Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant’s birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

REVIEW LITERATUR : DETERMINAN PEMBERIAN ASI EKSKLUSIF

Breastfeeding is an obligation for a mother which aims to provide life and welfare to her baby which begins after the birth of the baby. The only ideal food for babies 0-6 months is exclusive breast milk aged 0-6 months because it contains all the nutrients needed by babies. However, many mothers do not give exclusive breastfeeding, so the factors that influence it must be investigated to encourage the success of exclusive breastfeeding. This study uses the Literature Review method, searches through Google Scholar and PubMed with the keywords "exclusive breastfeeding", "exclusive breastfeeding factors", "breastfeeding", and "factors that influence exclusive breastfeeding". Found 8 articles that match the topic, namely 5 international journals and 3 national journals that provide varied information on the determinants of exclusive breastfeeding. Based on the analysis, 6 determinants of the success of exclusive breastfeeding were found, including work, self-motivation, knowledge, family support, early breastfeeding initiation behavior (IMD) in mothers, and support from medical personnel

A Path Analysis to Identify Factors Influencing the Provision of Water in Addition to Breast Milk by Mothers of Infants under Six Months of Age in Conakry and Kindia Regions, Republic of Guinea

Water provision to infants under six months of age (IU6M) can hamper exclusive breastfeeding (EBF). Understanding factors and their relationships influencing this practice is needed to tailor EBF promotion programs. Using a validated questionnaire, this study aims to identify pathways in which individual factors and the environment interact to affect the provision of water in addition to breast milk among 300 mothers of IU6M. Our finding shows that 75% of mothers intended to provide water in addition to breast milk to their IU6M and that about 60% reported doing it. Results of the final path show that the subjective norm/SN (β = 0.432, p < 0.001), the attitude (β = 0.349, p < 0.001), and to a lesser extent the perceived control/PC (β = 0.141, p = 0.005) predict the intention of mothers to provide water in addition to breast milk to their IU6M. The environment scores predict the attitude (β = 0.210, p = 0.001) and the SN (β = 0.284, p < 0.001). Having the mother practicing early breastfeeding initiation at birth positively predicted the PC score (β = 0.157, p = 0.017) and predicted an increasing score of SN (β = 0.221, p = 0.003). Even though predicting the final behavior is complex, this research provides directions to nutrition education programs to tailor their content to the context and be more efficient in reducing the proportion of women providing water to their IU6M, hence contributing to the improvement of EBF.

Lockdown-Associated Hunger May Be Affecting Breastfeeding: Findings from a Large SMS Survey in South Africa

The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27). A positive correlation was found between not breastfeeding and not going to the health clinic. The odds of hungry mothers breastfeeding were significantly lower (OR = 0.66; p = 0.045). This result also holds in a multivariate framework, including covariates such as depressive symptoms, attendance of a PHC facility, and whether the infant was older than 3 months. Support for breastfeeding must include support, such as economic support, for breastfeeding mothers, to enable them to access nutritious diets. Mothers also need reassurance on the quality of their breastmilk and their ability to breastfeed and should be encouraged to continue to attend the health clinic regularly.

Early Initiation of Breastfeeding up to Six Months and Breastfeeding Experience of Mothers who had Cesarean Section: A Scoping Review

Background: Breastfeeding is a gold nutritional feeding for the infant for optimal growth and development. Early initiation of breastfeeding is an important initial step for successful continuing breastfeeding. Cesarean section (C-section) has been reported to have negative effects on early initiation of breastfeeding. However, no current literature summarized the breastfeeding rate after C-section and vaginal delivery globally. Therefore, this scoping review aimed to systematically collect, assess, and map the existing literature regarding the rate and experience of breastfeeding of mothers after C-section.Design: We conducted a scoping review in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR) statement.Methods: We performed an electronic database search on Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, Cochrane Library, and PsychINFO on March 16, 2021. The inclusion criteria were (a) research, experiential, and case reports; (b) reports on the rate of breastfeeding after C-section and vaginal delivery; (c) qualitative studies on the experience of breastfeeding after C-section.Results: The search identified 4635 potentially relevant articles. After screening, 27 articles (24 quantitative and three qualitative studies) were included in the scoping review from 1990 to 2020. Most studies reported a higher breastfeeding rate in mothers who had vaginal delivery than in mothers who had C-Section at breastfeeding initiation, hospital discharge, one month, three months, and six months postoperatively. A large difference in breastfeeding rate was found at early breastfeeding initiation between the vaginal delivery and C-section groups. Most studies showed a breastfeeding rate of more than 30% at late breastfeeding initiation, one month, and three months after C-section. A mother’s physical discomfort, low self-efficacy, and lack of knowledge, and the insufficient support from healthcare providers were identified as breastfeeding barriers after C-section.Conclusions: The rate of breastfeeding after C-section has remained low to date. Lack of breastfeeding knowledge and insufficient healthcare provider support after C-section are the common underlying issues. Approaches to enhance breastfeeding must be developed and consistently implemented.

Factors associated with breastfeeding initiation and continuation in Canadian-born and non-Canadian-born women: a multi-centre study

Objective: To identify factors associated with breastfeeding initiation and continuation in Canadian-born and non-Canadian-born women. Design: Prospective cohort of mothers and infants born from 2008–2012: the CHILD Cohort Study. Setting: General community setting in four Canadian provinces. Participants: 3455 pregnant women from Vancouver, Edmonton, Winnipeg, and Toronto between 2008 and 2012. Results: Of 3010 participants included in this study, the majority were Canadian-born (75.5%). Breastfeeding initiation rates were high in both non-Canadian-born (95.5%) and Canadian-born participants (92.7%). The median breastfeeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breastfeeding initiation and continuation were older maternal age, higher maternal education, living with their partner, and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breastfeeding initiation, but not continuation at 6-months postpartum. Factors associated with non-initiation of breastfeeding and cessation at 6-months postpartum were maternal smoking, living with a current smoker, cesarean birth, and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breastfeeding initiation, and lower odds of breastfeeding continuation at 6 months, and older maternal age and recruitment site were associated with breastfeeding continuation at 6 months. Conclusions: Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breastfeeding initiation rates, breastfeeding initiation and continuation are more strongly associated with sociodemographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breastfeeding continuation in both groups and may indicate geographic disparities in breastfeeding rates nationally.

What does early initiation and duration of breastfeeding have to do with childhood mortality? Analysis of pooled population-based data in 35 sub-Saharan African countries

Background Breastfeeding practices and their impact on infant health and survival are unquestionably of global interest. The aim of this study was to examine the link between breastfeeding initiation within one hour of birth, breastfeeding duration and childhood mortality in sub-Saharan Africa. Methods This study used data from the Demographic and Health Survey, which was conducted in 35 Sub-Saharan African countries between 2008 and 2017. Early initiation and duration of breastfeeding, food consumption indices, and infant mortality were all important variables. Analysis used percentage, median/interquartile range, and regression models (logistic, linear, Cox). Results Early initiation of breastfeeding within one hour after birth was lowest in Chad (23.0%) and highest in Burundi (85.0%). The pooled median duration of breastfeeding was 12 months. Female children had 3% significant lower odds of consuming tinned, powdered or fresh milk, compared with male children (OR 0.97; 95% CI 0.94, 0.99). Conversely, female children were more likely to be put to breast within one hour after birth, compared with male children (OR 1.03; 95% CI 1.01, 1.05). Results from the pooled sample showed approximately 20% (HR 0.80; 95% CI 0.67, 0.96) and 21% (HR 0.79; 95% CI 0.77, 0.80) reduction in infant mortality for children breastfed within one hour after birth and for every unit increase in the months of breastfeeding respectively. In addition, countries with the leading infant mortality rate include; Sierra Leone (92 deaths per 1000 live births), Chad (72 deaths per 1000 live births), Nigeria (69 deaths per 1000 live births), Cote d’ Ivoire (68 deaths per 1000 live births), Guinea (67 deaths per 1000 live births), Burkina-Faso (65 deaths per 1000 live births) and Mozambique (64 deaths per 1000 live births) respectively. Conclusions The findings from this study underscores the need for early breastfeeding initiation and prolong breastfeeding to be considered in programmes on improving childhood survival. Efforts should be made to improve optimal breastfeeding practices as only about half of children in the pooled sample had best practices of breastfeeding.

Implementing a successful proactive telephone breastfeeding peer support intervention: volunteer recruitment, training, and intervention delivery in the RUBY randomised controlled trial

Background The RUBY randomised controlled trial demonstrated the benefit of proactive telephone peer support in promoting breastfeeding continuation in a setting with high breastfeeding initiation, where typically this is difficult to achieve. This paper describes the implementation and delivery of the peer support intervention with a focus on recruitment, training, and support of peer volunteers, and includes a description of the key components of the calls. Methods Data collection occurred between December 2012 and June 2016 in Melbourne, Australia. Volunteers completed enrolment forms at the training session and recorded data related to each call in a Call Log maintained for each mother supported. Data were summarised using descriptive statistics and responses to open-ended questions analysed using content analysis. Results A total of 693 women expressed interest in the peer support role, with 246 completing training, that is, 95% of whom supported at least one mother. Each supported a mean of two mothers (range 1 to 11). Training session topics included respecting individual values, using positive language, confidence building, active listening, empathetic support, and normal baby behaviour. There were 518 periods of support where at least one call was made between a volunteer and a mother to whom she was allocated. Of the 518 periods of support, 359 Call Logs (69%) were returned. The 359 call logs recorded a total of 2398 calls between peers and mothers. Call length median duration was 12 min (range 1 to 111 min). Volunteers perceived the most valued aspects of the calls were the provsion of ‘general emotional support’ (51%) and ‘general information/discussion about breastfeeding’ (44%). During the first call, mothers raised questions about ‘nipple pain/ damage’ (24%) and 'general breastfeeding information’ (23%). At ≥12 weeks postpartum, issues raised related to ‘normal infant behaviour’ (22%), ‘feed frequency’ (16%), and ‘general breastfeeding information’ (15%). Volunteers referred women to other resources during 28% of calls, most commonly to the Australian Breastfeeding Association. Conclusions Our findings demonstrate that the RUBY trial was feasible and sustainable in terms of recruiting volunteers who were willing to participate in training and who proceeded to provide peer support. Call content was responsive to the evolving breastfeeding information needs of mothers and the provision of emotional support was perceived by volunteers to be important. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831.

Children’s Health Capital Investment: Effects of U.S. Infant Breastfeeding on Teenage Obesity

Obesity, as a health and social problem with rising prevalence and soaring economic cost, is increasingly drawing scholarly and public policy attention. While many studies have suggested that infant breastfeeding protects against childhood obesity, empirical evidence on this causal relationship is fragile. Using the health capital development theory, this study exploited multiple data sources from the U.S. and a three-way error components model (ECM) with a jackknife resampling plan to estimate the effect of in-hospital breastfeeding initiation and breastfeeding for durations of 3, 6, and 12 months on the prevalence of obesity during teenage years. The main finding was that a 1% rise in the in-hospital breastfeeding initiation rate reduces the teenage obesity prevalence rate by 1.7% (9.6% of a standard deviation). The magnitude of this effect declines as the infant breastfeeding duration lengthens—e.g., the 12-month infant breastfeeding duration rate is associated with a 0.53% (3.7% of a standard deviation) reduction in obesity prevalence in the teenage years (9th to 12th grades). The study findings agree with both the behavioral and physiological theories on the long-term effects of breastfeeding, and have timely implications for public policies promoting infant breastfeeding to reduce the economic burden of teenage and later adult-stage obesity prevalence rates.

Factors Affecting Midwives Knowledge About Early Initiation of Breastfeeding at Lut Tawar District Health Center of Central Aceh Regency in 2020

Background: Data from the World Health Organization (WHO) shows that there are 170 million children worldwide experiencing malnutrition, 3 million of whom leave each year due to malnutrition. Therefore, WHO recommends, all infants need to receive colostrum (first and second day milk) to fight infection and exclusively breastfed for 6 months to ensure adequate nutrition for infants. This study aims to determine the factors that influence the knowledge of midwives about early initiation of breastfeeding in the working area of the Lut Tawar City Health Center, Central Aceh Regency in 2020. Methods: The research method used is an analytical survey method with a cross sectional approach. The population in this study were all midwives in the area. The city health center serves as many as 59 people. The sampling method uses a total sampling technique that uses all members of the population as a sample. Data collection was carried out on November 15-19, 2020. Results: The results showed that respondents aged > 40 years had good knowledge, namely 64.3%, respondents with DIII education had less knowledge, namely 56.8%, respondents who had never attended breastfeeding initiation training 69.6% respondents who did not often do early initiation of breastfeeding have good knowledge that is 63.9%, respondents who do not get information about early initiation of breastfeeding mostly lack of knowledge that is 58.1%. Conclusion: Factors that influence the knowledge of midwives on early initiation of breastfeeding are education and experience participating in training related to early initiation of breastfeeding.