Infant feeding patterns on Mauritius Island, 1991

The 1991 Mauritius Contraceptive Prevalence Survey (CPS) included a special module on infant feeding patterns in Mauritius. Since 1985, when a similar CPS was conducted, the incidence of breast-feeding has fallen from 86% to 72%. The duration of any breast-feeding among those breast-fed remained constant at 13.6 months. The module allowed for an assessment of the World Health Organization (WHO) breast-feeding indicators on exclusive breast-feeding, timely complementary feeding and continued breast-feeding. Only 16% of infants 0–3 months old are exclusively breast-fed; only 29% of infants 6–9 months old receive breast milk and complementary foods and only 27% of children 12–15 months are still breast-fed. These patterns of limited breast-feeding and early supplementation may signal future declines in breast-feeding for other African and Asian countries. Published by Elsevier Science Ltd     

Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey.

OBJECTIVES: This analysis uses nationally representative data from the 1988 National Maternal and Infant Health Survey to explore the factors, including employment, associated with breast-feeding initiation and duration. METHODS: Multiple logistic regression was used to model the determinants of breast-feeding initiation among 9087 US women. Multiple linear regression was used to model the duration of breast-feeding among women who breast-fed. RESULTS: Fifty-three percent of mothers initiated breast-feeding in 1988, and the decision to breast-feed was not associated with maternal employment. However, among breast-feeders, returning to work within a year of delivery was associated with a shorter duration of breast-feeding when other factors were controlled. Among employed mothers, the duration of maternity leave was positively associated with the duration of breast-feeding. CONCLUSIONS: The low rates of breast-feeding initiation in the United States are not attributable to maternal participation in the labor force. However, returning to work is associated with earlier weaning among women who breast-feed.     

Infant feeding dilemmas created by HIV: South African experiences

Breast-feeding is a route of HIV transmission from an HIV infected mother to her infant. However, breast-feeding is an important pillar of child survival and part of a mother's womanhood. This paper highlights the dilemma created by the risks and the benefits of breast-feeding and will discuss the implementation in South Africa, of the Safer Breastfeeding Programme, to reduce some of the known risk factors associated with HIV transmission. Operations research was carried out, including infant HIV testing at 6 wk, and 9, 12, and 15 mo. Among 188 breast-fed infants enrolled in the program who were HIV negative at 6 wk, 4 became infected by 9 mo of age (2.6%). Infants enrolled in the Safer Breastfeeding Programme had less breast pathology than is usually reported for HIV infected women. Limited success was attained in promoting heat treatment of expressed breast milk; however, it does appear to be a feasible option after 6 mo of age, and it is believed that mothers would practice it more widely if sufficient promotion and support was given to it. Mothers found it difficult to stop breast-feeding earlier than the norm, and it therefore is important that mothers considering early cessation of breast-feeding be given sufficient preparation and support.     

The duration of breast-feeding. A longitudinal prospective study in Denmark.

A longitudinal prospective study was performed to investigate the total duration of breast-feeding. Three hundred and sixty-six mothers were followed-up until 3 years after delivery. At 1 month 93% were breast-feeding, at 3 months 73%, at 6 months 52%, at 1 year 20% and 1% breast-fed more than 3 years. Correlations were found between duration of breast-feeding and maternal age, education and social class. Mothers who had breast-fed an older child usually breast-fed the next child for a period of similar length. Solid food was most frequently introduced when the infants were 4 months old. At 6 months 4% were still exclusively breast-fed. Breast-feeding has become popular: only 1% did not want to breast-feed at all and 89% of mothers intended to breast-feed their children for 6 months or more. Even though the mothers now breast-feed longer than earlier, only 39% succeeded in breast-feeding for as long as or longer than they had intended.     

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.     

Factors associated with the duration of exclusive breast-feeding in asthmatic families

This study was part of a randomized controlled trial in which verbal and written advice about exclusive breast-feeding for 6 months was provided to Dutch women expecting a child with a high risk of developing asthmatic traits. Eighty-nine women completed a theory-based self-report questionnaire between the third and sixth months of pregnancy, which served as the baseline measurement. The aim of this study was to examine the factors that influence the duration of exclusive breast-feeding. Cox multiple regression analysis showed a positive significant association between the duration of exclusive breast-feeding and the mother's breast-feeding knowledge (P < 0.01), her intended hours of work per week after maternity leave (P < 0.01) and her age (P 相似文献   

Prolonged breast-feeding and malnutrition among rural Indian children below 3 years of age.

Long periods of exclusive as well as partial breast-feeding in poor communities are of considerable importance from a nutritional standpoint, as it is in these communities that malnutrition is predominant. Although benefits of exclusive breast feeding have been well documented, those for partial breast-feeding have not been examined. The present study in particular examines the effects of prolonged breast-feeding, i.e. exclusive breast-feeding beyond 6 months or partial breast-feeding up to 2-3 years, in terms of prevalent malnutrition and morbidity among rural children. A total of 395 children were observed for weight, height, information on duration of breast-feeding, age at weaning and morbidity in terms of recent illness in the 7 days prior to the day of visit. Exclusive breast-feeding beyond 6 months and up to 12 months appeared beneficial in terms of reduced morbidity. Beyond infancy, there was no evidence of any protective effect of partial breast-feeding. This could be due to poor lactational performance of mothers and their unawareness about it resulting in inadequate weaning foods being offered to partially breast-fed children. Significant differences in male and female children in the extent of malnutrition pointed towards discrimination against girls even in respect of exclusive breast-feeding. The study highlights the need for advocating proper weaning practices while recommending prolonged breast-feeding in poor communities.     

The National Breastfeeding Policy in Nigeria: the working mother and the law

In this article, we examine the National Breastfeeding Policy in Nigeria, the extent to which the law guarantees and protects the maternity rights of the working mother, and the interplay between the law and the National Breastfeeding Policy. Our aim is to make people aware of this interplay to lead to some positive efforts to sanitize the workplace and shield women from some of the practices against them in employment relations in Nigeria as well as encourage exclusive breastfeeding by employed mothers.We conclude that the provisions of the law in this regard are not in accord with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the 6 months as propagated by Baby Friendly Hospital Initiative (BFHI) and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations. We, therefore, suggest a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations. It is hoped that such laws will not only limit some of the practices against women in employment but also will encourage and promote exclusive breastfeeding behaviour by employed mothers.     

Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence.

OBJECTIVE: Feeding mode in infancy and differences in childhood growth have been studied in several longitudinal studies, but few studies have followed children up to adolescent age. There is evidence that formula-fed infants weigh more and are taller than their breast-fed counterparts, and indications that this difference may sustain. RESEARCH METHODS AND PROCEDURES: We have studied the relations between length of breast-feeding, growth, and body composition in a group of 781 representatively chosen adolescents. Data on feeding pattern in infancy and on weight and height from birth up to 18 years were collected. We studied the relation between high body mass index (BMI) (defined as < or =85th percentile) in adolescence and length of breast-feeding. RESULTS: Girls who were not breast-fed or breast-fed for less than 3 months had a significantly higher height curve than girls exclusively breast-fed for more then 3 months. There were tendencies towards higher values of adipose tissue measured by skinfolds in girls breast-fed for 3 months or less. Short duration of exclusive breast-feeding was associated with higher BMI (p<0.04). In a subgroup of 194 adolescents, body composition was measured with dual energy X-ray. Both boys and girls who were exclusively breast-fed for more than 3 months were leaner and showed a trend towards lower skinfold values. CONCLUSION: These results are important to include in the debate about optimal feeding in infancy. Regarding breast-feeding as a standard, our results imply that formula fed infants may be at risk for overfeeding, which might lead to overweight, even up to adolescent age.     

Breast-feeding and overweight in adolescence: within-family analysis [corrected

BACKGROUND: Previous reports have found associations between having been breast-fed and a reduced risk of being overweight. These associations may be confounded by sociocultural determinants of both breast-feeding and obesity. We addressed this possibility by assessing the association of breast-feeding duration with adolescent obesity within sibling sets. METHODS: We surveyed 5,614 siblings age 9 to 14 years and their mothers. These children were a subset of participants in the Growing Up Today Study, in which we had previously reported an inverse association of breast-feeding duration with overweight. We compared the prevalence of overweight (body mass index exceeding the age-sex-specific 85th percentile) in siblings who were breast-fed longer than the mean duration of their sibship with those who were breast-fed for a shorter period. Then we compared odds ratios from this within-family analysis with odds ratios from an overall (ie, not within-family) analysis. RESULTS: Mean +/- standard deviation breast-feeding duration was 6.4 +/- 4.0 months, and crude prevalence of overweight was 19%. On average, siblings who were breast-fed longer than their family mean had breast-feeding duration 3.7 months longer than their shorter-duration siblings. The adjusted odds ratio (OR) for overweight among siblings with longer breast-feeding duration, compared with shorter duration, was 0.92 (95% confidence interval = 0.76-1.11). In overall analyses, the adjusted OR was 0.94 (0.88-1.00) for each 3.7-month increment in breast-feeding duration. CONCLUSION: The estimated OR for the within-family analysis was close to the overall estimate, suggesting that the apparent protective effect of breast-feeding on later obesity was not highly confounded by unmeasured sociocultural factors. A larger study of siblings, however, would be needed to confirm this conclusion.     

Influence of parental mental health on early termination of breast-feeding: a case-control study

BACKGROUND: The WHO recommends exclusive breast-feeding for babies up to 6 months of age. The association between maternal mental health and breast-feeding duration is contradictory. This is a case-control study to investigate this association. METHODS: 153 families with 4-month-old babies from an urban area in southern Brazil were investigated: in 51 families, breast-feeding had being discontinued (cases); in 102, babies were being breast-fed (controls). Two researchers evaluated maternal and paternal mental health during home visits using semistructured interviews and scales. RESULTS: Disorders were found in 59% of case mothers versus 48% of control mothers. Depression was the most prevalent disorder affecting both mothers and fathers. We did not identify a statistically significant association between maternal mental disorder at 4 months after delivery and early termination of breast-feeding. When the mother had mental problems during the first month after delivery, however, she was twice as likely to interrupt breast-feeding. Among the mothers with mental disorders during puerperium, 76% still had the problem 4 months postpartum. An association was observed between maternal and paternal mental health. CONCLUSIONS: Parental mental health does not seem to be associated with breast-feeding at 4 months in this culture setting where most mothers have good family and social support for breast-feeding. Maternal mental disorders during puerperium, however, may negatively affect the duration of breast-feeding.     

The National Breastfeeding Policy in Nigeria: The Working Mother and the Law

In this article, we examine the National Breastfeeding Policy in Nigeria, the extent to which the law guarantees and protects the maternity rights of the working mother, and the interplay between the law and the National Breastfeeding Policy. Our aim is to make people aware of this interplay to lead to some positive efforts to sanitize the workplace and shield women from some of the practices against them in employment relations in Nigeria as well as encourage exclusive breastfeeding by employed mothers.

We conclude that the provisions of the law in this regard are not in accord with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the 6 months as propagated by Baby Friendly Hospital Initiative (BFHI) and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations. We, therefore, suggest a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations. It is hoped that such laws will not only limit some of the practices against women in employment but also will encourage and promote exclusive breastfeeding behaviour by employed mothers.     

Duration of breast feeding and language ability in middle childhood

There is controversy over whether increased breast-feeding duration has long-term benefits for language development. The current study examined whether the positive associations of breast feeding on language ability at age 5 years in the Western Australian Pregnancy (Raine) Cohort, were still present at age 10 years. The Raine Study is a longitudinal study of 2868 liveborn children recruited at approximately 18 weeks gestation. Breast-feeding data were based upon information prospectively collected during infancy, and were summarised according to four categories of breast-feeding duration: (1) never breast-fed, (2) breast-fed predominantly for <4 months, (3) breast-fed predominantly for 4-6 months, and (4) breast-fed predominantly for >6 months. Language ability was assessed in 1195 children at the 10 year follow-up (mean age = 10.58 years; standard deviation = 0.19) using the Peabody Picture Vocabulary Test - Revised (PPVT-R), which is based around a mean of 100 and a standard deviation of 15. Associations between breast-feeding duration and PPVT-R scores were assessed before and after adjustment for a range of sociodemographic, obstetric and psychosocial covariates. Analysis of variance revealed a strong positive association between the duration of predominant breast feeding and PPVT-R at age 10 years. A multivariable linear regression analysis adjusted for covariates and found that children who were predominantly breast-fed for >6 months had a mean PPVT-R score that was 4.04 points higher than children who were never breast-fed. This compared with an increase of 3.56 points at age 5 years. Breast feeding for longer periods in early life has a positive and statistically-independent effect on language development in middle childhood.     

Breast-feeding counselling and its effect on the prevalence of exclusive breast-feeding

This prospective intervention study was undertaken to assess the impact of repeated breast-feeding counselling on the rate of exclusive breast-feeding up to five months. The study was carried out in two breast-feeding counselling sub-centres, established at the community level in the vicinity of two maternity facilities and one main centre established in an urban children hospital. Eighty-four pregnant mothers who attended the maternity facilities for delivery of babies were randomly selected and repeatedly counselled regarding breast-feeding--once just before delivery and subsequently at the completion of 1, 2, 3, 4, 5, 6, 9, and 12 month(s) of age of the child. These child-mother pairs comprised the intervention group. Another group of 90 child-mother pairs was selected from the maternity facilities. Mothers in this group (comparison group) received a single session of breast-feeding counselling just before delivery of babies. Fifty-nine and 55 child-mother pairs in the intervention and the comparison groups respectively completed the one-year follow-up. In the intervention group, 54.2% and in the comparison group 36.4% of the babies were exclusively breastfed up to five months of age. Forty-two (88%) children in the intervention group and 29 (53%) in the comparison group were given complementary foods at the optimum time, e.g. after completion of five months, and 81% of the children in the intervention group and 100% of the children in the comparison group were given complementary foods in the first year of life. It was observed that repeated organized breast-feeding counselling significantly improved the prevalence of exclusive breast-feeding to 54% which is much above the existing national prevalence (12.7%) in Bangladesh.     

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.     

Infant feeding and risk of severe diarrhoea in Basrah city, Iraq: a case-control study

A case-control study of the relationship between feeding mode and risk of hospitalized diarrhoea in infants (aged 2-11 months) in Basrah city was conducted between September 1983 and May 1984. A total of 597 cases were recruited from among infants admitted with diarrhoea to the major paediatric hospital in the city, while 723 controls were recruited from among healthy infants attending any of the seven maternal and child health clinics in Basrah. A variety of potentially confounding variables were controlled in the analysis. For infants aged 2-5 months, breast-feeding alone or breast-feeding plus food were the least risky feeding modes. Bottle-feeding was dangerous and bottle-feeding alone was associated with a risk of 55 among infants aged 2-3 months, and 37 among infants aged 4-5 months, relative to exclusive breast-feeding. For older infants (6-11 months), the risks of hospitalized diarrhoea were not significantly different among different partial breast-feeding modes, but non-breastfeeding was dangerous, especially exclusive bottle-feeding. Food intake was associated with a reduced risk of severe diarrhoea among bottle-fed infants but not with an increased risk among breast-fed infants. Among bottle-fed infants, no association was found between risk of severe diarrhoea and method of bottle-cleaning. Previous breast-feeding conferred no current protection.     

Health consequences of breast-feeding: doctors' visits and hospitalizations during the first 18 months of life in Hong Kong Chinese infants

BACKGROUND: The evidence on whether breast-feeding reduces health services use in nonwhite infants is scant. We examined the effects of breast-feeding on health services utilization in Hong Kong Chinese infants. METHODS: We followed a population-based cohort of 8327 infants born in 1997 for 18 months. The main outcome measures were higher (above the sample mean) utilization of outpatient visits and hospitalizations for jaundice, gastrointestinal or respiratory/febrile illnesses, and all illnesses. RESULTS: Breast-fed infants had fewer illness-related doctor visits overall through the first 18 months of life. Results were strongest for infants breast fed exclusively for 2 to 3 months (odds ratio [OR] for higher utilization = 0.78; 95% confidence interval [CI] = 0.62-0.99) and for 4 or more months (0.65; 0.53-0.81). However, breast-fed infants were more likely to receive outpatient care for jaundice, particularly in the first 3 months of life (ORs ranging from 2.5 to 8.4). Any breast-feeding was also associated with more jaundice-related hospital admissions, the effects of which were most acute in the first 3 months of life. Compared with exclusively formula-fed infants, the OR (CI) for mixed breast- and formula-fed was 2.4 (1.7-3.5); for exclusive breast-feeding up to 1 month, 4.5 (2.7-7.6); for exclusive breast-feeding 2 to 3 months, 3.2 (1.8-5.7); and for exclusive breast-feeding 4 or more months, 3.4 (2.0-5.7). CONCLUSIONS: Breast-feeding in Hong Kong Chinese infants reduces doctor visits overall, but increases both outpatient visits and hospitalizations for jaundice.     

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 Navarra

The state of breast-feeding in our autonomous community between 1986 and 1993 is reviewed. Two comparable Navarrese neonatal groups from our main maternity hospital are studied. The prevalence of the different types of breast-feeding at the time of discharge from the maternity hospital is compared, as well as monthly rates until the sixth month of life. The following conclusions can be drawn from this study: 1. The category of breast-feeding in Navarra is type 1 of the WHO. 2. Breast-feeding is abandoned in an early and massive way throughout the first six months of life in Navarra, with figures for this practice being undetectable by the sixth month. 3. There are barely any significant differences between the figures for 1986 and 1993.