerciasis and Associated Factors among Adults Aged ≥ 15 Years in Semen Bench District, Bench Maji Zone, Southwest Ethiopia: Community Based Cross-Sectional Study

Advances in Public Health ◽

10.1155/2019/7276230 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Bedilu Kifle ◽

Kifle Woldemichael ◽

Mamo Nigatu

Keyword(s):

Logistic Regression ◽

Associated Factors ◽

Statistical Significance ◽

Health Department ◽

Cross Sectional Study ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Southwest Ethiopia ◽

Bivariate Logistic Regression

Background. Though onchocerciasis control and elimination through community directed treatment with ivermectin were conducted for the last fifteen years, prevalence of onchocerciasis and factors associated with it in the study area are yet not known. The aim of the current study is to assess prevalence of onchocerciasis and associated factors among adults aged greater than or equal to fifteen years in Semen Bench district, Bench Maji zone, southwest Ethiopia: community based cross-sectional study 2018. Methods. Community based cross-sectional study was conducted on 553 study participants selected by multistage sampling in April 2018. Data were collected using a pretested interviewer-administered questionnaire. Data were entered using EpiData version 3.1 and exported to SPSS version 20 for statistical analysis. Descriptive statistics were done to summarize dependent and independent variables. Bivariate logistic regression was done to select candidate variables. Multivariable logistic regression was performed to identify independent predictors of onchocerciasis infection. Adjusted odds ratios with 95% CI were calculated to assess association and statistical significance, respectively. Confidence interval was used to declare statistical significance. Result. The overall prevalence of onchocerciasis infection in the study area was 6.32%. Age category of 35-44 years (AOR: 13.48, 95%CI: 3.51, 51.76), age of 45 years and above (AOR: 9.41, 95% CI: 2.26, 39.06), male sex (AOR 4.568, 95% C.I: 1.622, 12.861), not being compliant with ivermectin treatment (AOR: 3.804, 95%CI: 1.524, 9.49), and residing at less than 2Km from the river (AOR: 9.15, 95%CI: 3.9, 21.49) were significantly associated with onchocerciasis infection. Conclusion and Recommendation. After more than a decade of treatment with ivermectin, onchocerciasis in the study area is still hypoendemic. Zonal health department and other stakeholders should evaluate therapeutic coverage and community directed treatment with ivermectin in the study area. Zonal health department with other stokeholds should give community based information education communication, giving due attention to older ages, male residents, and those living near the rivers. Further community based study should also be done to identify factors hindering the community compliance with the treatment.

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Relationship between obesity indices and hypertension among middle-aged and elderly populations in Taiwan: a community-based, cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031660 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031660 ◽

Cited By ~ 1

Author(s):

Yen-An Lin ◽

Ying-Jen Chen ◽

Yu-Chung Tsao ◽

Wei-Chung Yeh ◽

Wen-Cheng Li ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Cross Sectional Study ◽

Multiple Logistic Regression ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Elderly Populations ◽

Obesity Indices ◽

Northern Taiwan

ObjectiveObesity and hypertension (HTN) have become increasingly prevalent in Taiwan. People with obesity are more likely to have HTN. In this study, we evaluated several anthropometric measurements for the prediction of HTN in middle-aged and elderly populations in Taiwan.DesignCross-sectional observational study.SettingCommunity-based investigation in Guishan Township of northern Taiwan.ParticipantsA total of 396 people were recruited from a northern Taiwan community for a cross-sectional study. Anthropometrics and blood pressure were measured at the annual health exam. The obesity indices included body mass index (BMI), body fat (BF) percentage and waist circumference (WC).Outcome measuresStatistical analyses, including Pearson’s correlation, multiple logistic regression and the area under ROC curves (AUCs) between HTN and anthropometric measurements, were used in this study.ResultsOf the 396 people recruited, 200 had HTN. The age-adjusted Pearson’s coefficients of BMI, BF percentage and WC were 0.23 (p<0.001), 0.14 (p=0.01) and 0.26 (p<0.001), respectively. Multiple logistic regression of the HTN-related obesity indices showed that the ORs of BMI, BF percentage and WC were 1.15 (95% CI 1.08 to 1.23, p<0.001), 1.07 (95% CI 1.03 to 1.11, p<0.001) and 1.06 (95% CI 1.03 to 1.08, p<0.001), respectively. The AUCs of BMI, BF percentage and WC were 0.626 (95% CI 0.572 to 0.681, p<0.001), 0.556 (95% CI 0.500 to 0.613, p=0.052) and 0.640 (95% CI 0.586 to 0.694, p<0.001), respectively.ConclusionsWC is a more reliable predictor of HTN than BMI or BF percentage. The effect of abdominal fat distribution on blood pressure is greater than that of total BF amount.

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App use frequency and condomless anal intercourse among men who have sex with men in Beijing, China: a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462419860293 ◽

2019 ◽

Vol 30 (12) ◽

pp. 1146-1155 ◽

Cited By ~ 3

Author(s):

Qianqian Luo ◽

Zunyou Wu ◽

Zihuang Chen ◽

Yue Ma ◽

Guodong Mi ◽

...

Keyword(s):

Logistic Regression ◽

Sexual Behaviors ◽

Anal Intercourse ◽

Cross Sectional Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Condomless Anal Intercourse ◽

Adjusted Logistic Regression ◽

Sex With Men ◽

Beijing China

Gay dating applications (apps) are popular among men who have sex with men (MSM) in China. This study examined the relationship between gay dating app use frequency and condomless anal intercourse (CAI) in a sample of MSM in Beijing. In October 2017, a web-based, cross-sectional survey was conducted among MSM from Beijing, China. Demographics, frequency of app use, and sexual behaviors were collected and analyzed. Multivariable logistic regression and restricted cubic splines were used to evaluate the association between app use frequency and CAI. Of the 9280 participants, the proportion of CAI within one month prior to the survey was 43.3%, and 43.7% logged onto the app ≥11 times per week. In adjusted logistic regression analysis, logging onto the app 6–10 times per week and ≥11 times per week were inversely associated with CAI (adjusted odds ratio [AOR] =0.88 [95%CI, 0.78–0.99]; AOR = 0.88 [95%CI, 0.82–0.97], respectively). Among those 40 years of age or older, logging onto the app ≥11 times per week was associated with lower rates of CAI (AOR = 0.57 [95%CI, 0.40–0.81]). Results indicate that frequent app use was associated with lower odds of CAI among MSM in Beijing, China. Innovative interventions, which take advantage of this popular media platform, should be developed as such apps have been found to reduce the odds of CAI in Beijing.

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Preferred rehabilitation setting among stroke survivors in Nigeria and associated personal factors

African Journal of Disability ◽

10.4102/ajod.v7i0.352 ◽

2018 ◽

Vol 7 ◽

Author(s):

Grace Vincent-Onabajo ◽

Zulaiha Mohammed

Keyword(s):

Inpatient Rehabilitation ◽

Outpatient Setting ◽

Outpatient Rehabilitation ◽

Personal Factors ◽

Stroke Patients ◽

Community Based ◽

Cross Sectional ◽

Home Based ◽

Community Based Rehabilitation ◽

Cross Sectional Design

Background: Incorporating patients’ preferences in the care they receive is an important component of evidence-based practice and patient-centred care.Objective: This study assessed stroke patients’ preferences regarding rehabilitation settings.Methods: A cross-sectional design was used to examine preferences of stroke patients receiving physiotherapy at three hospitals in Northern Nigeria. Personal factors and preferred rehabilitation setting data were obtained using the Modified Rankin Scale (to assess global disability) and a researcher-developed questionnaire. Associations between preferences and personal factors were explored using bivariate statistics.Results: Sixty stroke patients whose mean age was 53.6 ± 14.8 years participated in the study. Most of the participants (38.3%) preferred an outpatient setting, 19 (31.7%) preferred rehabilitation in their homes, 14 chose inpatient rehabilitation (23.3%), while 4 (6.7%) preferred the community. Age and source of finance were significantly associated with preferences. The majority (66.7%) of those aged ≥ 65 years expressed a preference for rehabilitation in the home or community (X2 = 6.80; p = 0.03). Similarly, most of the participants (53.3%) who depended on family finances preferred home- or community-based rehabilitation, while most of those who depended on employment income for finances preferred an outpatient rehabilitation setting (X2 = 16.80; p = 0.01).Conclusion: A preference for rehabilitation in outpatient facilities predominated followed by home-based rehabilitation, and preferences varied based on age and source of finance. These variations in preferences have implications for making rehabilitation decisions.

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Association of statin use and risk for severe headache or migraine by serum vitamin D status: A cross-sectional population-based study

Cephalalgia ◽

10.1177/0333102414559733 ◽

2014 ◽

Vol 35 (9) ◽

pp. 757-766 ◽

Cited By ~ 15

Author(s):

Catherine Buettner ◽

Rami Burstein

Keyword(s):

Vitamin D ◽

Logistic Regression ◽

Serum Vitamin ◽

Severe Headache ◽

Vitamin D Status ◽

Cross Sectional ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

Adjusted Logistic Regression ◽

Statin Use

Objective The objective of this article is to evaluate whether statin use and vitamin D status is associated with severe headache or migraine in a nationally representative sample. Methods We conducted a cross-sectional study of US individuals aged ≥40 years for whom information on statin use, serum 25-hydroxy vitamin D (25(OH)D), and self-reported severe headache or migraine had been collected. We calculated prevalence estimates of headache according to statin and 25(OH)D, and conducted adjusted logistic regression analyses stratified by the median 25(OH)D (≤57 and >57 nmol/l). Results Among 5938 participants, multivariable-adjusted logistic regression showed that statin use was significantly associated with a lower prevalence of severe headache or migraine (OR 0.67; 95% CI 0.46, 0.98, p = 0.04). We found a significant interaction between statin use and 25(OH)D with the prevalence of severe headache or migraine ( p for interaction = 0.005). Among participants who had serum 25(OH)D > 57 nmol/l, statin use was associated with a multivariable-adjusted odds ratio of 0.48 (95% CI 0.32, 0.71, p = 0.001) for having severe headache or migraine. Among those with 25(OH)D ≤ 57 nmol/l, no significant association was observed between statin use and severe headache or migraine. Conclusion Statin use in those with higher serum vitamin D levels is significantly associated with lower odds of having severe headache or migraine.

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