Do babies need water in Sri Lanka?

OBJECTIVES: To study the prevalence of exclusive breast feeding and the reasons for water supplementation, and investigate whether water is necessary in the humid climate of Colombo. SETTING: Well baby clinic in De Soysa Maternity Hospital for Women, Colombo. SUBJECTS: 200 breast fed infants born in a baby friendly hospital between the ages of 1 and 4 months. METHODS: The study sample was randomly selected. Sick infants and those of working mothers were excluded. The mothers' knowledge of feeding practices was recorded in an interviewer administered questionnaire. The infants' weights, lengths and rectal temperatures were measured and the osmolality of urine estimated. The room temperature and relative humidity were recorded on each day of study. The data were analysed using the Chi-Square statistical test. RESULTS: 69% of mothers introduced supplementary fluids within the first 4 months, because of advice from grandmothers or relatives, thirst, hiccups or constipation. 45% had introduced water with "rathakalkaya", a fluid traditionally given to infants in Sri Lanka. 90% of mothers had attended antenatal clinics in the De Soysa Hospital for Women. 70% of mothers who gave supplementary fluids were aware of the importance of exclusive breast feeding. The range of urine osomolalities of exclusively breast fed infants was 60 to 204 mosmol/kg. There were no significant differences in core temperatures and number of times urine was voided daily, or urine osmolalities, between exclusively breast fed and fluids-supplemented group of infants. CONCLUSIONS: Despite delivery in a baby friendly hospital a majority of mothers supplemented breast milk with water or other fluids during the first 4 months. The advice of grandmothers had a significant influence on early feeding practices. Exclusively breast fed infants were found to maintain water homeostasis under the hot, humid climatic conditions of this study.     

Effectiveness of baby friendly hospital initiative on the promotion of exclusive breast feeding among the Dhaka city dwellers in Bangladesh

To assess the effectiveness of baby friendly hospital initiative on exclusive breast feeding status; this longitudinal study designed to compare the incidence of exclusive breast feeding at 30, 60, 90, 120 and 150 days post partum for mothers who delivered at baby friendly hospital and mothers who delivered at a nearby non-baby friendly hospital. 105 mothers from baby friendly hospital and 104 mothers from non-baby friendly hospital were recruited and followed up for determining duration of exclusive breast-feeding. The median survival time of exclusive breast-feeding was 73.85 days among mothers of baby friendly hospital and 30 days among mothers of non-baby friendly hospital, with a difference of 43.85 days. Life table cumulative surviving proportion for exclusive breast-feeding shows that 82 percent mothers of baby friendly hospital continue at 30 days, compared with 50 percent mothers off non-baby friendly hospital. At 150 days, 16 percent mothers of baby friendly hospital continue exclusive breast-feeding compared with 6 percent mothers of non-baby friendly hospital. Finally 8 percent mothers of baby friendly hospital continue exclusive breast feeding between two hospital was found highly significant (P < 0.001). Duration of exclusive breast-feeding is longer among the mothers who have been delivered in a baby friendly hospital than those mothers who have been delivered in a non-baby friendly hospital.     

Feeding practices of infants delivered in a district hospital during the implementation of Baby Friendly Hospital Initiative

A study on infant feeding practices was conducted during the implementation of the Baby Friendly Hospital Initiative (BFHI) in a district hospital. The aim was to identify which population subgroups had lower breastfeeding rates at 4 months and the effect of attendance of antenatal breastfeeding education on breastfeeding practices. All infants delivered in May 1996 were followed-up. 204 respondents were analyzed. This study demonstrated a higher exclusive and any breastfeeding rates at 4 months than some other studies. (48% and 76% respectively). It was found that the Malays were more likely to be breastfeeding exclusively at 4 months (72%) than the Indians (32%) and the Chinese (4%). (P < 0.01). There were more non-working mothers breastfeeding exclusively at 4 months than working mothers. (60% versus 26%) P < 0.01. Antenatal breastfeeding education in the form that was given appeared to improve breastfeeding rates at 4 months. Future efforts to promote breastfeeding should target the Chinese mothers and the working mothers.     

Impact of individualized nutritional counseling on infant and young child feeding practices

BackgroundImproper complementary feeding practices are common in India, thus leading to malnutrition. The objective was to compare complementary feeding practices of mothers with children aged between 6 months and 2 years before and after individualized nutritional counseling.MethodsThis before-and-after interventional study was carried out in a tertiary care teaching hospital between June 2018 and August 2018 on 30 mothers attending an immunization clinic. Feeding practices were assessed using interview techniques with the Breastfeeding Promotion Network of India Maharashtra checklist for Complementary Food Counseling (Diet Audit), and scoring was carried out. Baseline data included history of inclusion of items from food groups such as cereals; pulses; vitamins A, C, and D; vegetables/fruits; milk/dairy products; non-vegetarian items; and iron-rich foods; and consumption of baby feeds and junk foods. Individualized counseling was given to all study subjects, which lasted for 30–40 min. Models of various food items were shown to mothers. Feeding practices were reassessed after 4 weeks of one-to-one counseling.ResultsFeeding by mothers improved significantly in the form of items from the total number of groups from 4.3 (1.4) to 5.6 (1.3) after nutritional counseling (p: 0.001). Consumption of junk foods decreased significantly from 4.3 (2.8) to 2.6 (1.8; p: 0.001) and baby foods decreased from 0.8 (0.7) to 0.2 (0.4; p: 0.001).ConclusionIndividualized nutritional counseling of mothers can improve complementary feeding practices and ensure food diversification.     

Teledermatology in Air Force: Our Experience

Background

Teledermatology is the science of telemedicine applied to the field of dermatology, with an aim to avoid travelling to nearest specialist facility.

Methods

Patients from Air Force Stations Jaisalmer, Naliya, 5 Air Force Hospital, Jorhat and 9 Air Force Hospital, Halwara were consulted by the dermatologist at Command Hospital (Air Force) Bangalore through the telemedicine network provided by ISRO, Bangalore from March 06 to May 08.

Result

115 patients underwent teledermatology consultation using virtual teleconference (VTC) and this was compared with Store and Forward (S and F) consultation at all four stations as well as Face to Face (FTF) consultation at 5 Air Force Hospital Jorhat. Diagnosis concordance was 52.5% and 53% for Jorhat and Halwara for VTC vs S and F, while it was 75% and 25% for Jaisalmer and Naliya. For VTC vs FTF, the concordance improved to 60.66% and for S and F vs FTF it improved to 91.8%. Concordance was better for localized lesions than for generalized lesions especially of the papulosquamous group of disorders. Another reason for the discordance with VTC was poor resolution of cameras at the peripheral units.

Conclusion

Teledermatology is useful for patient care in the absence of local specialist cover and the patients have to travel long distances resulting in loss of manhours. However, better camera resolution at peripheral centres will result in greater concordance.Key Words: Teledermatology, Virtual teleconference, Store and forward, Face to face     

Promoting and supporting breastfeeding for optimal nutrition during infancy

As general physician one can significantly influence a mother's or family's decision to optimally feed their baby and good feeding practices during first year greatly reduce the risk of a child being sick and being malnourished. It is recommended that health personnel should focus on exclusive breastfeeding for first six months and continued breastfeeding for up to two years along with appropriate and timely complementary foods that are started at the age of six months. Mothers need breastfeeding information and support during antenatal time; during hospital stay or at health care facility, and during postpartum visits. Encouragement especially during antenatal period increases breastfeeding rates. Subsequent paediatric and matemal visits are also important for promotion of breastfeeding. In this paper we would provide you new and updated information on recommended feeding practices, how you can support and help mothers, and what kind of skilled help is needed to initiate breastfeeding early, maintain exclusive breastfeeding and avoid artificial feeding. We will also discuss some strategies to support mothers.     

Infant feeding practices in the urban slum of Karad in west Maharashtra

Infant feeding practices have been studied amongst 181 women residing in a semiurban area of Maharashtra. Information on socio-economic status of the family with special reference to maternal literacy and occupation was collected. Data pertaining to the type of prelacteal feed, time of beginning of breast feeding, age at introduction and type of supplementary food were obtained. Instead of colostrum, 73.49% mothers used various inaugural feeds. Social factors viz, lack of education, poverty, lack of knowledge about the nutritional requirement of the infant and feeding of infants by elder sister or brother (foster mother) were the major determinants for erroneous feeding practices.     

Effect of antenatal expression of breast milk at term in reducing breast feeding failures

Background: Though breast feeding is natural, during the first 2–3 days, when enough breast milk is not available with mother, she may introduce bottle feeding erroneously for improving nutrition to her baby. We studied the effect of antenatal expression of breast milk at term in reducing breast feeding failure as compared to conventional method of initiation of breast feeding.     

Infant and young child feeding practices amongst children referred to the paediatric outpatient department

Background

Worldwide, sub-optimal breastfeeding still accounts for deaths of 1.4 million children aged less than five years. Optimal infant and young child feeding (IYCF) practices have been recognised as the most important intervention for improving child survival and development. Causal association has been found between exclusive breastfeeding with infection-specific infant morbidity and mortality.

Methods

A cross sectional study was undertaken to assess the IYCF practices among 100 caregivers of children aged less than five years, using a semi-structured questionnaire, attending the Paediatric OPD.

Results

Children from higher income groups were not given colostrum at birth. 57% mothers started breastfeeding within an hour and 88% of the mothers admitted to have given prelacteal feed. Healthy complementary food was found to be given by most of the mothers. Prevalence of infections was found to be higher (p < 0.05) in children whose birth weight < 2.5 kg and in bottle fed children.

Conclusion

Traditional beliefs and practices, besides lack of knowledge regarding current feeding recommendations, were found to have played an important role in the feeding practices. Creating an enabling environment for comprehensive nutrition education of mothers by health care providers is required.     

Complete coverage and covering completely: Breast feeding and complementary feeding: Knowledge,attitude, and practices of mothers

Background

Knowing current trends for timely comprehensive action for health promotion practices is an important prerequisite for medical practitioners and policy makers.

Practical therapeutics: present day hospital practices influencing breastfeeding in Nairobi, Kenya

Practices which influence infant feeding in a private hospital in Nairobi, Kenya, were described both before and after the hospital modified its practices in response to the growing awareness of the negative impact of bottle feeding on infant health. In 1978, many practices in the hospital's prenatal clinic and maternity ward encouraged bottle feeding. Representatives from infant formula companies routinely gave talks and passed out infant formula promotional literature in the waiting room of the hospital's prenatal clinic, and clinic personnel distributed the companies' literature to patients who inquired about infant feeding. Observations, that same year, of hospital routines in the maternity ward revealed that mothers and infants were separated within minutes of delivery. 55% of the mothers were not given an apportunity to initiate breastfeeding until 6-24 hours following delivery, and for 40% of the mothers breastfeeding commencement was delayed for more than 24 hours. The remaining 5% did not breastfeed. All the babies received their 1st feed from bottles. Mothers were told that supplementary bottle feeding was necessary. Each time the babies were brought to the mothers, the mothers were given a bottle of baby formula. Babies were brought to the mothers for feeding 5 times a day, and in between these visits, nurses gave bottle feeds to the infants. Mothers were given littl assistance in establishing breastfeeding and received no support for breastfeeding following discharge. At discharge, free samples of formula were distributed to the mothers. The negative effects of the anti-breastfeeding campaign were brought to the public's attention by a 1978-79 Kenya survey, which revealed that breastfeeding was declining markedly, and by the informational activities of the Breastfeeding Information Group (BIG). During 1979 practices at the prenatal clinic were markedly altered due to the efforts of the clinic's manager, the hospital's dietitian, and a guest researcher. Representatives of the formula industry were barred from the waiting room, distribution of the promotional literature was halted, and the bottle feeding promotional posters provided by the industry were removed from the clinic's walls. The Nairobi BIG was invited to talk to the clinic's patients at routinely scheduled times and to sell, for a nominal fee, literature on breastfeeding. The literature was sold rather than distributed free in the belief that people are more likely to read purchased materials than materials that are simply handed to them. Efforts to alter the hospital's postnatal practices were less successful; however, milk nurses were barred from the maternity ward, and mothers were no longer given free samples of formula at discharge. Efforts by BIG personnel to visit mothers after they returned to their homes were frequently obstructed by relatives who believed that breastfeeding should be discouraged. Breastfeeding is actively promoted now at the well baby clinic, and mothers received supportive breastfeeding assistance from the clinic's staff. This case study reveals that there are many ways in which hospitals can offset the impact of the anti-breastfeeding campaign.     

Breast Feeding Practices among Families of Armed Forces Personnel in a Large Cantonment

Background

There seems to be a gap in the available literature and scientific knowledge about breast-feeding practices among families of armed forces personnel in our country, which needs to be studied.

Methods

A cross sectional epidemiological study design was undertaken on a randomly selected sample of 175 families of armed forces personnel staying in a large cantonment and having at least one child in the age group of 3–24 months.

Result

The study observed positive association between various breast feeding practices such as feeding colostrum, demand/scheduled feeding, exclusive breast feeding for 4–6 months, partial breast feeding for 6 – 18 months and various sociodemographic variables such as age, religion, socio-economic status of mother (military rank of husband), parity and place of residence of the mother (where childhood was spent).

Conclusion

Higher proportion of mothers feeding colostrum was observed because of better educational status of mothers and organized health education activities available to the families of armed forces personnel. Majority (89.14%) gave demand feed and only 10.86% gave scheduled feed. On the other hand a relatively smaller percentage (47.43% and 29.32%) followed the correct practice about duration of exclusive and partial breast-feeding respectively.Key Words: Colostrum, Demand/Scheduled feeding, Breast feeding     

Breastfeeding patterns among six-week-old term infants at the University Hospital of the West Indies

Eighty-nine mothers attending post-natal clinics at the University Hospital of the West Indies were interviewed at six weeks postpartum regarding their breast-feeding patterns and problems. Breastfeeding was practised by 97.8% of the mothers, with 29.9% practising exclusive breastfeeding and 70.1% partial breastfeeding. Only two women were solely bottle feeding. The pattern of breastfeeding was not significantly affected by maternal parity, age, education, employment or socioeconomic status. An intention to wean later (at six months) or when the mother felt the baby was 'ready,' was associated with increasing parity, age and further education. Babies who were exclusively breastfed achieved greater weight gain compared with those who partially breastfed but this difference did not achieve statistical significance. Breastfeeding trends appear to have remained stable over the last several years.     

HBV携带产妇血清、乳汁HBV-DNA载量状态与实施母乳喂养安全性的研究

目的：探讨HBV携带产妇血清、乳汁HBV-DNA载量的不同状况与实施母乳喂养安全性的关系.方法：检测产妇血清、乳汁及婴儿血标本HBV-DNA载量.对母乳和人工两种喂养方式婴儿做追踪观察.结果：HBsAg、HBeAg双阳性产妇的血清、乳汁HBV-DNA阳性率分别为100%、49.45%（P＜0.01）.两种喂养方式婴儿的HBV感染率为15.63%和13.56%,无显著性差异;婴儿抗-HBs检测,母乳组抗体几何平均滴度（GMT）明显高于人工喂养组;结论：HBV携带产妇乳汁HBV-DNA阳性率和病毒载量明显低于血清.母乳喂养不影响母婴传播阻断效果,且有助于提高婴儿抗-HBs的GMT水平.     

Effect of Antenatal Expression of Breast Milk at Term in Reducing Breast Feeding Failures

Background

Though breast feeding is natural, during the first 2-3 days, when enough breast milk is not available with mother, she may introduce bottle feeding erroneously for improving nutrition to her baby. We studied the effect of antenatal expression of breast milk at term in reducing breast feeding failure as compared to conventional method of initiation of breast feeding.

Methods

A prospective study was carried out in 180 booked cases at term. Daily expression of breast milk at least once a day after 37 weeks of pregnancy was introduced in randomly selected 90 pregnant ladies. Prior examination was done to exclude any inverted or cracked nipples and appropriate treatment instituted.

Result

The study group who expressed breast milk daily after 37 weeks did not find it difficult to initiate breast feeding after vaginal or cesarean delivery. Sufficient milk started flowing within half an hour of initiation of breast feeding in most 85 (94.4%) subjects of study group as compared to 63 (70%) patients of control group, which was statistically significant. There was no increase in any delivery complication. There were two partial breast feeding failures in control group but none in study group.

Conclusion

Daily antenatal breast milk expression after 37 completed weeks of pregnancy significantly reduced the time for establishing full breast feeding and reduced breast feeding failures.Key Words: Antenatal milk expression, Breast feeding failure     

Improving exclusive breast feeding in the first 24 h of life using Plan-Do-Study-Act cycle in a tertiary care hospital

BackgroundBreast milk is the most ideal form of nutrition for neonates, but the rate of early initiation of breast feeding is as low as 41.6% in India. We aimed to improve the proportion of new-borns on exclusive breast feeds in first 24 h after birth in our hospital from a baseline rate of 33% to more than 90% by 6 weeks using concepts of quality improvement (QI) initiative.MethodsWe implemented this QI initiative using Plan-Do-Study-Act (PDSA) cycles and the project was conducted from 07 May 2017 to 17 Jun 2017. All singleton term neonates with birth weight above 2.5 kg were included. Neonates requiring any form of resuscitation at birth, respiratory distress requiring any form of respiratory support, and neonates requiring observation in NICU for any other reason were excluded. We ran PDSA cycles (including educating residents and nurses on breast feeding, initiating skin to skin contact and breast feeding in first hour of birth, demonstrating all mothers face to face about attachment and positioning and restriction on issue of formula milk) to improve breast feeding exclusivity.ResultsA total of 199 neonates were enrolled, over a span of 6 weeks. We could achieve sustained exclusive breast feeding in first 24 h of life in more than 90% of the enrolled neonates by adhering to the QI initiative.ConclusionThis QI project using PDSA methodology has significantly improved the rates of exclusive breast feeding in first 24 h of life in normal neonates roomed in with their mothers.     

Evaluation of utilization of antenatal services by mothers of babies with severe birth asphyxia

Objective:To evaluate the utilization of antenatal services by mothers of babies delivered with severe birth asphyxia at the University of Port Harcourt Teaching Hospital(UPTH) Port Harcourt,Nigeria.Methods: A case control study of the utilization of antenatal services by 97 mothers of newborns with severe birth asphyxia delivered at UPTH from 1st February to 31st October 2009 compared with mothers of newborns with normal Apgar scores was done.Relevant pregnancy,birth,family and social history was obtained by personal interviews and referral to case notes.Results: Significantly more of the mothers of babies with normal Apgar score booked early(4 months or less) and had up to 8 or more antenatal visits prior to delivery than mothers of asphyxiated babies 86(88.6%) vs 68(70.2%),P=0.002;93(95.7%) vs 68(70.2%),P=0.001 respectively.Significantly more subjects 56(57.7%) than the controls 45(46.4%) were primiparous,P= 0.04.Also,significantly more subjects 19(19.5%) suffered delay prior to intervention in labour than the controls 5(5.1%),P=0.004.Conclusion: Primiparity,delayed booking,inadequate antenatal visits and late intervention in labour have been identified as significant contributors to severe birth asphyxia.     

Factors influencing adherence to exclusive breast feeding among HIV positive mothers in Kabarole district, Uganda

OBJECTIVE: To identify the factors influencing adherence to exclusive breast feeding (EBF) among HIV positive mothers in Kabarole district, Uganda. DESIGN: Cross-sectional study. SETTING: Kabarore district, western Uganda. SUBJECTS: HIV infected women attending for psychosocial support that adhered or did not adhere to EBF. MAIN OUTCOME MEASURES: We compared personal factors, influence from other people, barriers and supports towards adherence to EBF among 139 HIV infected women who adhered and among 139 women who did not adhere to EBF using univariate and multivariate analyses. RESULTS: The independent predictors of adherence to EBF are: having formal education (Adjusted Odds Ratio [AOR] 2.21, 95% confidence interval [CI] 1.01-4.84), knowledge of EBF as a method of preventing mother to child transmission of HIV (AOR 2.53, CI 1.11-5.75), attending at least four antenatal infant feeding counselling sessions (AOR 3.86, CI 1.82-8.19), attending at least six postnatal counselling sessions (AOR 12.52, CI 3.89-40.30), health workers being consulted for breastfeeding problems (AOR 13.11, CI 3.75-45.81), mothers thinking that they are able to produce enough milk (AOR 3.92, CI 1.74-8.84), initiation of breastfeeding within one hour of birth (AOR 10.17, CI 4.52-22.88), getting support from the father to EBF (AOR 5.27, CI 1.87-14.81) and getting support from the family to EBF (AOR 4.54, CI 2.09-9.84). CONCLUSION: In order to improve adherence to EBF there is need to: involve the family especially fathers in infant feeding counselling and education, target less educated mothers for more intense infant feeding counselling using appropriate methods, intensify education on benefits of EBF and on how to produce enough milk and to encourage mothers to attend regularly for ante-natal and post-natal care.     

Breast Feeding Practice among Medical Women in Nigeria

BACKGROUND: Health care workers are important in the promotion, protection and support of breast feeding. Their ability to do this may be influenced by their knowledge, personal experiences and work. PATIENTS AND METHOD: The breast feeding experience of 36 female medical doctors who had babies within the preceding two years and had resumed work was evaluated using a semi-structured self administered questionnaire. RESULT: All respondents knew that babies should be exclusively breast fed for the first six months of life but only 60% knew that breast feeding should continue until two years. The exclusive breast feeding rate for the studied doctors was 11.1%. Before their babies were six months old, about 75% of respondents had resumed work whilst over 50% had started taking calls. Most could not breast feed during working or call hours. Alternative feeds during working or call hours included expressed breast milk in 34.4% and infant formula in 21.9%. Feeding bottle was the major method (77.4%) for feeding these alternatives. Work schedule was rearranged to allow breast feeding in only 27.3% of respondents. CONCLUSION: Failure to carry out exclusive breast feeding, the use of infant formula and feeding bottles (rather than cup feeding) are practices that may be inimical to the practice of breast feeding in society in general. The suboptimal breast feeding experience in these doctors and the identified knowledge deficits may limit their effectiveness in promoting and supporting breast feeding among their patients and communities. Female medical personnel should be empowered to carry out optimal feeding of their own infants.