Maternal employment, breastfeeding, and health: evidence from maternity leave mandates

Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.     

运用健康信念模式分析影响蒙、汉族婴幼儿母乳喂养的因素

目的比较蒙、汉族婴幼儿母乳喂养状况,探讨健康信念模式在分析母乳喂养影响因素中的作用,为提高母乳喂养率提供建议。方法依据健康信念模式自行设计问卷,采用分层随机整群抽样方法,对117名蒙族婴幼儿母亲和218名汉族婴幼儿母亲进行入户访谈式问卷调查,资料收集时间为2004年4月。结果蒙、汉族婴幼儿4个月母乳喂养率分别为79.5%和73.4%,平均开奶时间为54.5小时,平均断母乳时间为15.4个月,蒙、汉族差异无显著性。蒙族母亲较汉族母亲感知到的母乳喂养益处更多,而障碍更少,二者的差异有显著性。运用健康信念模式分析显示,母乳喂养障碍和母亲年龄是影响母乳喂养的主要因素,R2=0.462,母乳喂养障碍越少,母亲越年轻,越有利于母乳喂养。结论母乳喂养障碍为影响母乳喂养的主要可变因素,蒙、汉族婴幼儿母乳喂养水平相当;健康信念模式可以在一定程度上解释和预测母乳喂养行为。     

母乳喂养时间及辅食添加时机与婴幼儿过敏性疾病相关性研究

目的:探讨母乳喂养时间及辅食添加时机与婴幼儿过敏性疾病发生的相关性。方法:收集接受过敏性疾病诊断的婴幼儿160例,通过调查问卷方式调查每位婴幼儿母乳喂养时间及蛋黄和蛋白、鱼虾、坚果添加时机。结果:母乳喂养时间>3个月的婴幼儿过敏性疾病发生率显著低于母乳喂养时间≤3个月婴幼儿,6个月前和6个月后添加蛋黄和蛋白、8个月前和8个月后添加鱼虾的婴幼儿过敏性疾病发生率差异无统计学意义(P>0.05)。>1岁添加坚果的婴幼儿过敏性疾病发生率低于1岁前添加的婴幼儿。结论:婴幼儿母乳喂养时间应>3个月,蛋黄和蛋白可在6个月前添加,鱼虾可在8个月前添加,坚果应在1岁后添加。     

AIDS in the family and community: The impact on child health in Malawi

Pediatric HIV infections jeopardize children’s health and survival. Much less is known about how the experiences of being orphaned, living with chronically ill parents, or living in a severely affected community impact child health. Our study responds by examining which HIV/AIDS-related experiences place children at greatest risk for poor health. Data from the 2004–2005 Malawi Integrated Household Survey were analyzed using logistic multilevel modeling to examine whether HIV/AIDS-related experiences within the family and community predicted reported health status among children age 6–17 years. We found higher burdens of acute and chronic morbidity for children whose parents have an AIDS-related illness. No other AIDS-related exposure, including orphanhood and recent household deaths, demonstrated a clear relationship with health status. Children living with sick parents may be at increased risk due to the spread of infectious disease and receiving limited adult care. Community home-based care programs are best situated to identify children in these difficult circumstances and to mitigate their disadvantage.     

不同健康宣教形式对产妇母乳喂养影响的研究

目的分析不同孕期健康宣教形式对产妇母乳喂养的影响,为促进母乳喂养干预提供依据。方法依据产妇孕期在医院接受母乳喂养健康宣教形式分组,比较医护人员门诊宣教、孕妇学校宣教和两种形式结合宣教的产妇生后第1天和出院前24小时的母乳喂养情况。结果两种宣教形式结合组产妇出院前24小时的母乳喂养率64.67%,高于门诊宣教组(57.29%)和孕妇学校宣教组(49.55%)。采用门诊和孕妇学校结合的宣教形式对产妇生后第1天和出院前24小时的母乳喂养效果优于单纯门诊宣教和单纯孕妇学校宣教。结论医院门诊宣教与孕妇学校宣教相结合的母乳喂养健康教育方式,更有利于促进母乳喂养的成功。     

Caesarean sections and breastfeeding initiation among migrants in Switzerland

Summary Objectives: Twenty-six percent of all women giving birth in Switzerland are of non-Swiss nationality. Differences in reproductive health outcomes such as preterm deliveries, Caesarean sections, and breastfeeding initiation for mother-child pairs of various nationalities are investigated, and the influence of the educational level was assessed. In order to identify trans-national differences, national breastfeeding rates from 22 countries and Caesarean section rates from 24 countries were compared to the rates in Swiss hospitals. Study Sample: Drawing on routinely collected monitoring data, 37 332 mother-child pairs from various nationalities, who delivered in Swiss Baby-Friendly hospitals between 2000 and 2002, were included in the study. All nationalities with at least 150 deliveries were coded individually, while the remaining were summarised in regional groups. Results: Sub-Saharan African, Latin American and Asian mothers had higher rates of Caesarean sections compared to Swiss mothers (OR = 1.77, 95 % CI 1.49–2.22; OR = 1.80, 1.51–2.17; OR = 1.37, 1.18.1.59). African and Asian children were at an increased risk of being transferred to neonatal care units (OR = 1.48, 95 % CI 1.19–1.83; OR = 1.45, 1.21–1.73;). In addition, infants from Balkan countries, who showed lowest Caesarean section rates, were also more likely to be transferred to an ICU (OR = 1.30, 95 % CI 1.12–1.52). Apart from the country or region of origin, the maternal educational level was an important influence and modified the effect of the mother’s nationality. Mothers from all regions, apart from Western Europe, were significantly more likely to breastfeed their children after being discharged. Established determinants for breastfeeding duration, including feeding exclusively with breast milk in maternity wards, early initiation of breastfeeding, rooming-in and pacifier use, varied according to nationality. The comparison of Caesarean section and breastfeeding rates with the rates in the mother’s country of origin additionally investigates the relation between reproductive health outcomes of migrant women in Switzerland compared to their country of origin. In both cases, a significant rank correlation (Spearman) could be established between the rate in Swiss hospitals and the rate in the mother’s country of origin (P < 0.001, P = 0.04). Conclusions: Our data confirms inequalities in reproductive health outcomes and responses to health promotion programmes among migrant women in Switzerland. These differences are dependent on educational level and on the mothers’ nationality. The large variation suggests that different trans-national experiences play some role in health-related decision-making and access to health care. This should be considered when planning health promotion programs and the individual counselling of pregnant mothers in Switzerland. Submitted: 7 March 2006; Revised: 28 October 2006; Accepted: 19 February 2007     

中国西部农村婴幼儿营养、喂养以及保健方面的性别差异研究

目的探索中国西部农村地区婴幼儿营养、喂养以及保健方面的性别差异。方法利用西部农村大样本横断面调查数据,共凋查14 532名儿童;运用logistic回归模型控制有关背景因素来估计性别在3岁以下农村儿童的营养、喂养和保健方面所起的作用。结果西部南北方地区男女儿童的生长迟缓、低体重和消瘦患病率接近,但是控制了可能的影响因素后,营养不良的性别差异只出现在北方儿童中,表现为北方1孩家庭的男童低体重的风险要高于女童(OR=1.27),3孩以上家庭的男童患生长迟缓的风险却低于女童(OR=0.60);在南方地区无论是在1孩还是多孩家庭以上三指标均没有显著的性别差异。北方地区只表现为2孩家庭的男童添加鸡蛋的频率要显著高于女童,而此种情况也出现在南方1孩家庭中;此外,南方地区表现为2孩家庭的女童在4月龄内比男童更倾向于接受纯母乳喂养。在保健方面,男童较女童更容易患病,贫血患病率分别为36.2%和33.4%,2周感冒和腹泻患病率分别为29.0%和27.4%,19.0%和17.5%。结论中国西部农村婴幼儿在营养、喂养和保健方面存在着一定的性别差异,北方地区比南方地区表现突出。     

Supporting breastfeeding in rural Newfoundland and Labrador communities during COVID-19

Exclusive breastfeeding for the first 6 months of life has become the global standard of infant feeding for its extensive benefits to maternal and infant health. Public health programs, such as the Baby-Friendly Initiative, have helped increase the national breastfeeding initiation rate to 90%. However, initiation rates in Newfoundland and Labrador (NL) continue to rank the lowest in the country at 70%, with a 6-month exclusivity rate of 16%. This commentary will discuss the influence of geographical location, societal norms, and accessibility to health care services on breastfeeding in rural and remote NL communities. While the SARS-CoV-2 virus itself does not impact the mother’s ability to breastfeed, the indirect impacts of COVID-19 on health care services, social isolation, and economic burden challenge breastfeeding initiation and continuation. Priority solutions will draw on capacity building by emphasizing relationships within the community to deliver innovative and appropriate support programs. Continued education with health practitioners and further research into breastfeeding barriers in rural communities is critical moving forward.     

1998～2003年中国母乳喂养与婴儿过渡期食物添加状况分析

[目的]从第三次国家卫生服务调查资料中了解我国婴儿喂养现状,从而发现问题、提出建议.[方法]利用第三次国家卫生服务调查的资料,对婴儿喂养情况进行描述性分析.[结果]1998～2003年间我国产妇早开奶率为19%～26%,且在县（区）级以上医院或妇幼保健院住院分娩的产妇早开奶情况并不好于不在上述医院住院分娩的产妇;城乡的母乳喂养情况较好;农村地区儿童辅食添加存在问题,普遍存在辅食添加过晚的现象,而四类农村地区存在过早添加辅食现象,在四类农村,有约50%的婴儿在4个月内添加了辅食.[结论]近年我国儿童母乳喂养率高,但产妇早开奶情况无明显改善;在农村地区,儿童辅食添加过早和过晚现象同时存在.     

The implementation of environmental health policies in health care facilities: The case of Malawi

Establishing and maintaining safe and sufficient environmental health (EH) conditions in health care facilities (HCFs) is important to prevent and control infections. In 2018, the Government of Malawi finalized an environmental health policy that defines specific targets and programs for EH in healthcare settings. This and other related policies have been used since 2010 as a guide for EH practice in HCFs, but the implementation of these policies has been incomplete to-date. This study qualitatively examines the successes and shortcomings of implementing these policies in Malawi's public HCFs. Thematic analysis of interviews with 53 respondents from all levels of government was used to identify the successes of the policies and the barriers to effective implementation using Contextual Interaction Theory. The greatest identified strength lies in the design of the EH department and its ability to connect individual HCFs and EH actors directly to the policy-making level of government. Identified barriers to implementation include: insufficient financial support; lack of human resources; incomplete reporting; poor stakeholder coordination; and insufficient training of EH actors. We recommend refresher trainings for all EH actors, the establishment of a directorate level EH position, and strengthened coordination to improve the collection, analysis, and reporting of monitoring data to enable EH actors to advocate for the additional funding needed to develop programs for EH personnel and to apply effective EH interventions.     

我国居民婴儿喂养基本知识调查及影响因素分析

目的:了解我国居民对婴幼儿喂养知识了解的现状,为进一步开展健康教育,制定健康教育策略提供理论依据。方法:采用多阶段分层整群抽样的方法调查了我国15～69岁的城乡常住居民79 542名。结果:调查对象对"母乳比配方奶更有营养"、"开始母乳喂养越早越好"、"孩子出生后6个月起添加辅食"辅食应首先添加谷物类"的知识知晓率分别为91.1%、78.9%、60.0%、33.9%。非条件Logistic回归模型多因素分析发现,城乡、地区、性别、年龄、文化程度、民族、职业、婚姻状况和家庭人均月收入与辅食应首先添加谷物类的知识知晓率具有统计学联系。结论:应进一步加强普及母乳喂养知识,尤其应加强辅食添加种类知识的健康传播,且开展健康教育的对象主要是农民。     

Physical and sociocultural facilitators and barriers to access and utilization of a nutrition program in rural Malawi: a qualitative study

ABSTRACT

Childhood stunting holds consequences for child development. A nutrition program delivering small-quantity lipid based nutrient supplements (SQ-LNS) to children 6-23 months and child feeding messages was implemented in Malawi to reduce stunting. This study sought to understand the facilitators and barriers to program participation using in-depth interviews, pile sorts, direct observations, and focus group discussions with caretakers, village leaders and program volunteers. Perceptions of the LNS were positive, and visible changes in child health contributed to program participation. Conflicting priorities that prevented monthly collection of SQ-LNS and limited knowledge of child feeding messages constituted barriers to program participation.     

Hemoglobin concentration, breastfeeding and complementary feeding in the first year of life

OBJECTIVE: To assess the relationship between hemoglobin concentration and breastfeeding and complementary feeding during the first years of life. METHODS: Cross-sectional study with 553 children under age 12 months, who attended public healthcare facilities. Hemoglobin concentration was measured by the cyanmethaemoglobin method, using the HemoCue system. Associations of interest were analyzed through multiple linear regression. RESULTS: Hemoglobin concentrations compatible with anemia were identified in 62.8% of the children studied, with greater occurrence among the 6-12 months age group (72.6%). Exclusive breastfeeding during the first six months of life was associated with the highest levels of hemoglobin. The remaining feeding regimes were associated with different levels of reduction in hemoglobin levels, which became compatible with anemia in children fed with formula (p=0.009). Tea and/or water consumption was associated with a reduction in hemoglobin concentration of 0.76 g/dl (p<0.001) among children under age 6 months. For children aged 6-12 months, hemoglobin concentrations increased significantly with the consumption of sugar (p=0.017) and beans (p=0.018), and decreased significantly with the consumption of fruit (p<0.001). CONCLUSIONS: Exclusive breastfeeding until age 6 months and continuation of breastfeeding after this age, combined with qualitatively and quantitatively appropriate feeding may contribute towards an increase in hemoglobin concentration in the first year of life.     

Behind the scenes: International NGOs’ influence on reproductive health policy in Malawi and South Sudan

ABSTRACT

Global health donors increasingly embrace international non-governmental organisations (INGOs) as partners, often relying on them to conduct political advocacy in recipient countries, especially in controversial policy domains like reproductive health. Although INGOs are the primary recipients of donor funding, they are expected to work through national affiliates or counterparts to enable ‘locally-led’ change. Using prospective policy analysis and ethnographic evidence, this paper examines how donor-funded INGOs have influenced the restrictive policy environments for safe abortion and family planning in South Sudan and Malawi. While external actors themselves emphasise the technical nature of their involvement, the paper analyses them as instrumental political actors who strategically broker alliances and resources to shape policy, often working ‘behind the scenes’ to manage the challenging circumstances they operate under. Consequently, their agency and power are hidden through various practices of effacement or concealment. These practices may be necessary to rationalise the tensions inherent in delivering a global programme with the goal of inducing locally-led change in a highly controversial policy domain, but they also risk inciting suspicion and foreign-national tensions.     

Breast-, complementary and bottle-feeding practices in Kenya: stagnant trends were experienced from 1998 to 2009

The pattern of infant and young child feeding that provides the most benefit includes being put to the breast within an hour of birth, exclusive breastfeeding for 6 months, continued breastfeeding along with complementary foods up to 2 years of age or beyond, and avoidance of any bottle-feeding. However, since there are no published data from Kenya regarding trends in these feeding practices, this research undertook time trend estimation of these feeding practices using the 1998, 2003, and 2008-2009 Kenya Demographic and Health Survey and also examined the multivariate relationships between sociodemographic factors and feeding practices with data from 2008 to 2009. Logistic regression was used to test the significance of trends and to analyze sociodemographic characteristics associated with feeding practices. There was a significant decline in early initiation of breastfeeding among children in Central and Western provinces and those residing in urban areas. Trends in exclusive breastfeeding showed significant improvement in most sociodemographic segments, whereas trends in complementary feeding and breastfeeding remained stable. Bottle-feeding significantly decreased among children aged 12 to 23 months, as well as those living in Coast, Eastern, and Rift Valley provinces. In the multivariate analysis, the province was significantly associated with feeding practices, after controlling for child's size, birth order, and parity. The stagnant (and in some cases worsening) trends in early initiation of breastfeeding and complementary feeding with breastfeeding paint a worrisome picture of breastfeeding practices in Kenya; therefore, efforts to promote the most beneficial feeding practices should be intensified.     

Use of multiple opportunities for improving feeding practices in under-twos within child health programmes

Objectives: In a community randomized trial, we aimed to promoteexclusive breastfeeding and appropriate complementary feedingpractices in under-twos to ascertain the feasibility of usingavailable channels for nutrition counselling, their relativeperformance and the relationship between intensity of counsellingand behaviour change. We also assessed whether using multipleopportunities to impart nutrition education adversely affectedroutine activities. Methods: We conducted a community randomized, controlled effectivenesstrial in rural Haryana, India, with four intervention and fourcontrol communities. We trained health and nutrition workersin the intervention communities to counsel mothers at multiplecontacts on breastfeeding exclusively for 6 months and on appropriatecomplementary feeding practices thereafter. The interventionwas not just training health and nutrition workers in counsellingbut included community and health worker mobilization. Findings: In the intervention group, about 32% of caregiverswere counselled by traditional birth attendants at birth. Themost frequent sources of counselling from birth to 3 monthswere immunization sessions (45.1%) and home visits (32.1%),followed closely by weighing sessions (25.5%); from 7 to 12months, home visits (42.6%) became more important than the othertwo. An increase in the number of channels through which caregiverswere counselled was positively associated with exclusive breastfeedingprevalence at 3 months (p = 0.002), consumption of milk/cerealgruel or mix use at 9 months (p = 0.004) and 18 months (p =0.003), undiluted milk at 9 months (p<0.0001) and 24 hournon-breast-milk energy intakes at 18 months (p = 0.023), aftercontrolling for potential confounding factors. Interventionareas, compared with the control, had higher coverage for vitaminA (45% vs. 11.5%) and iron folic acid (45% vs. 0.4%) supplementation. Conclusions: Using multiple available opportunities and workersfor counselling caregivers was feasible, resulted in high coverageand impact, and instead of disrupting ongoing services, resultedin their improvement.