不同喂养方式对乙型肝炎病毒母婴传播的影响

目的研究乙型肝炎病毒（HBV）表面抗原（HBsAg）阳性产妇所生婴儿母乳喂养和人工喂养对HBV母婴传播的影响。方法选择2001～2010年孕期或住院分娩时检测乙肝病毒表面抗原（HBsAg）阳性的母亲及其儿童206对,进行问卷调查和采集血清标本,用固相放射免疫法（SPRIA）检测HBV血清学标志物,比较母乳喂养和人工喂养对儿童HBV感染的影响。结果 206名儿童中母乳喂养100人,阳性3人,阳性率3.00%;人工喂养106人,阳性2人,阳性率1.89%。母亲在双阳性（HBsAg、乙肝病毒e抗原（HBeAg）均阳性）或单阳性（HBsAg阳性、HBeAg阴性）情况下,母乳喂养和人工喂养儿童HBsAg阳性率的差异均无统计学意义。结论母乳喂养未增加儿童感染乙肝的风险。     

Replacement-fed infants born to HIV-infected mothers in India have a high early postpartum rate of hospitalization

Access to safe breast-feeding alternatives for HIV-infected mothers and their infants in many settings is limited. We compared the rates of early postpartum hospitalization of infants born to HIV-infected mothers using different infant-feeding practices in a large government hospital in Pune, India. From March 1, 2000 to November 30, 2001, infants born to HIV-infected mothers were followed in a postpartum clinic. All mothers had received a standard short course of antenatal zidovudine. Infant-feeding practices were assessed within 3 d of delivery, prior to postpartum hospital discharge. Sixty-two of 148 mothers (42%) were breast-feeding their infants. Eighty-six of the mothers (58%) were providing replacement feeding, primarily diluted cow, goat or buffalo milk (top feeding). Twenty-one of the 148 participating infants (14.2%) born during the study period required hospitalization within the 1st 6 mo of life and 6 infants required repeat hospitalization. All hospitalized infants were receiving replacement feeding with a rate of 0.093 hospitalizations per 100 person-days (95% CI, 0.062 to 0.136). The reasons for hospitalization included acute gastroenteritis (48.1%), pneumonia (18.5%), septicemia (11.1%) and jaundice (11.1%). A high risk for early postpartum hospitalization was seen in replacement-fed infants born to HIV-infected mothers in Pune, India. In settings such as India, where access to safe replacement feeding is limited, interventions making exclusive breast-feeding safer for HIV-infected mothers and infants are needed. Such interventions would be valuable additions to the very effective national prevention programs that currently rely on the provision of short-course zidovudine and nevirapine.     

HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate

Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were <67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe.     

Patterns of variation in breast-feeding behaviors

This paper describes the range and patterning of variation in specific breast-feeding behaviors among a sample of 62 American mothers, as well as the relationship of the patterns to duration of exclusive breast feeding. Infant feeding data were collected using 24-hr records completed by mothers every 8 days through the first 6 months post partum. Behaviors examined were: number of daily feedings, minimum and maximum intervals between feedings, length of feedings and total daily nursing duration. Variation in magnitude of these behaviors ranged from three- to eight-fold. Principal components analysis found this variation patterned in two dimensions, relating to feeding frequency and length of time spent breast feeding. These dimensions accounted for approximately equal proportions of variance in the breast-feeding behaviors, totaling about 80% of all variance at 4 and 8 weeks. There was significant continuity of breast-feeding styles practiced by any one woman from 4 to 8 weeks. The feeding frequency dimension was strongly associated with duration of exclusive breast feeding. Three explanations--cultural, biological and biocultural--are proposed to account for this association. It is argued that the intracultural variation in breast-feeding styles in this sample may be sufficient to cause corresponding variation in breast milk production, in part accounting for variation in duration of exclusive breast feeding. Predictions of exclusive breast-feeding duration will be most accurate for women with a breast-feeding style of infrequent feedings, while predictions for women with a style of frequent feeding will be confounded by cultural factors which have an independent effect on breast-feeding supplementation.     

西部贫困农村地区健康信息传播对婴幼儿母亲科学喂养认知的促进

目的 明晰西部贫困农村地区健康信息传播模式对婴幼儿母亲母乳喂养认知的影响,为提高该类地区妇女的婴幼儿喂养认知,从而改善婴幼儿的健康状况,提供科学建议。 方法 分别于2014年、2019年在我国西部贫困农村地区,选取24月龄及以下婴幼儿及其母亲为研究对象,通过问卷调查收集其人口学特征、健康信息传播模式、科学喂养认知等资料。运用回归分析健康信息传播模式对婴幼儿母亲的科学喂养认知的影响。 结果 共纳入1 284对（2014年）、1 049对（2019年）母婴。2019年婴幼儿母亲早开奶知晓率（72.64%）、纯母乳喂养知晓率（31.36%）均分别显著高于2014年（65.73%,25.30%）（均 P < 0.05）。在信息传播模式中,70.54%的婴幼儿母亲主要通过基层医务工作者获取喂养信息。回归分析显示,基层医务工作者结合信息传播材料传递母乳喂养信息( OR = 2.23, 95% CI 1.03～4.85)促进了婴幼儿母亲的早开奶认知;基层医务工作者传播母乳喂养信息( OR = 1.57, 95% CI 1.04～2.38)、基层医务工作者与亲友协同传播母乳喂养信息的交互作用( OR = 2.39, 95% CI 1.48～3.87)促进了婴幼儿母亲纯母乳喂养认知。 结论 以基层医务工作者为核心的母乳喂养信息传播模式促进了西部贫困农村地区婴幼儿母亲早开奶、纯母乳喂养的认知。     

Effect of two types of hospital feeding gift packs on duration of breast-feeding among adolescent mothers

Two hundred forty-four adolescent mothers under 18 years of age during a 15-month period, and 53% elected to breast-feed. A subset of 60 primiparous breast-feeding adolescents were enrolled in an investigator-blind, randomized; prospective study to compare the effects on breast-feeding duration of a standard hospital discharge feeding gift pack containing for mula and a specially designed study pack that was free of infant formula. Thirty-five percent of the 60 women breast-fed less than 1 month; 22% nursed longer than 1 month but less than 2 months; and 43% breast-fed more than 2 months. There was no significant difference in breast-feeding duration among mothers by gift pack group, although those who received the study gift pack rated it higher in usefulness (p < (0.025). The provision of infant formula samples did not appear to have a deleterious effect on the duration of breast-feeding among a population of adolescent mothers.     

Breast-feeding counselling in a diarrhoeal disease hospital.

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother-infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practices.     

Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study

OBJECTIVES: To describe the first-week feeding patterns for breast- vs bottle-fed babies, and their association with sustained breast-feeding and infant weight gain at 6 weeks. DESIGN: A longitudinal cohort study. SETTING: Feeding diaries were completed by mothers in an urban UK community shortly after birth; follow-up weight and feeding data were collected at routine health checks. SUBJECTS: Mothers of 923 full-term infants born during the recruiting period agreed to join the study. In all, 502 usable diaries were returned from 54% of the cohort. RESULTS: Breast-fed infants were fed more frequently (2.71 h between feeds) than bottle-fed infants (3.25 h between feeds) and mixed-fed infants (3.14 h between feeds) (P<0.001) in the first week of life, while duration of feeds was similar. Only exclusive breast-feeding in the first week (P<0.001) and maternal education (P=0.004) were related to continued breast-feeding at 6 weeks. Greater first-week feeding frequency (as measured by feed-to-feed interval, h) was associated with higher weight gain at 6 weeks for breast-feeders, but no analysed factors were associated with higher weight gain for bottle-feeders. CONCLUSIONS: This large-scale study of first-week feeding patterns sheds light on the important and complicated issues of breast-feeding continuation and infant weight gain, with implications for the feeding advice given to mothers. Supplementary bottle feeds were clearly associated with discontinued breast-feeding at 6 weeks. Over that period, higher weight gain was associated with more frequent feeding for breast-fed infants only. SPONSORSHIP: Henry Smith Charity, SPARKS, Child Growth Foundation.     

Session 1: Public health nutrition. Breast-feeding practices in Ireland

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering 'any' breast milk to their infants at 6 weeks. Mothers' positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and 'any' breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers' attitudes and beliefs pertaining to breast-feeding. These results suggest that the 'cultural' barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve.     

Breast-feeding and fertility. Part I: Lactational amenorrhoea.

A cross-sectional survey describing the current fertility performance and breast-feeding of 1134 urban mothers, who gave birth within the last 2 years was carried out. Mothers were recruited from MCH centers in Alexandria governorate. The results indicated that the mean time elapsed since birth before return of menstruation was (5.1 +/- 4.3) months for breast-feeding mothers and (2.5 +/- 2.3) months for non-breast feeding mothers. At four-month of postpartum period, 50% of the mothers were still amenorrhoeic and at six-month, 31% of the mothers were still amenorrhoeic. A total confirmed pregnancies was 8.5% and 3% of new pregnancies occurred during amenorrhoea and while women were breast-feeding. Use of contraceptives was practiced by 57% of mothers, with 65% of all users starting as early as the second month.     

Perceptions of mothers and use of breastmilk substitutes in Dhaka,Bangladesh

To explore the actual practices and perceptions of giving breastmilk and breastmilk substitutes (BMS), this cross-sectional study was conducted among 326 mothers of low (income/month < Tk 4,000, n = 163) and middle (income/month > Tk 4,000, n = 163) socioeconomic status (SES) with infants aged 6-12 months in Dhaka city during February-April 2001. Qualitative data on perceptions of mothers on appropriate breast-feeding practices were also documented through focus-group discussions (FGDs). The prevalence of exclusive breast-feeding was low in both the socioeconomic groups but was comparatively higher among the mothers of middle SES (3.1% vs 12.3%, p < 0.001), although predominant breast-feeding was high among the mothers of low SES. In addition, the use of BMS was higher among the mothers of middle SES than among the mothers of low SES (55.8% vs. 43.5%, p < 0.001). The majority (62.3%) of the mothers mentioned insufficiency of breastmilk as the main reason for introducing BMS. Perception on appropriate feeding practices was also significantly different between the two groups. Approximately, 90% of the mothers of low SES could not differentiate between infant formula and milk powder compared to 70% of the mothers of middle SES (p < 0.001). The findings of FGDs revealed that some middle-class mothers thought that infant formula was the best food for their infants. Programmes to impart proper knowledge on breast-feeding practices should be strengthened.     

Carotenoid composition and content of legumes, tubers and roots by HPLC

A survey was carried out in the district of Kemaman, Terengganu, Malaysia to study infant feeding practices in rural and semi-urban communities. A total of 593 mothers were interviewed and their socio-demographic information recorded. Data on infant feeding practices were collected from mothers who had children up to 15 months of age. Among breast-feeding mothers (n =157), 42.0 % fed their babies for less than 3 months and 58.0% bottle fed for more than 6 months. Sixteen children were found to be fed on sweetened condensed milk with 62.5% of them for the first 3 months. Among those who breast fed their babies, 40.1% were found to have bottle fed at one time or another. The majority of breast feeding mothers belonged to the groups having incomplete primary schooling or completed primary education only and household income below RM600 per month. A substantial number of breast fed babies were given weaning foods in the form of porridge mixture (rice + egg, rice + vegetables, rice + meat, rice+ fish and cereals) between the age of 0 - 3 months. The findings of this study concluded that although breast-feeding is widely practiced, however, their duration has dwindled, and early introduction of solid foods is widespread.     

Weaning practices and breast-feeding duration in Northern Thailand.

Current infant feeding guidelines recommend exclusive breast-feeding until the infant is about 4 months old to reduce the risks of early termination of breast-feeding, undernutrition and infection. In many societies, however, supplementary foods are given well before 4 months of age. The present paper describes weaning practices, factors associated with early supplementation and the effects of supplementation on duration of breast-feeding in a random sample of sixty northern Thai breast-fed infants studied prospectively from birth to 2 years of age. Composition of supplementary foods, energy and protein intake from supplements and changes in the supplementary diet with increasing infant age are also described. Rice-based foods were given from soon after birth; 81% of the sample had received supplements by 6 weeks of age. Early supplementary feeding was significantly associated with rural residence, large household size, maternal employment in agriculture and maternal age. Girls and infants with lower birth weights tended to be supplemented earlier. Despite early feeding of supplements, breast-feeding was prolonged, with median duration of 12 months. Early introduction of supplements and quantity of supplements consumed in the first 3 months were not associated with duration of breast-feeding. However, mothers who gave infant formula as the first supplementary food stopped breast-feeding slightly earlier, as did younger mothers living in households with more children.     

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.     

Breast-feeding and bottle-feeding of twins, triplets and higher order multiple births

OBJECTIVE: This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed. METHODS: The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected. RESULTS: There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety. CONCLUSION: This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.     

Breast-feeding among the urban poor in southern Brazil: reasons for termination in the first 6 months of life

A study of breast-feeding practices over the first 6 months of life among a cohort of urban poor infants in southern Brazil indicated that the median duration of breast-feeding was 18 weeks, and at 6 months 41% of the infants were still being breast-fed. The duration of breast-feeding was significantly associated with the following: the infant's sex, mother's colour, type of first feed, timing of the first breast-feed, breast-feeding regimen and frequency of breast-feeding at 1 month, and the use of hormonal contraceptives by the mother. The following were significant risk factors for early termination of breast-feeding: the infant's sex, type of first feed, use of supplementary feeds, frequency of breast-feeding, feeding regimen, weight-for-age, and weight-for-age after controlling for birth weight. Dissatisfaction with their infant's growth rate was the most frequent reason given by mothers for supplementing the diets of infants who were exclusively breast-fed in the first 3 months of life. Also, the mothers' perception that their milk output was inadequate was the most frequent reason expressed for stopping breast-feeding in the first 4 months. The roles of health services and family support in providing favourable conditions for increasing the duration of breast-feeding in the study population are discussed, as well as the possibility of bias being introduced into studies of the relationship between infant feeding and growth by the effect of the infant's rate of growth on the mother's decision to continue breast-feeding.     

The motivational determinants of breast-feeding: predictors for the continuation of breast-feeding

OBJECTIVE: The aim of this study was to evaluate the motivational determinants of the continuation of breast-feeding until 3 months postpartum. METHODS: A prospective cohort study using the Integrated Change Model in 341 women in 5 child health care centers. RESULTS: At birth, 73% of the mothers started with breast-feeding and 39% of them continued at least 3 months postpartum. Mothers who continued for 3 months differed in almost all the motivational determinants from mothers who discontinued. In the multiple logistic regression analysis, social support for formula feeding from significant others and situational self-efficacy for breast-feeding made a significant independent contribution to the continuation of breast-feeding. Among the predisposing determinants, the strongest positive predictor of continuation was the intention to return to work at 1 month postpartum. CONCLUSION: The Integrated Change Model is valid to explain and predict the continuation of breast-feeding. Hence, the results may be used to tailor future interventions aimed at promoting breast-feeding. In the discussion, we use the results to target interventions.     

Understanding the social and cultural influences on breast-feeding today

Breast-feeding is a key public health target but social and cultural factors are often overlooked when encouraging mothers to choose breast-feeding as their method of infant feeding. Historically, there have always been some mothers who have sought alternatives to breast-feeding. Age, level of education and occupation impact upon a mother's choice, and the sexualization of the female breast can lead to embarrassment when mothers breast-feed outside the home. Fear of damaging their body shape can prevent some mothers from breast-feeding, while others see breast-feeding as desirable as it can lead to weight loss. The attitudes of partners, relatives and friends can influence mothers to varying degrees in their choice of infant feeding. Knowledge of various influences can assist health professionals in their public health role and help them to give mothers advice relevant to their circumstances.     

Baby-feeding support: a view from the coalface

The author gives her views on some of the problems of baby-feeding support in the community. There appear to be inconsistencies in the way "breast-feeding" is defined, which can lead to confusing data and may inflate the figures for hospital breast-feeding rates. Early discharge of mothers after a birth and shortage of community midwives make it more difficult for mothers to establish breast-feeding. Support for both breast-feeding and bottle-feeding mothers is often lacking. The author describes an inclusive support group that welcomes mothers whether they are exclusively breast-feeding, partially breast-feeding, or bottle feeding.