Background: The World Health Organisation (WHO) recommends exclusive breastfeeding during the first six months of life for optimal growth, development and health. Breastfeeding should continue up to two years or more and nutritionally adequate, safe, and appropriately-fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant. Little evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference to WHO recommendations. Methods: Data from a longitudinal study conducted in two Nairobi slums are used. The study used information on the first year of life of 4299 children born between September 2006 and January 2010. All women who gave birth during this period were interviewed on breastfeeding and complementary feeding practices at recruitment and this information was updated twice, at four-monthly intervals. Cox proportional hazard analysis was used to determine factors associated with cessation of breastfeeding in infancy and early introduction of complementary foods. Results: There was universal breastfeeding with almost all children (99%) having ever been breastfed. However, more than a third (37%) were not breastfed in the first hour following delivery, and 40% were given something to drink other than the mothers’ breast milk within 3 days after delivery. About 85% of infants were still breastfeeding by the end of the 11 th month. Exclusive breastfeeding for the first six months was rare as only about 2% of infants were exclusively breastfed for six months. Factors associated with sub-optimal infant breastfeeding and feeding practices in these settings include child’s sex; perceived size at birth; mother’s marital status, ethnicity; education level; family planning (pregnancy desirability); health seeking behaviour (place of delivery) and; neighbourhood (slum of residence). Conclusions: The study indicates poor adherence to WHO recommendations for breastfeeding and infant feeding practices. Interventions and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education, and family planning.

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Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya

There is significant evidence to support the importance of prenatal care in preventing adverse outcomes such as preterm birth and low infant birth weight. Previous studies have indicated that the benefits of prenatal care are not evenly distributed throughout the social strata. In addition, emerging evidence suggests that among particular populations, rates of preterm birth are unchanged or increasing. This suggests that an alternate care model is necessary, one that seeks to addresses some of the myriad of social factors that also contribute to adverse birth outcomes. In previous studies, the group prenatal care model CenteringPregnancy® had been shown to reduce adverse birth outcomes, but to date, no comparison had been made with a model that included prenatal education. This study sought to investigate whether any significant difference remained within the comparison groups when both models accounted for social factors. This analysis was based on survey data collected from a prospective cohort of pregnant women through the All Our Babies Study in Calgary, Alberta. At baseline, there were significant differences between the comparison groups in their psychosocial health, with the women in the CenteringPregnancy® group scoring higher levels of depressive symptoms, stress and anxiety. At four months postpartum, the differences between the groups were no longer significant. Conclusions: These results suggest that CenteringPregnancy® can recruit and retain a demographically vulnerable group of women with a constellation of risk factors for poor pregnancy and birth outcomes, including poverty, language barriers and poor mental health. Post program, the rates of stress, anxiety and depression were similar to other women with more social and financial advantage. These findings suggest that CenteringPregnancy® may be a community based care strategy that contributes to improved mental health, knowledge, and behaviours to optimize outcomes for mothers and children.

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Comparing CenteringPregnancy® to standard prenatal care plus prenatal education

Background:Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding.Objectives:The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed.Methods:The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother’s intent to breastfeed.Results:The mean ± SD of the total IIFAS score of the overall sample was 64.0 ± 10.4. There were no significant differences in attitudes between ...

Assessing Infant Feeding Attitudes of Expectant Women in a Provincial Population in Canada: Validation of the Iowa Infant Feeding Attitude Scale.

Resumo Estudo correlacional que objetivou verificar a associacao entre variaveis maternas e aleitamento materno exclusivo em um ambulatorio especializado do estado do Ceara, Brasil. Verificou-se a pratica do aleitamento materno exclusivo, apresentando sua diminuicao no decorrer dos seis primeiros meses de vida da crianca. A maioria das mulheres era jovem, com companheiro, com bom nivel de escolaridade, multigesta e que realizou ate seis consultas de pre-natal em postos de saude. Houve associacao significativa entre as variaveis multiparidade e aleitamento materno exclusivo, mostrando-se como uma variavel protetora para essa pratica. A maioria das mulheres que amamentou exclusivamente afirmou nao ter recebido orientacao sobre aleitamento materno durante o pre-natal, o que evidencia a existencia de outros fatores externos que podem influenciar no aleitamento materno exclusivo.

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Factors Associated with Adherence to the Exclusive Breastfeeding

OBJETIVO: Analizar beneficios laboristas y factores asociados al mantenimiento de los indices de amamantamiento entre madres trabajadoras. METODOS: La muestra fue constituida por 200 mujeres trabajadoras formales que retornaron al trabajo antes del nino completar seis meses de vida, en el municipio de Piracicaba, SP. Entre las participantes, 100 duos madre-lactante recibieron orientaciones y apoyo para la practica de la lactancia en un programa de prevencion en salud bucal y los otros 100 duos fueron abordados en una campana de vacunacion infantil. Se realizo analisis de regresion logistica multiple para identificar variables relacionadas al destete al cuarto mes de vida. RESULTADOS: La mayor parte de las participantes era primipara, paso por cesarea, inicio el amamantamiento en menos de cuatro horas posterior al parto y permanecio con su hijo en alojamiento conjunto. Tuvieron mayor probabilidad de parar el amamantamiento: madres no participantes del programa de incentivo (OR= 3,04 [IC95% 1,35;6,85]), madres que no tenian intervalo de 30 minutos durante la jornada laboral (OR= 4,10 [IC95% 1,81;9,26]) y madres cuyos hijos utilizaban chupete (OR= 2,68 [IC95% 1,23;5,83]) o tetero (OR= 14,47 [IC95% 1,85;113,24]). CONCLUSIONES: Las madres que participaron en el grupo de incentivo de la lactancia, no ofrecieron chupete y tetero a los hijos y tenian intervalo durante el trabajo pararon el amamantamiento posterior al cuarto mes. Apoyo, informaciones sobre el manejo de la lactancia y sobre sus derechos garantizados por ley, en conjunto con la ampliacion del tiempo de licencia maternidad, podran tener un papel importante en el mantenimiento de la practica de la lactancia materna.

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El amamantamiento entre hijos de mujeres trabajadoras

This research aimed to identify the determinants of full breastfeeding (FBF) and any breastfeeding (ABF) cessation before 6 months, through a six-month follow-up of 248 mothers going a postpartum visit Data were collected by personal interview during the first month and telephone interviews at four and six months postpartum Coxs proportional hazards model was used Not having previous ABF experience, previous ABF duration <or=4 months and worse evaluation of previous experience were associated with cessation of ABF and FBF Lower educational level was associated with cessation of ABF and the use of pacifiers or occasional breast-milk substitutes with cessation of FBF Attending childbirth education was a protective factor against early FBF or ABF cessation Activities supporting breastfeeding should be intensified for mothers with poorer access to information and with negative or without ABF previous experience The use of pacifiers and not-medically indicated breast milk substitutes should be controlled

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Factors associated to breastfeeding cessation before 6 months

O objetivo da pesquisa foi identificar os fatores associados ao abandono do aleitamento materno (AM) e do aleitamento materno completo (AMC). Foram acompanhadas 248 maes que fizeram visita pos-parto. Os dados foram coletados mediante entrevista pessoal durante o primeiro mes pos-parto e, pelo telefone, aos quatro e seis meses seguintes. A analise se realizou mediante a Regressao de Cox. Os resultados mostram associacao entre o abandono da AMC e do AM com o fato de nao se ter amamentado anteriormente, com AM anterior ≤4 meses, e, com pior avaliacao da experiencia anterior. O menor nivel de estudos se relaciona com maior abandono do AM e das chupetas, ou suplementos no hospital com o abandono da AMC. A educacao pre-natal e fator protetor para o AMC e o AM. Conclui-se que o apoio ao AM deveria intensificar-se nas maes: sem experiencia anterior, com experiencia negativa, e, com pior acesso a informacao; tambem deveria ser controlado o uso da chupeta e dos suplementos de leite artificial (LA) nao indicados.

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Fatores associados ao abandono do aleitamento materno durante os primeiros seis meses de vida

El objetivo de la investigacion fue identificar los factores asociados al abandono de la lactancia materna (LM) y de la lactancia materna completa (LMC). Fueron acompanadas 248 madres que acudieron a la visita posparto. Los datos fueron recolectados mediante entrevista personal durante el primer mes posparto y por telefono a los cuatro y seis meses siguientes. El analisis se realizo mediante la Regresion de Cox. Los resultados muestran una asociacion con el abandono de la LMC y de la LM con no haber amamantado anteriormente, con LM anterior ≤4 meses, y, con una peor valoracion de la experiencia anterior. El menor nivel de estudios se relaciona con un mayor abandono de la LM y los chupetes o suplementos en el hospital con el abandono de la LMC. La educacion prenatal es un factor protector para la LMC y la LM. Se concluye que el apoyo a la LM deberia intensificarse las madres: sin experiencia anterior, con experiencia negativa, y, con peor acceso a la informacion; tambien deberia controlarse el uso de chupetes y suplementos de leche artificial (LA) no indicados.

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María del Mar Calatayud Pujalte

Papers

Factors associated to breastfeeding cessation before 6 months

Fatores associados ao abandono do aleitamento materno durante os primeiros seis meses de vida

Factores asociados al abandono de la lactancia materna durante los primeros 6 meses de vida