Suzanne Bartington

Bio: Suzanne Bartington is an academic researcher from University of Birmingham. The author has contributed to research in topics: Medicine & Environmental health. The author has an hindex of 7, co-authored 25 publications receiving 267 citations. Previous affiliations of Suzanne Bartington include UCL Institute of Child Health & Imperial College London.

Are breastfeeding rates higher among mothers delivering in Baby Friendly accredited maternity units in the UK

Abstract: Background The promotion and support of breastfeeding is a global priority with benefits for maternal and infant health, particularly in low-income and middle-income countries where its relevance for child survival is undisputed. However, breastfeeding rates are strikingly low in some higher-income countries, including the UK. Evidence to support the effectiveness of public health interventions to increase rates of breastfeeding initiation and duration in this setting is limited. We examined whether mothers were more likely to start and continue to breastfeed if they delivered in a UNICEF UK Baby Friendly accredited maternity unit, in a cohort with a high representation of disadvantaged and lower socioeconomic groups with traditionally low rates of breastfeeding. Methods We analysed maternally reported breastfeeding initiation and prevalence of any breastfeeding at 1 month for 17 359 singleton infants according to maternity unit Baby Friendly Initiative participation status at birth (accredited, certificated, or neither award). Results Mothers delivering in accredited maternity units were more likely to start breastfeeding than those delivering in units with neither award [adjusted rate ratio: 1.10, 95% confidence interval (CI) 1.05–1.15], but were not more likely to breastfeed at 1 month (0.96, 95% CI 0.84–1.09), after adjustment for social, demographic, and obstetric factors. Antenatal class attendance (1.14, 95% CI 1.11–1.17), vaginal delivery (1.05, 1.03–1.08), a companion at delivery (1.09, 1.04–1.16), and maternal post-partum hospital stay .24 h (1.06, 1.04–1.09) were also independently associated with breastfeeding initiation. Conclusions Policies to increase the proportion of maternity units participating in the UNICEF UK Baby Friendly Initiative are likely to increase breastfeeding initiation but not duration. Other strategies are required in order to support UK mothers to breastfeed for the recommended duration.

The Born in Guangzhou Cohort Study (BIGCS)

Abstract: The Born in Guangzhou Cohort Study (BIGCS) is a large-scale prospective observational study investigating the role of social, biological and environmental influences on pregnancy and child health and development in an urban setting in southern China. Pregnant women who reside in Guangzhou and who attend Guangzhou Women and Children’s Medical Center (GWCMC) for antenatal care in early pregnancy (<20 weeks’ gestation) are eligible for inclusion. Study recruitment commenced in February 2012, with an overall participation rate of 76.3%. Study recruitment will continue until December 2018 to achieve the target sample size of 30,000 mother–child pairs. At 30 April 2016, a total of 75,422 questionnaires have been collected, while 14,696 live births have occurred with planned follow-up of cohort children until age 18 years. During the same period a total of 1,053,000 biological samples have been collected from participants, including maternal, paternal and infant blood, cord blood, placenta, umbilical cord, and maternal and infant stool samples. The dataset has been enhanced by record linkage to routine health and administrative records. We plan future record linkage to school enrolment and national examination records.

Investigating the Association between Wood and Charcoal Domestic Cooking, Respiratory Symptoms and Acute Respiratory Infections among Children Aged Under 5 Years in Uganda: A Cross-Sectional Analysis of the 2016 Demographic and Health Survey

Abstract: Background: Household air pollution associated with biomass (wood, dung, charcoal, and crop residue) burning for cooking is estimated to contribute to approximately 4 million deaths each year worldwide, with the greatest burden seen in low and middle-income countries. We investigated the relationship between solid fuel type and respiratory symptoms in Uganda, where 96% of households use biomass as the primary domestic fuel. Materials and Methods: Cross-sectional study of 15,405 pre-school aged children living in charcoal or wood-burning households in Uganda, using data from the 2016 Demographic and Health Survey. Multivariable logistic regression analysis was used to identify the associations between occurrence of a cough, shortness of breath, fever, acute respiratory infection (ARI) and severe ARI with cooking fuel type (wood, charcoal); with additional sub-analyses by contextual status (urban, rural). Results: After adjustment for household and individual level confounding factors, wood fuel use was associated with increased risk of shortness of breath (AOR: 1.33 [1.10–1.60]), fever (AOR: 1.26 [1.08–1.48]), cough (AOR: 1.15 [1.00–1.33]), ARI (AOR: 1.36 [1.11–1.66] and severe ARI (AOR: 1.41 [1.09–1.85]), compared to charcoal fuel. In urban areas, Shortness of breath (AOR: 1.84 [1.20–2.83]), ARI (AOR: 1.77 [1.10–2.79]) and in rural areas ARI (AOR: 1.23 [1.03–1.47]) and risk of fever (AOR: 1.23 [1.03–1.47]) were associated with wood fuel usage. Conclusions: Risk of respiratory symptoms was higher among children living in wood compared to charcoal fuel-burning households, with policy implications for mitigation of associated harmful health impacts.

Objectively Measured Physical Activity and Fat Mass in a Large Cohort of Children

Abstract: Previous studies have been unable to characterise the association between physical activity and obesity, possibly because most relied on inaccurate measures of physical activity and obesity. We carried out a cross sectional analysis on 5,500 12-year-old children enrolled in the Avon Longitudinal Study of Parents and Children. Total physical activity and minutes of moderate and vigorous physical activity (MVPA) were measured using the Actigraph accelerometer. Fat mass and obesity (defined as the top decile of fat mass) were measured using the Lunar Prodigy dual x-ray emission absorptiometry scanner. We found strong negative associations between MVPA and fat mass that were unaltered after adjustment for total physical activity. We found a strong negative dose-response association between MVPA and obesity. The odds ratio for obesity in adjusted models between top and the bottom quintiles of minutes of MVPA was 0.03 (95% confidence interval [CI] 0.01-0.13, p-value for trend <0.0001) in boys and 0.36 (95% CI 0.17-0.74, p-value for trend = 0.006) in girls. We demonstrated a strong graded inverse association between physical activity and obesity that was stronger in boys. Our data suggest that higher intensity physical activity may be more important than total activity.

Impact of the baby-friendly hospital initiative on breastfeeding and child health outcomes: a systematic review.

Abstract: The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi-experimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding (BF) outcomes. There is a dose-response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.

Supporting breastfeeding mothers: qualitative synthesis

Abstract: Title. Supporting breastfeeding mothers: qualitative synthesis. Aim. This paper is a report of a synthesis of mothers’ and healthcare professionals’ experiences and perceptions of breastfeeding support. Background. Despite increasing knowledge, breastfeeding rates remain relatively static and mothers continue to report dissatisfaction with their experiences of breastfeeding. Greater understanding of breastfeeding may be achieved through rigorous qualitative research, and there has been a recent increase in such studies. Data sources. Electronic databases and citation lists of published papers were searched for articles listed between 1990 and 2005 and updated in May 2007. Studies were included if they used qualitative methods, were published in English, explored an aspect of breastfeeding and were based in a westernized country. Review methods. Papers were included if they reported studies using qualitative methods to explore breastfeeding and were published in English and based in a westernized country. Each study was reviewed and assessed independently, key themes extracted and grouped, and secondary thematic analysis used to explore key concepts. Results. From the 1990–2005 search, five themes emerged in health service support of breastfeeding: the mother-health professional relationship, skilled help, pressures of time, medicalization of breastfeeding and the ward as a public place. Social support had two themes: compatible and incompatible support. One additional theme emerged from the update to 2007: health professional relationships. Conclusion. Mothers tended to rate social support as more important than health service support. Health service support was described unfavourably with emphasis on time pressures, lack of availability of healthcare professionals or guidance, promotion of unhelpful practices and conflicting advice. Changes are required within the health services to address the needs of both mothers and staff.

Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis.

Abstract: Aim: To provide comprehensive evidence of the effect of interventions on early initiation exclusive continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above. Methods: Of 23977 titles identified through a systematic literature search in PUBMED Cochrane and CABI 195 articles relevant to our objective were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity we explored its causes by subgroup analysis and meta-regression and applied random effects model. Results: Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding exclusive breastfeeding and continued breastfeeding rates were seen when counselling or education were provided concurrently in home and community health systems and community health systems and home settings respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding. Conclusion: To promote breastfeeding interventions should be delivered in a combination of settings by involving health systems home and family and the community environment concurrently. ©2015 The Authors. Open Access.