Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan, China

Chinese studies indicate that the growth of rural infants and children lags behind that of their urban counterparts after 4 mo of age and that the gap is widening. However, the rural areas are home to >85% of China's 300 million children. Clearly, culturally appropriate rural complementary feeding interventions are needed to close the growth and health gaps. After a 1990 survey of infants in rural Sichuan confirmed that poor infant feeding practices rather than inadequate household food resources were responsible for the growth faltering, a year-long community-based pilot nutrition education intervention (n congruent with 250 infants each in Education and Control groups) was undertaken in four townships. The goal was to improve infant growth by improving infant feeding practices. Features of the intervention included the training and mobilizing of village nutrition educators who made monthly growth monitoring and complementary feeding counseling visits to all pregnant women and families with infants born during the intervention in the study villages. After 1 y, the Education group mothers showed significantly higher nutrition knowledge and better reported infant feeding practices than their Control group counterparts. Also, the Education group infants were significantly heavier and longer, but only at 12 mo (weight-for-age -1.17 vs. -1.93; P = 0.004; height-for-age -1.32 vs. -1.96; P = 0.022), had higher breast-feeding rates overall (83% vs. 75%; P = 0.034) and lower anemia rates (22% vs. 32%; P = 0.008) than the Control group infants. We conclude that these methods have potential for adaptation and development to other rural areas in the county, province and nation.     

Breast-feeding in the modern health sector in Indonesia: the mother's perspective

This paper presents findings of a study of postpartum women in major hospitals throughout Indonesia. The objective was to assess the mothers' practices and attitudes regarding several key aspects of breast-feeding and 'rooming-in'. The study found that most of the women breast-fed their babies, with many believing infants should be breast-fed for 18 months or longer. However, many mothers lacked information about ideal infant feeding patterns and were unaware of how to solve problems that may arise. Only 38% recognized the value of feeding colostrum, and many feared the effect of breast-feeding on breast shape. They often gave supplementary formula. Almost none understood the importance of frequent suckling in promoting milk production. Only 50% of infants were kept in the same hospital room with their mothers for 24 hr a day, or full rooming-in. Women who kept their infants in the nursery (39%) were generally younger, better educated, primiparous, or had non-normal deliveries. They knew little about rooming-in, and if given more information to allay their doubts, they might consider rooming-in as a viable and safe arrangement. The results of this study reinforce the importance of identifying the perceptions and the knowledge of women concerning breast-feeding and rooming-in, so that hospital administrator, and health professionals can design programs and provide environments that encourage women to breast-feed their infants in optimal ways.     

Infant-feeding practices of mothers of known HIV status in Lusaka,Zambia

BACKGROUND: Between 25 and 44% of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) occurs through breastfeeding. As a result, feeding guidelines for infants of HIV-infected mothers are being formulated in many resource-poor countries. The impact of introducing these guidelines on mothers' actual feeding practices has not previously been examined. Infant-feeding practices of mothers of known HIV status who should have received advice during pre- and post-test HIV counselling were assessed and compared with those of uninfected mothers. METHODS: Mothers of infants aged 2-12 months, 55 HIV-infected and 85 HIV-uninfected, were recruited from the HIV Family Support Unit in Lusaka, Zambia. HIV status was known to 121 of these mothers, who had all received pre- and post-test HIV counselling. Feeding practices were determined by verbal questionnaire. RESULTS: All mothers breastfed but only 35% of infants below 4 months were exclusively breastfed (received breast milk only). HIV-infected mothers introduced fluids and weaned their infants significantly earlier than HIV-uninfected mothers (p = 0.03 and p = 0.002, respectively). Infants of HIV-infected mothers had significantly lower weight for age Z (WAZ) scores indicating poorer nutritional or health status (p = 0.004). Commercial formula milk and cow's milk were used by 36 mothers as breast milk substitutes, and were introduced at a median age of 2.5 months. Thirteen mothers gave cow's milk, and no mother added water to cow's milk (as recommended), with two adding sugar and four adding salt. CONCLUSION: Infant-feeding practices of HIV-infected mothers differed significantly from HIV-uninfected mothers, and this may contribute to their poorer growth. Paradoxically these mothers feeding practice could be putting these infants at greater risk of both non-HIV-related morbidity and HIV transmission, as early introduction of foods other than breast milk may increase MTCT.     

Newborn care giving by primipara and multipara mothers at home in Tanta City

Recent researches are concerned with topics of newborn care giving, maternal knowledge and practices because it facilitates growth and development, protection against infection and detection of any abnormalities. The purpose of this study was to assess the mothers' knowledge and practices of basic newborn care given at home. The total sample included 55 primipara and multipara mothers with newborn babies. They were selected from Obstetric University Hospital in Tanta City. Interview questionnaire and observation checklists were designed to fulfill the aim of the study. The study revealed that mothers' knowledge and practices were within good and satisfactory average scores in most of the studied items related to newborn care giving at home except breast feeding. found between Significant differences were primipara and multipara mothers for most of the studied topics related to different topics of newborn care giving. practices were within good and satisfactory average scores in most of the studied items related to newborn care giving at home except breast feeding. Significant differences were found between primipara and multipara mothers for most of the studied topics related to different topics of newborn care giving.     

Relative importance of factors associated with duration of lactation in mothers of better socioeconomic status

In 1976, researchers surveyed 3999 mothers in urban and rural Hyderabad, India. 90% of the mothers breast fed their children. Al began breast feeding immediately after birth. Average age of complete weaning ranged from 5.1 months for the urban elite to 13.3 months for rural women. Postpartum amenorrhea varied from an average of 3.5 months for the urban elite to 11.4 months for rural women. There were significant differences between the different socioeconomic groups in terms of lactation and postpartum amenorrhea (p.05). Both duration of breast feeding and postpartum amenorrhea were positively correlated. In terms of the urban population, 60.7% of the urban elite, 42.75 of the urban middle class, and 37.5% had weaned their infants at or before 5 months. Urban elite children were more likely to receive food supplements earlier than rural children (p.05). On average, urban elite mothers introduced supplements at 5 months while rural mothers introduced them at 10 months. As the educational level of the mothers increased the percentage of lactating mothers decreased irrespective of the socioeconomic class. As the duration of lactation increased the levels of children born alive, mortality among live born siblings, and education of both parents decreased significantly (p.05). Urban elite and middle income women who breast fed for 6 months were more likely to be healthy, have children with higher body weights, and have commercial baby food than those who did for 6 months (p.05). Maternal age, parity, and mortality among siblings were positively associated with longer periods of lactation and postpartum amenorrhea. The leading indicator for duration of lactation among all urban women was age of introduction of supplements. The leading indicator for duration of postpartum amenorrhea was duration of lactation.     

The influence of health education on breast feedingpractices in Benin City, Nigeria

Many mothers from developing countries including Nigeria are introducing their babies to artificial milk feeding early in life. This is probably due to the rapidly increasing female education whereby working mothers had to go back to work 6–8 weeks after delivery.In this study, only 31·4% of the mothers wholly breast fed their babies at confinement in spite of the health educational activities of breast feeding practices during antenatal clinic (A.N.C.) attendances. Breast feeding declined rapidly after discharge from hospital, and artificial milk feeding was well established at 6–8 weeks, post confinement, for socio—economic reasons.It is suggested that for these working mothers, bottle-feeding practices should be welldemonstrated to them so as to minimize the ill effects that ignorance and malutilization of the artificial milk may cause. For the non-working mothers, health educational activities on the advantages of breast feeding and breast milk should be continuous and continuing.     

陕西部分农村母亲婴幼儿喂养知信行现况调查

目的:了解农村婴幼儿喂养现状,为进一步干预提供依据。方法:采用定量方法利用自编问卷对陕西泾阳县6个乡的311名儿童母亲进行现况调查;采用定性方法组织12名儿童母亲进行专题小组讨论,了解影响母亲喂养行为的因素。使用中位数、均数、标准差、频数、卡方检验等方法分析定量资料;使用分类归纳法分析定性资料。结果:定量调查显示,88.4%的母亲认为婴儿6个月内纯母乳喂养好,但6个月内纯母乳喂养率为55.3%;44.4%的母亲了解正确添加辅食的时间,但适时添加辅食率为26.1%;分别有92.9%、97.4%、76.2%的母亲认为应该每天给6个月及以上的孩子吃鸡蛋、蔬菜或肉类,但每周给6个月及以上的孩子添加6次及以上鸡蛋的比例为38.9%、蔬菜47.9%;给7个月及以上孩子每周添加1次以上肉类的比例只有21.6%。定性结果表明,没有坚持纯母乳喂养的母亲主要是自认为母乳不足而过早加辅食;过晚添加辅食的母亲主要是认为8个月以下的孩子对乳类以外的食物难以消化;不给孩子添加肉类食物的母亲主要是认为孩子1岁牙长好了才能消化肉类。结论:6个月婴儿纯母乳喂养率和适时添加辅食率低于同期其他农村地区水平,辅食种类单调,动物性食物摄入明显不足。建议加强对妇幼保健人员的培训,更新相关知识,提高健康教育技能;开发适合农村家长的科普书报、杂志等健康教育材料。     

Hospital and other influences on the uptake and maintenance of breast feeding: the development of infant feeding policy in a district

Hospital practices in the post-natal period are now recognised as one of a wide range of influences affecting the success of breast feeding. A study of 48 non-medical maternity unit staff and 250 recently delivered mothers at a District General Hospital was carried out in order to identify obstacles and sources of support in the establishment and maintenance of breast feeding. This study formed part of an evaluation of local policy development which included the appointment of a Baby Feeding Adviser. Eighty-two percent of mothers (95% confidence interval; 87.0-96.4) began breast feeding, and this fell to 57.4% (50.6-64.2) at 6 weeks. A majority of mothers reported that advice was at least partly conflicting, and of those who began breast feeding 92.7% had used supplements within 2 days. In multivariate analysis, factors significantly associated with a lower rate of initial breast feeding were: non-attendance at antenatal classes, Caucasian ethnicity, social class and religious denomination. Social factors were much less important in the maintenance of breast feeding, but mothers who had undergone Caesarian section were more likely to give up breast feeding by 6 weeks. The reported quality of advice and support from the hospital and community were not associated with the maintenance of breast feeding. Many of the maternity unit midwifery staff reported inadequate time for discussion of feeding with mothers. Although two-thirds of the staff felt that there should be an infant feeding policy or were not sure, most of those favouring a policy felt that it should not actively promote breast feeding. Their main reason for this view was the fear of inducing guilt in bottle-feeding mothers. The social and service-related factors associated with the initiation and maintenance of breast feeding may be useful for targeting additional support for some mothers. The ambivalence and concerns among maternity unit midwifery staff about promoting breast feeding must be addressed if successful policy implementation is to be achieved. Plans for implementing change and evaluation are described.     

Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling

BACKGROUND: The World Health Organization recommends exclusive breastfeeding until age 6 mo. Studies relying on mothers' self-reported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding. OBJECTIVE: We aimed to validate reported infant feeding practices in rural Bangladesh; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique. DESIGN: Subjects were drawn from the large-scale Maternal and Infant Nutrition Interventions, Matlab, study of combined interventions to improve maternal and infant health, in which women were randomly assigned to receive either exclusive breastfeeding counseling or standard health care messages. Data on infant feeding practices were collected by questionnaire at monthly visits. Intakes of breast milk and nonbreast-milk water were measured in a subsample of 98 mother-infant pairs (mean infant age: 14.3 wk) and compared with questionnaire data reporting feeding practices. RESULTS: Seventy-five of the 98 subjects reported exclusive breastfeeding. Mean (+/-SD) breast milk intake was 884 +/- 163 mL/d in that group and 791 +/- 180 mL/d in the group reported as nonexclusively breastfed (P = 0.0267). Intakes of nonbreast-milk water were 40 +/- 80.6 and 166 +/- 214 mL/d (P < 0.0001), respectively. Objective cross-validation using deuterium dilution data showed good accuracy in reporting of feeding practices, although apparent misreporting was widely present in both groups. CONCLUSIONS: The dose-given-to-the-mother deuterium dilution technique can be applied to validate reported feeding behaviors. Whereas this technique shows that the reports of feeding practices were accurate at the group level, it is not adequate to distinguish between feeding practices in individual infants.     

Infant feeding in Nigeria: A case study of practices in Ile-Ife community

Infant feeding practices and nutritional status of one hundred and ten infants in urban and rural areas of lle-lfe were investigated. Questionnaires were administered with the nursing mothers as respondents. Information was obtained on breastfeeding pattern, feeding of milk and non-milk supplements, and also health and medical history of the infants. Anthropometric measurements were also conducted on the infants aged between 0-2 years.

Analysis of the data showed that all nursing mothers breastfed their babies within the first three days up to an average of 12 months of life after which milk and non-milk supplements were introduced. Urban mothers were found to introduce milk supplements at an earlier age of life than their rural counterparts with urban infants being better nourished.     

Expressing yourself: A feminist analysis of talk around expressing breast milk

Recent feminist analyses, particularly from those working within a poststructuralist framework, have highlighted a number of historically located and contradictory socio-cultural constructions and practices which women are faced with when negotiating infant feeding, especially breastfeeding, within contemporary western contexts. However, there has been little explicit analysis of the practice of expressing breast milk. The aim of this article is to explore the embodied practice of expressing breast milk. This is done by analysing, from a feminist poststructuralist perspective, discourse surrounding expressing breast milk in sixteen first time mothers' accounts of early infant feeding. Participants were recruited from a hospital in the South Midlands of England. The data are drawn from the first phase of a larger longitudinal study, during which mothers kept an audio diary about their breastfeeding experiences for seven days following discharge from hospital, and then took part in a follow-up interview. Key themes identified are expressing breast milk as (i) a way of managing pain whilst still feeding breast milk; (ii) a solution to the inefficiencies of the maternal body; (iii) enhancing or disrupting the ‘bonding process’; (iv) a way of managing feeding in public; and (v) a way to negotiate some independence and manage the demands of breastfeeding. Links between these and broader historical and socio-cultural constructions and practices are discussed. This analysis expands current feminist theorising around how women actively create the ‘good maternal body’. As constructed by the participants, expressing breast milk appears to be largely a way of aligning subjectivity with cultural ideologies of motherhood. Moreover, breastfeeding discourses and practices available to mothers are not limitless and processes of power restrict the possibilities for women in relation to infant feeding.     

Effect of a lactation nurse on the success of breast-feeding: a randomised controlled trial.

An evaluation of a lactation nurse by means of a randomised controlled trial is described. The lactation nurse was employed to assist, support, and encourage mothers during the early weeks after parturition in hospital and at home. All mothers who breast-fed at least once were entered into the trial. Altogether 649 mothers were interviewed 12 months later to establish the duration of breast-feeding and to enquire after practices of and attitudes towards infant feeding. The lactation nurse significantly extended the duration of breast-feeding, particularly during the first four weeks and among women of lower social class. Although she did not reduce problems or change practices significantly, all the trends were consistently in the right direction. Mothers in the experimental group were more satisfied with the help they received than were mothers in the control group. It seems likely that the lactation nurse by consistent advice, assistance, support, and encouragement enabled mothers to cope more successfully with difficulties and that this led to significantly fewer ending breast-feeding prematurely.     

Attitudes toward breast-feeding and infant feeding among Iranian, Afghan, and Southeast Asian immigrant women in the United States: implications for health and nutrition education.

A nutritionist analyzed data on 150 immigrant mothers living in California but from Iran, Afghanistan, Vietnam, Cambodia, or Laos who had participated in or were eligible for WIC (Women, Infants, and Children), a US supplemental food program, to examine cultural and socioeconomic factors linked with breast feeding practices. 95% of the mothers had exclusively breast fed their infants in their countries compared to 32% after they arrived in the US In fact, 85% exclusively breast fed for at least 5 months in their countries whereas only 14% did so after coming to the US Further, after immigrating to the US, 38% fed their infants both breast milk and formula. Moreover 30% only offered their infants formula. In the US, 82% of Iranian mothers exclusively breast fed their infants compared to 42% of Afghan mothers, 14% of Vietnamese mothers, 19% of Laotian mothers, and 9% of Cambodian mothers (p.00001). Iranian mothers noted societal support for breast feeding in Iran by the postrevolutionary government, by the Moslem religion, and by support groups they formed in the US Mothers who exclusively breast fed their infants reported breast feeding to be more advantageous than the other groups (p.05). The cited advantages included bonding, best food for infant, protection against infection, and successful breast feeding in the past. Mothers who partially or exclusively used formula were more likely to have returned to school, had problems with the infant's presence, consider bottle feeding to be convenient, received free formula, and state economic reasons. Further those who exclusively breast fed were more likely to 1st breast feed their infant in the delivery room than were the other mothers (p.01). These results indicated that economic reasons were the main reason for not breast feeding. Besides US health care providers in the hospital or those involved in WIC did not provide substantial support for breast feeding. Sound recommendations concluded this report.     

Trends in Rural and Urban Deliveries and Vaginal Births: California 1998‐2002

ABSTRACT: Context: Pregnant women in rural areas may give birth in either rural or urban hospitals. Differences in outcomes between rural and urban hospitals may influence patient decision making. Purpose: Trends in rural and urban obstetric deliveries and neonatal and maternal mortality in California were compared to inform policy development and patient and provider decision making in rural health care settings. Methods: Deliveries in California hospitals identified by the California Department of Health Services, Birth Statistical Master Files for years 1998 through 2002 were analyzed. Three groups of interest were created: rural hospital births to all mothers, urban hospital births to rural mothers, and urban hospital births to urban mothers. Findings: Of 2,620,096 births analyzed, less than 4% were at rural hospitals. Neonatal death rates were significantly higher in babies born to rural mothers with no pregnancy complications who delivered a normal weight baby vaginally at an urban hospital compared to urban mothers delivering at an urban hospital (0.2 [CI 0.2‐0.4] deaths per 1,000 births versus 0.1 [CI 0.1‐0.1]). Logistic regression analysis showed that delivery in a rural hospital was a protective factor compared to urban mothers delivering in an urban hospital, with an odds ratio of 0.8 (CI 0.6‐0.9). Maternal death rates were not different. Conclusions: Rural obstetric services in this period showed favorable neonatal and maternal safety profiles. This information should reassure patients considering a rural hospital delivery, and aid policy makers and health care providers striving to ensure access to obstetric services for rural populations.     

Mother's feeding practices for children 3-10 years of age and their associations with child demographics

The present study examined relationships between mothers' feeding practices and child demographics such as gender, age, weight status, and family income. This cross-sectional analysis was conducted using data from 2259 children between 3 and 10 years of age who were sampled for the development of the Parent Mealtime Action Scale. No child gender differences were found in mothers' feeding practices. Older children received more Fat Reduction and Many Food Choices, but less Positive Persuasion, Use of Rewards, Insistence on Eating, and Special Meals, with differences in these feeding practices being most notable from before to after school age. Overweight children received less Insistence on Eating and more Fat Reduction than underweight or normal weight children. Children with the lowest family incomes received less Fat Reduction, less Daily FV Availability, more Use of Rewards. Results suggest that mothers respond to changing conditions, possibly including feedback from school nurses, increases in children's weight status, and availability of financial resources.     

Breastfeeding and weaning practices in rural communities of Kelantan

A survey of infant-feeding and weaning practices of 566 mothers, systematically sampled from 15 rural villages, randomly selected in the district of Tumpat, Kelantan was carried out. Almost all mothers (97.3%) breastfed their children, reinforcing the previously reported high incidence of breast-feeding among rural Malaysian mothers. One hundred and seventeen (21.3%) of the 551 children breastfed were also given mixed feeding with infant fomulae as well. Weaning started before 4 months of age in 28.3% of the children and after 6 months of age in 12.8% of the children. The 3 most common type of food used in weaning were Nestum (45.0%), rice porridge or paste (42.6%) and wheat porridge or cakes (11.5%). Forty eight children (12.1%) discontinued breastfeeding once weaning was initiated. The main reasons for initiating weaning was mothers' perception that there was insufficient milk and that the child was always hungry (55.7%). Most mothers were also given advice by the health clinic staff on weaning, including the timing and the suitable weaning foods to give. All of the mothers were able to name at least one commercial weaning food product available in their community.     

Beliefs about infant feeding in China and the United States: implications for breastfeeding promotion

This study investigates cultural differences in mothers' views regarding infant feeding and socialization. The majority of mothers reported breastfeeding as one of their methods of infant feeding, although more than half reported using both breast and bottle. Mothers in China expressed concerns that breastfeeding is not compatible with work outside of the home. American mothers were more likely to believe that breastfeeding is difficult to establish. "Happiness" was ranked the most important socialization goal by both groups. Public health initiatives must be culturally relevant and reflect an understanding of parenting values and beliefs.     

母亲母乳喂养知识和信念对婴儿喂养方式影响的研究

目的:了解母亲母乳喂养知识和信念对婴儿喂养方式的影响.方法:用自行设计的母乳喂养调查表,对131名在门诊就诊的月龄在1～4月的婴儿母亲进行调查.结果:在出生后1周时和现场调查时纯母乳喂养比例,婴儿母亲知晓母乳喂养好处组均明显高于不知晓组,知晓放弃母乳喂养危害组明显高于不知晓组,母亲在孩子出生前就树立母乳喂养信心组均明显...     

Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia

STUDY OBJECTIVES: The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period. DESIGN: A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42. SETTING: The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia. PARTICIPANTS: A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42. MAIN RESULTS: At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p < 0.01) as perceived by mothers. There were more mothers in Group B (p < 0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (p < 0.03). In both groups the mothers' perceived own health problems, were significantly higher (p < 0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p < 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p < 0.01). CONCLUSIONS: There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care.