Exposure to different types of mass media and timing of antenatal care initiation: insights from the 2016 Uganda Demographic and Health Survey

Background Early initiation of antenatal care (ANC) within the first trimester is highly recommended in the current 2016 World Health Organization (WHO) guidelines. Mass media has the potential to promote early initiation of ANC because it has been used successfully in several programs. However, there is paucity of literature on the effect of exposure to different types of media on the timing of ANC initiation in Uganda. Our study aimed at exploring associations between exposure to different types of mass media and timing of ANC initiation among women in Uganda. Methods We used a cross sectional study design, to conduct a secondary analysis of data collected in the 2016 Uganda Demographic and Health Survey (UDHS). We included weighted data of all the 10,152 women of reproductive age (15–49 years). Multistage stratified sampling was used to select study participants. Multivariable logistic regression was used to determine the association between exposure to different types of mass media and early initiation of ANC. Results Almost a third of the women (2953/10,152, 29.1%, 95% CI 27.9–29.6) initiated their first ANC contact in the first trimester. Women who listened to radio at least once a week (adjusted OR (aOR 1.14, 95% CI 1.01–1.30) and those who watched television less than once a week (aOR 1.28, 95% CI 1.07–1.53) had higher odds of initiating ANC earlier compared to their counterparts not exposed to radio and television respectively. Conclusion Exposure to radio and television is associated with timing of ANC initiation in Uganda. Importantly, the two types of mass media have the potential to reach women with low levels of education and encourage them to utilize maternal health services. The Ugandan government needs to prioritize and intensify the use of radio and television to promote the benefits associated with timing of ANC initiation.

Combined therapy with early initiation of infliximab following drainage of perianal fistulising Crohn’s disease: a retrospective cohort study

Background Recent studies have confirmed that combined surgery and anti-TNF therapy could improve outcomes in patients with perianal fistulising Crohn’s disease (PFCD). However, the optimal timing for infliximab infusion after surgical intervention is uncertain. We aimed to determine the long-term efficacy of early initiation of infliximab following surgery among PFCD patients. Methods We performed a retrospective cohort study of PFCD patients who received combined infliximab and surgical treatment between 2010 and 2018 at a tertiary referral hospital. Patients were grouped according to the time interval between surgery and infliximab infusion, with < 6 weeks into early infliximab induction group and > 6 weeks into delayed infliximab induction group. The primary outcome was to compare surgical re-intervention between early and delayed infliximab induction groups. The secondary outcomes were fistula healing and predictors associated with these outcomes of early infliximab induction approach. Results One hundred and seventeen patients were included (73 in early infliximab induction, 44 in delayed infliximab induction). The median interval between surgery and infliximab initiation was 9.0 (IQR 5.5–17.0) days in early infliximab induction group and 188.0 (IQR 102.25–455.75) days in delayed infliximab induction group. After followed-up for a median of 36 months, 61.6% of patients in early infliximab induction group and 65.9% in delayed infliximab induction group attained fistula healing (p = 0.643). The cumulative re-intervention rate was 23%, 32%, 34% in early infliximab induction group and 16%, 25%, 25% in delayed infliximab induction group, at 1, 2, and 3 years respectively (p = 0.235). Presence of abscess at baseline (HR = 5.283; 95% CI, 1.61–17.335; p = 0.006) and infliximab maintenance therapy > 3 infusions (HR = 3.691; 95% CI, 1.233–11.051; p = 0.02) were associated with re-intervention in early infliximab induction group. Presence of abscess at baseline also negatively influenced fistula healing (HR = 3.429, 95% CI, 1.216–9.668; p = 0.02). Conclusion Although no clear benefit was shown compared with delayed infliximab induction group, early initiation of infliximab after surgery could achieve promising results for PFCD patients. Before infliximab infusion, durable drainage is required for patients with concomitant abscess or prolonged infliximab maintenance therapy.

Frequency of early initiation of breastfeeding among women in Thatta, Sindh and factors associated with it: A secondary data analysis

Introduction: It is recommended by the World Health Organization to initiate breastfeeding within first hour of birth. In recent time, many efforts are being taken by international and national stakeholders to promote mothers to initiate early breastfeeding. However, only 42% of newborns in South Asia and 45% of newborns in world are put to breastfeeding within first hour of birth. The aim of this study was to determine the prevalence of early initiation of breastfeeding and factors associated with it in rural areas of Sindh, Pakistan. Methodology: The data for this study were extracted from the survey related to Exclusive breastfeeding among women in Thatta, 2019. Survey was implemented in areas of Thatta registered in Maternal and Neonatal Health Registry (MNHR). MNHR is a population-based study for low- and middle-income countries (LMICs) to assess pregnancy related outcomes. About 397 women with complete information on timing of initiation of breastfeeding were used in the analysis. Results: The early initiation of breastfeeding to their newborn baby i.e. within first hour of the birth, were found in 20.4% of mothers. Factors associated with early initiation of breastfeeding include adequate knowledge (AOR=3.63, 95% CI= 1.99-6.59), place of delivery AOR=2.66 (95% CI=1.51-4.67), gestational age of baby (AOR= 1.89, 95% CI=1.10-3.24) and Age of mother (AOR=1.07, 95% CI=1.02-1.13). Conclusion: Providing counselling and health education for mother before, during and after the pregnancy are important to motivate mothers to initiate breastfeeding early and continue exclusive breastfeeding for recommended period i.e. 6 months.

Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities

Background The effects of breastfeeding practices on children’s health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria. Methods Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC. Results The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers’ education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment. Conclusion Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators.

Exploration of Breastfeeding Practices in India: A Systematic Review

Introduction: Breastfeeding is essential and a unique way of providing food to infants for development and healthy growth. Various breastfeeding practices are followed in different regions of India. Objective: This study aims to collect the information for practices related to prelacteal feed, early initiation of breastfeeding, exclusive breastfeeding, and weaning in India. Materials and Methods: A systematic search was conducted in PubMed, MEDLINE, Embase, Google Scholar, Clinical key, the Cochrane Library, and Science Direct databases to identify studies on practices related to the initiation of early breastfeeding, prelacteal feed, Exclusive Breastfeeding (EBF) practices, and weaning as outcomes. Quality assessment of each study was done by the Newcastle-Ottawa scale. Results: Twenty-four studies were included in this systematic review. Seven studies reported an early initiation of breastfeeding within 1-6 hours of birth. Six studies reported various prelacteal foods given to infants, such as tea, boiled water, honey, sugar, jaggery, or glucose with plain water and diluted animal milk. Four studies stated that exclusive breastfeeding was a suboptimal practice, often continued for less than six months for reasons like working mothers (not enough time for breastfeeding), traditional beliefs, and inadequate milk output. Four studies explored the causes of early onset of weaning, and the most common reasons were initiation of supplementary feeding before six months, insufficient breastmilk, and lack of knowledge. Conclusion: Overall, the results of the individual studies indicate that unhealthy breastfeeding practices such as prelacteal feeding, suboptimal exclusive breastfeeding, and early initiation of weaning practices were prevalent and almost the same across India.

Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia

Background: The world is now suffering from malnutrition and remains one of the leading causes of death for under 5 children. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Therefore, the aim of this study was to assess the EIBF practices and determinants among children aged less than 24 months in West Belessa district, Northwest Ethiopia, 2019. Methods: A community-based cross-sectional study was conducted from January 2 to February 28, 2019 in the West Belessa district. A total of 569 mother-children pairs were participated in the study. Study particnapants were selected by using simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable and Multivariable logistic regression analysis were done. Odds ratio with 95% confidence was done to determine the level of significance value less than .05 considered as significant with the outcome variable. Result: The prevalence of early initiation of breastfeeding (EIBF) was found to be 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR = 2.76, 95%CI [1.21, 6.27]), antenatal care (ANC) (AOR = 3.79, 95%CI [2.58, 9.94]), and number of antenatal care visit (AOR = 1.85, 95%CI [1.03, 3.85]) were significantly associated with early initiation of breastfeeding. Conclusion and Recommendation: In this study, more than three fourth of children were received early initiation of breastfeeding within 1 hour after delivery. Age of the mother, antenatal, and number of antenatal care were associated with EIBF. Therefore, during this contact period, improve antenatal services by increasing accessibility and providing counseling is important to improve EIBF utilization.

Pattern of Alcohol Use and its Effects in Relation to the Age of Initiation of Alcohol Use among the Residents of Jhaukhel Area of Bhaktapur District

Over the past few decades, alcohol consumption has increased in quantity and frequency. Several studies have suggested that people who start drinking at younger age have an increased risk of alcohol use disorder. This study was carried out to assess the pattern of alcohol consumption in relation to the age of initiation of alcohol use among the residents of Jhaukhel area of Bhaktapur district. A cross sectional descriptive survey was conducted in Jhaukhel area of Bhaktapur district among the permanent residents aged 15 years and above through a purposive sampling technique using a pre tested self-constructed proforma. Assessment of alcohol use, harmful/ hazardous drinking and alcohol dependence was done using an AUDIT questionnaire as a tool. Chi-square test and Fisher’s exact test were applied and ‘p’ value was calculated to see the association between age of onset of alcohol use and the alcohol use pattern and effects. The level of significance was set at 5%, and ‘p’ value of < 0.05 was considered statistically significant. A total of 190 respondents were interviewed. Mean age of the respondents was 41.25 ± 16.4 years while mean age of initiation of alcohol consumption was 20 ± 4.3 years and 31 (30.4 %) of drinkers initiated alcohol consumption before legal drinking age (18 years). This was more among males (36.5%) than females (14.3%), (p-value: 0.03, OR: 3.4, 95%CI: 1-11) Initiating alcohol consumption early in life before 18 years was strongly associated with binge drinking pattern (P value: <0.001, OR: 9.5, 95%CI: 2.7-33.3). Those who initiate drinking before 18 years were more likely to suffer from alcohol related medical problems compared to those who initiated drinking after 18 years (OR: 6.63, 95% CI: 2.3-19.3, P value: 0.001). Parental consumption of alcohol was found to be associated with the early initiation of alcohol use (OR: 2.7, 95%CI: 1.01-6.96, P value: 0.03). Early initiation of alcohol consumption before legal drinking age was not only a predictor for binge drinking and alcohol dependence, but also a risk factor for alcohol related medical problem, accidents and self-inflicted injuries. Hence this is a serious issue which needs to be addressed at the individual, family as well as community level.