Infant feeding practices among macrosomic infants: A prospective cohort study

The health benefits of breastfeeding are well recognised, but breastfeeding rates worldwide remain suboptimal. Breastfeeding outcomes have yet to be explored among women who give birth to macrosomic (birthweight ≥4000 g) infants, a cohort for whom the benefits of breastfeeding may be particularly valuable, offering protection against later‐life morbidity associated with macrosomia. This longitudinal prospective cohort study aimed to identify whether women who give birth to macrosomic infants are at greater risk of breastfeeding non‐initiation or exclusive breastfeeding (EBF) cessation. A total of 328 women in their third trimester were recruited from hospital and community settings and followed to 4 months post‐partum. Women gave birth to 104 macrosomic and 224 non‐macrosomic (<4000 g) infants between 2018 and 2020. Longitudinal logistic regression models calculated odds ratios (ORs) and 95% confidence intervals (CIs) to assess likelihood of EBF at four timepoints post‐partum (birth, 2 weeks, 8 weeks, and 4 months) between women who gave birth to macrosomic and non‐macrosomic infants, adjusted for maternal risk (obesity and/or diabetes), ethnicity and mode of birth. Macrosomic infants were more likely to be exclusively breastfed at birth and 2 weeks post‐partum than non‐macrosomic infants with adjusted OR = 1.94 (95% CI: 0.90, 4.18; p = 0.089) and 2.13 (95% CI: 1.11, 4.06; p = 0.022), respectively. There were no statistically significant associations between macrosomia and EBF at 8 weeks or 4 months post‐partum. Macrosomia may act as a protective factor against early formula‐milk supplementation, increasing the likelihood of EBF in the early post‐partum period, but rates of exclusive breastfeeding continued to decline over the first 4 months post‐partum.     

Factors influencing breastfeeding practices in China: A meta‐aggregation of qualitative studies

The World Health Organization recommends that women exclusively breastfeed until their babies are 6 months old and continue to breastfeed while introducing complementary foods. A meta‐aggregation methodology was used to systematically review and synthesise the qualitative studies on factors influencing breastfeeding practices of healthy Chinese women in Greater China. English and Chinese databases were searched to identify peer‐reviewed qualitative studies (published 2008–2019). Relevant data were extracted, and key themes related to factors influencing breastfeeding practices were identified. Of 7587 articles identified, 22 qualitative studies met inclusion criteria for the review, 10 of which were published in Chinese. A total of 87 themes were extracted from all included studies and classified into 9 subcategories: government enactment of policies, implementation of policies in workplaces, social expectations, social support, medical and health services, services with Chinese characteristics, breastfeeding and pumping facilities, maternal perceptions of breastfeeding and self‐efficacy to breastfeed. The nine subcategories were then grouped into four categories. Potential effect associations among these influence factors of breastfeeding practices emerged from categories and subcategories. Family members'' influence on breastfeeding motivation and self‐efficacy suggest a potential benefit of breastfeeding promotion interventions targeting the whole family. The role of primary care should be fully exploited in breastfeeding promotion, including both prenatal education and post‐partum visits. Standardising the training and qualifications of maternity matrons (yuesao) and folk breastfeeding specialists (cuirushi) can promote evidence‐based approaches to facilitating breastfeeding during the confinement period. Increased availability of breastfeeding and pumping facilities in the workplace would facilitate continuing breastfeeding after returning to work.     

Exclusive Breastfeeding in the Northwest: Disparities Related to Race/Ethnicity and Substance Use

Background and ObjectivesMothers who are Black, Indigenous, and people of color (BIPOC) are disproportionately impacted by substance use in pregnancy and less likely to breastfeed. Our objectives were to assess relationships between substance use in pregnancy and exclusive breastfeeding at discharge (EBF) and race/ethnicity and EBF, and determine the extent to which substance use influences the relationship between race/ethnicity and EBF.MethodsThis is a retrospective cohort study of term mother-infant dyads using 2016 to 2019 data from a Northwest quality improvement collaborative, Obstetrical Care Outcomes Assessment Program. Stepwise and stratified multivariable logistic regression analyses were conducted to determine associations between independent variables consisting of characteristics, including maternal race/ethnicity and substance use, and the dependent variable, EBF.ResultsOur sample consisted of 84,742 dyads, 69.5% of whom had EBF. The adjusted odds of EBF for non-Hispanic Black and Hispanic mothers were half, and for American Indian/Alaska Native mothers two-thirds, that of White mothers (aOR [95% CI]: 0.52 [0.48, 0.57], 0.51 [0.48, 0.54], 0.64 [0.55, 0.76], respectively). Substance use did not mediate the association between race/ethnicity and EBF, but it modified the association. Among those reporting nicotine or marijuana use, Hispanic mothers were half as likely as White mothers were to exclusively breastfeed. Other factors associated with a lower likelihood of EBF included public or no insurance, rural setting, C-section, NICU admission, and LBW.ConclusionsDisparities in EBF related to race/ethnicity and substance use were pronounced in this study, particularly among Hispanic mothers with nicotine or marijuana use.     

The Infant Feeding Intentions scale demonstrates construct validity and comparability in quantifying maternal breastfeeding intentions across multiple ethnic groups

Research tools that are comparable across ethnic groups are needed in order to understand sociodemographic disparities in breastfeeding rates. The Infant Feeding Intentions (IFI) scale provides a quantitative measure of maternal breastfeeding intentions. IFI score ranges from 0 (no intention to breastfeed) to 16 (very strong intentions to fully breastfeed for 6 months). The objective of this study was to examine intra‐ and inter‐ethnic validity of the IFI scale. The IFI scale was administered to 218 white non‐Hispanic, 75 African‐American, 80 English‐speaking Hispanic, 62 Spanish‐speaking Hispanic and 64 Asian expectant primiparae. Participants were asked their planned duration of providing breast milk as the sole source of milk (full breastfeeding). The IFI scale was examined for intra‐ethnic internal consistency and construct validity and for inter‐ethnic comparability. For all five ethnic categories, principal component analysis separated the scale into the same two factors: intention to initiate breastfeeding and intention to continue full breastfeeding. Across ethnic categories, the range in Cronbach's alpha was 0.70–0.85 for the initiation factor and 0.90–0.93 for the continuation factor. Within each ethnic category, IFI score increased as planned duration of full breastfeeding increased (P < 0.0001 for all). Within the planned duration categories of <1, 1–3, 3–6 and ≥6 months, the median IFI score by ethnic category ranged from (low–high) 5–8, 9–10, 12–14 and 16–16, respectively. The IFI scale provides a valid measure of breastfeeding intentions in diverse populations of English‐ and Spanish‐speaking primiparae, and may be a useful tool when researching disparities in breastfeeding practices.     

Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study

AIM: To report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding. METHODS: Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed, breast and bottle feed, bottle feed, or uncertain) at 32 wk of pregnancy: intention in the first week, intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months. RESULTS: Data were available on 10,548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth, only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum, the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3, 4.4), compared with 2.5 mo (95% CI 2.4, 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression, using intended duration as the only explanatory variable, correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months. CONCLUSIONS: This large population-based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.     

Effectiveness of the baby‐friendly community initiative on exclusive breastfeeding in Kenya

The baby‐friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby‐friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub‐county. Pregnant women aged 15–49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention group n = 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%; P < .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85; P < .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings.     

Breastfeeding practices in Mexico: Results from the National Demographic Dynamic Survey 2006–2018

Although actions have been taken to improve breastfeeding in Mexico, trends over the last decade and their associated factors have not been analysed. We estimated trends in breastfeeding practices at the national, rural/urban, and regional level indigenous ethnicity and socio‐economic level, and their associated factors using the National Demographic Dynamics Survey (2006, 2009, 2014 and 2018). We assessed breastfeeding indicators of women with children <24 months according to The World Health Organization recommendations. Logistic regressions models of pooled data were used to estimate trends and associations with biological and sociodemographic characteristics. Between 2006 and 2018, the prevalence of ever breastfed increased from 91.8% to 94.2% (p < 0.001), whereas early initiation of breastfeeding increased from 40.8% to 59.7% (p < 0.001), with similar increments by urban/rural level. Between 2009 and 2018, the prevalence of exclusive breastfeeding in children <6 months increased from 13.0% to 20.7% (p < 0.001). The largest increase was seen in Mexico City, in nonindigenous women and those with a high socio‐economic status, whereas indigenous women and those from the South had the lowest or no improvements. Breastfeeding education during pregnancy [odds ratio (OR) 1.3; 95% confidence interval (CI) 1.1–1.5] was positively associated with exclusive breastfeeding, whereas being employed (OR 0.8; 95% CI 0.6–0.9) was negatively associated. Breastfeeding practices improved but are still far from recommendations. Implementing strategies like breastfeeding counselling and programmes and policies that promote and support breastfeeding for poor, indigenous, single and working mothers should be a priority for the government to ensure that all children have the best start in life.     

Human immunodeficiency virus‐positive women's perspectives on breastfeeding with antiretrovirals: A qualitative evidence synthesis

Human immunodeficiency virus (HIV)‐positive women can breastfeed with minimal risk of mother‐to‐child transmission if taking antiretrovirals. Guidelines surrounding infant feeding for HIV‐positive women have evolved several times over the last two decades. Our review aimed to explore perspectives of breastfeeding with antiretrovirals from HIV‐positive women since the World Health Organization (2010) infant feeding and antiretroviral guidelines. HIV‐positive pregnant and postnatal women from all countries/settings were eligible. HIV‐positive women were either on an antiretroviral regimen at the time of the study, previously on an antiretroviral regimen, not initiated on a regimen yet, or enrolled in prevention of mother‐to‐child transmission (PMTCT) care. Quality assessment of all included studies were conducted. Four databases (CINAHL, EMBASE, MEDLINE and PsycINFO) were searched for studies conducted from January 2010 to October 2020. Nine papers were included in the review, of which two presented findings from the same study. Five analytical themes were developed via thematic synthesis: (1) awareness of breastfeeding with antiretrovirals, (2) turmoil of emotions, (3) coping mechanisms, (4) the intertwining of secret, stigma and support and (5) support needed. Support from family and health care professionals and coping approaches were important to overcome stigma and the emotional challenges of breastfeeding with antiretrovirals. Health care professionals should be familiar with the most updated national and local guidance surrounding infant feeding and antiretrovirals. Further research into interventions to encourage HIV‐positive women to adhere and commit to lifelong antiretroviral treatment (Option B+) for breastfeeding is required.     

Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation

OBJECTIVE: To determine the impact of immigration status as well as race/ethnicity and social and economic factors on breastfeeding initiation. DESIGN: Cohort. SETTING: Multisite group practice in eastern Massachusetts. PARTICIPANTS: One thousand eight hundred twenty-nine pregnant women prospectively followed up in Project Viva. MAIN OUTCOME MEASURE: Whether the participant breastfed her infant. RESULTS: The overall breastfeeding initiation rate was 83%. In multivariate models that included race/ethnicity and social, economic, and demographic factors, foreign-born women were more likely to initiate breastfeeding than US-born women (odds ratio [OR], 3.2 [95% confidence interval (CI), 2.0-5.2]). In models stratified by both race/ethnicity and immigration status, and further adjusted for whether the mother herself was breastfed as an infant and the mother's parents' immigration status, US-born and foreign-born black and Hispanic women initiated breastfeeding at rates at least as high as US-born white women (US-born black vs US-born white women, OR, 1.2 [95% CI, 0.8-1.9], US-born Hispanic vs US-born white women, OR, 1.1 [95% CI, 0.6-1.9], foreign-born black vs US-born white women, OR, 2.6 [95% CI, 1.1-6.0], and foreign-born Hispanic vs US-born white women, OR, 1.8 [95% CI, 0.7-4.8]). Calculations of predicted prevalences showed that, for example, the 2.6-fold increase in odds for the foreign-born black vs US-born white women translated to an increase in probability of approximately 1.4. Higher maternal education and household income also predicted higher initiation rates. CONCLUSIONS: Immigration status was strongly associated with increased breastfeeding initiation in this cohort, implying that cultural factors are important in the decision to breastfeed. Immigrants of all races/ethnicities initiated breastfeeding more often than their US-born counterparts. In addition, US-born minority groups initiated breastfeeding at rates at least as high as their white counterparts, likely due in part to high levels of education and income as well as to access to a medical care system that explicitly supports breastfeeding.     

Types and timing of breastfeeding support and its impact on mothers' behaviours

Aim: To determine the types and timing of breastfeeding support for mothers of newborn babies and the extent to which this affects breastfeeding intentions and behaviours in a region with low rates of breastfeeding initiation and duration. Methods: A cross‐sectional study by interviewer‐administrated questionnaire was undertaken of women birthing at a large teaching hospital in South Western Sydney, between August and October 2006 (n= 164), with a 2‐week follow‐up of breastfeeding or breastfeeding‐intending women (n= 107). Types, timing and satisfaction with personal and professional sources of support (e.g. antenatal classes, help at birth, practical lessons on how to breastfeed, providing information, and attitude towards breastfeeding) and the impact of these on breastfeeding intention and behaviours were assessed. Results: Most women had intended to breastfeed (76.2%), and, within the first 24 hours, 77.4% of babies were breastfed to some extent (45.1% exclusively), and at 2 weeks 65.9% were breastfed (9.7% exclusively). Women felt most supported by their partners and least supported by their health‐care team. Antenatal classes, breastfeeding help within half an hour of birth and positive health‐care team attitudes were related to improved breastfeeding intentions and behaviours. However, these supports were infrequently reported. Personal support was commonly reported although support delivered by professionals was related to better breastfeeding behaviours. Conclusion: Despite the effectiveness of professional support interventions, particularly those delivered in the antenatal and immediate post‐natal period, access to these sources of support was very low. For breastfeeding outcomes to be improved, effective professional support strategies need to be much more widely available.     

Variation in breastfeeding behaviours, perceptions, and experiences by race/ethnicity among a low-income statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants in the United States

The objective of this study was to examine how breastfeeding behaviours, perceptions and experiences vary by race/ethnicity among a low-income sample in the USA. Bilingual interviewers conducted a cross-sectional telephone survey of 767 white, African American or Hispanic mothers who received the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Rates of breastfeeding initiation and duration varied by race/ethnicity. Hispanic mothers were more likely to initiate breastfeeding than African American (91% vs. 65%) or white (61%) mothers. Hispanic mothers breastfed longer (mean 5 months) than either African American (mean 3.5 months) or white (mean 3 months) mothers. The most common reason for not breastfeeding was fear of difficulty or pain during breastfeeding (35.6%). Among mothers who did not initiate breastfeeding, African American and white mothers were more likely than Hispanic mothers to report perceptions of breastfeeding difficulty or pain, and Hispanic mothers were more likely than African American and white mothers to report perceptions of infant breast rejection. The most common reason reported for breastfeeding cessation was not having enough milk (23.4%). Hispanic mothers were more likely than African American and white mothers to cite perceptions of milk insufficiency and infant breast refusal than concerns regarding breast discomfort or pain. African American mothers were more likely than white mothers to report cessation to return to work. In conclusion, while breastfeeding initiation rates approach Healthy People 2010 goals, breastfeeding duration remains far below these goals. Race/ethnicity differences in experiences related to breastfeeding cessation suggest that culturally sensitive breastfeeding interventions are necessary.     

Breastfeeding practices after a counselling intervention for factory workers in Bangladesh

Breastfeeding may be particularly challenging for female factory workers who have long working hours and inadequate access to health information and care. In Chattogram, Bangladesh, a peer counselling intervention was undertaken to improve infant feeding practices of factory workers. Counselling started during pregnancy and continued until children were 18 months old. This article presents the results of a cross‐sectional survey undertaken during 2 weeks in March–April 2017, after the project''s conclusion. The aim was to compare breastfeeding practices, specifically early breastfeeding initiation and exclusive breastfeeding (EBF), among factory workers who had received peer counselling in the intervention areas (IA) with those of non‐counselled factory workers in the nearby comparison areas (CA). Six female interviewers, trained over 3 days, conducted interviews at the workers'' homes. Data were analysed to assess the association of peer counselling with infant feeding practices. Factory workers (N = 382) with infants between 0 and 18 months of age participated in the survey, in IA (n = 188) and in CA (n = 194). Although there were more health facility deliveries among the CA workers, only 43 (22%) of those workers had initiated breastfeeding within 1 h of birth versus 166 (88%) of the IA workers (p < .001). EBF prevalence on 24‐h recall in infants aged 0–6 months was only 7/83 (8%) for the CA workers versus 73/75 (97%) for IA workers (p < .001). The survey showed that breastfeeding practices of factory workers in the IA after the intervention were significantly better than those of factory workers in the CA.     

After their wives have delivered,a lot of men like going out: Perceptions of HIV transmission risk and support for HIV prevention methods during breastfeeding in sub‐Saharan Africa

Female‐initiated HIV prevention methods, such as oral pre‐exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, male partners and grandmothers (N = 196) and 36 in‐depth interviews with key informants in Malawi, South Africa, Uganda and Zimbabwe. We analysed the data using a framework analysis method. Overall, breastfeeding was the norm, and participants described the transference of health (e.g., nutrition) and disease (e.g., HIV) to children through breast milk. Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub‐Saharan Africa.     

Stress,social support,and racial differences: Dominant drivers of exclusive breastfeeding

Exclusive breastfeeding is recommended for 6 months; however, many childbearing people wean their infants before 6 months. Psychosocial factors such as stress, social support and race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stress and social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, race and social support on exclusive breastfeeding over 6 months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared with White, participants were less likely to breastfeed exclusively for 6 months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6 months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio: 0.01, 95% confidence interval: 0.001–0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress.     

Monitoring breastfeeding indicators in high‐income countries: Levels,trends and challenges

Monitoring indicators of breastfeeding practices is important to protect and evaluate the progress of breastfeeding promotion efforts. However, high‐income countries lack standardized methodology to monitor their indicators. We aimed to update and summarize nationally representative annual estimates of breastfeeding indicators in high‐income countries and to describe methodological issues pertaining to the data sources used. A review was conducted through population‐based surveys with nationally representative samples or health reports from nationally representative administrative data of electronic surveys or medical records. Methodological aspects and rates of all breastfeeding indicators available were summarized by country. The median and annual growth of breastfeeding in percentage points within countries with time‐series data were estimated. Data from 51 out of 82 high‐income countries were identified. The data were obtained through surveys (n = 32) or administrative data (n = 19). Seventy‐one percent of countries have updated their indicators since 2015. Ever breastfed was the indicator most frequently reported (n = 46), with a median of 91%. By 6 months of age, the median equals 18% for exclusive and 45% for any breastfeeding. At 12 months, the median of continued breastfeeding decreased to 29%. The annual growth rate for ever breastfed, exclusive and any breastfeeding at 6 months and continued at 12 months varied from 1.5 to −2.0, 3.5 to −3.1, 5.0 to −1.0 and 5.0 to −1.9, respectively, with positive changes for most countries. Stronger interventions are needed to promote breastfeeding in high‐income countries as a whole, and investments are required to monitor trends with standardized methodologies.     

The financing need for expanding paid maternity leave to support breastfeeding in the informal sector in the Philippines

In low‐ and middle‐income countries, almost three‐fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non‐contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non‐contributory maternity cash transfer programme to the informal sector in the Philippines. Using a costing framework developed in Mexico, the study estimated the annual cost of a maternity cash transfer programme. The methodology estimated the unit cost of the programme, the incremental coverage of maternity leave and expected number of enrollees. Different unit and incremental costs assumptions were used to provide a range of scenarios. Administrative costs for running the programme were included in the analysis. The annual financing need of implementing maternity cash transfer programme in the Philippines ranges from a minimum scenario of USD42 million (14‐week maternity cash transfer) to a more ideal scenario of USD309 million (26‐week maternity cash transfer). The latter is financially feasible as it is equivalent to less than 0.1% of the country''s gross domestic product substantially lower than the share cost of not breastfeeding (0.7%). The annual cost of the programme is only 10% of the total cost of the largest conditional cash transfer programme.     

Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh

Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control.During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.     

Effectiveness of interventions on breastfeeding self‐efficacy and perceived insufficient milk supply: A systematic review and meta‐analysis

The aim of this systematic review and meta‐analysis was to assess the efficacy on an intervention on breastfeeding self‐efficacy and perceived insufficient milk supply outcomes. The literature search was conducted among 6 databases (CINAHL, Medline, PsyncInfo, Scopus, Cochrane, and ProQuest) in between January 2000 to June 2016. Two reviewers independently assessed the articles for the following inclusion criteria: experimental or quasi‐experimental studies; healthy pregnant women participants intending to breastfeed or healthy breastfeeding women who gave birth to a term singleton and healthy baby; intervention administered could have been educational, support, psycho‐social, or breastfeeding self‐efficacy based, offered in prenatal or postnatal or both, in person, over the phone, or with the support of e‐technologies; breastfeeding self‐efficacy or perceived insufficient milk supply as outcomes. Seventeen studies were included in this review; 12 were randomized controlled trials. Most interventions were self‐efficacy based provided on 1‐to‐1 format. Meta‐analysis of RCTs revealed that interventions significantly improved breastfeeding self‐efficacy during the first 4 to 6 weeks (SMD = 0.40, 95% CI 0.11–0.69, p = 0.006). This further impact exclusive breastfeeding duration. Only 1 study reported data on perceived insufficient milk supply. Women who have made the choice to breastfeed should be offered breastfeeding self‐efficacy‐based interventions during the perinatal period. Although significant effect of the interventions in improving maternal breastfeeding self‐efficacy was revealed by this review, there is still a paucity of evidence on the mode, format, and intensity of interventions. Research on the modalities of breastfeeding self‐efficacy should be pursued.     

Can neighborhoods explain racial/ethnic differences in adolescent inactivity?

OBJECTIVE: To determine if neighborhoods and their attributes contribute to racial/ethnic disparities in adolescent inactivity. METHODS: We undertook a cross-sectional analysis of the National Longitudinal Study of Adolescent Health (n = 17,007), a nationally representative school-based study in the United States. Stratifying by gender, we used multivariate linear regression and multi-level modeling to determine whether neighborhood of residence may partially explain racial/ethnic disparities in adolescent physical inactivity, defined as hours viewing television or videos/DVDs and/or playing computer/video games each week. RESULTS: Participants lived in largely segregated communities. Black and Hispanic adolescent girls reported higher levels of inactivity than White adolescent girls (21 vs. 15 vs. 13 hours/week, respectively, p <0.001). Similar patterns were seen in adolescent boys, with Black adolescent males reporting a mean of 26 hours/week; Hispanic boys a mean of 20 hours/week; and White boys a mean of 17 hours/week of inactivity (p <0.001). After accounting for between-neighborhood variation, there were no residual within-neighborhood differences in inactivity between Hispanic and White adolescent girls (gamma = -0.06, p =0.93); when living in the same neighborhood Hispanic and White girls had similar levels of inactivity. Black adolescent girls and boys were found to have higher levels of inactivity no matter where they lived (gamma =7.00, p <0.001 for girls; gamma = 6.96, p <0.001 for boys). Hispanic boys had similar patterns of inactivity to White boys (gamma =-1.57, p = 0.12). In both males and females, the reported rate of violent crime in the neighborhood was associated with inactivity, despite the individual's perception of his/her neighborhood as safe not being predictive. CONCLUSIONS: Although inactivity varies by race/ethnicity and gender, only in Hispanic adolescent girls does neighborhood fully explain the differential use. Our findings suggest that approaches other than changing neighborhood characteristics are needed to eliminate racial/ethnic disparities in adolescent inactivity.     

Racial and Ethnic Disparities in Emergency Department Wait Times for Children: Analysis of a Nationally Representative Sample

ObjectiveTo evaluate the association of race and ethnicity with wait times for children in US emergency departments (ED).MethodsWe performed a cross-sectional study of ED encounters of children (<18 years) from 2014 to 2019 using a multistage survey of nonfederal US ED encounters. Our primary variable of interest was composite race and ethnicity: non-Hispanic White (NHW), non-Hispanic Black, Hispanic, and all others. Our outcome was ED wait time in minutes. We evaluated the association between race and ethnicity and wait time in Weibull regression models that sequentially added variables of acuity, demographics, hospital factors, and region/urbanicity.ResultsWe included 163,768,956 survey-weighted encounters. In univariable analysis, Hispanic children had a lower hazard ratio (HR) of progressing to evaluation (HR 0.84, 95% confidence interval [CI] 0.76–0.93) relative to NHW children, indicating longer ED wait times. This association persisted in serial multivariable models incorporating acuity, demographics, and hospital factors. This association was not observed when incorporating variables of hospital region and urbanicity (HR 0.91, 95% CI 0.83–1.00). In subgroup analysis, Hispanic ethnicity was associated with longer wait times in pediatric EDs (HR 0.76, 95% CI 0.63–0.92), non-metropolitan EDs (HR 0.75, 95% CI 0.64–0.89), and the Midwest region (HR 0.77, 95% CI 0.69–0.87). No differences in wait times were observed for children of Black race or other races.ConclusionsHispanic children experienced longer ED wait times across serial multivariable models, with significant differences limited to pediatric, metropolitan, and Midwest EDs. These results highlight the presence of disparities in access to prompt emergency care for children.