Breast feeding promotion in an urban and a rural Jamaican hospital

Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n = 62) and one rural (n = 51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital.(ABSTRACT TRUNCATED AT 250 WORDS)     

Newborn care practices in low socioeconomic settlements of Karachi, Pakistan

To explore traditional neonatal beliefs and care practices and to assess the predictors for giving prelacteal feeds, a qualitative and quantitative study was conducted in low socioeconomic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth semi-structured interviews were conducted in July and August 2000; structured questionnaires were administered to 525 recently delivered women through November. Antenatal care coverage was common; a little over half of the women delivered at home with traditional birth attendants. Among the 387 women who reported at least one antenatal visit, most (78.6%) reported receiving counseling on breastfeeding by their healthcare provider. A significant proportion of women (44.8%) reported giving lacteals; colostrum (41.7%) or animal/formula milk (3.1%), as the first feed. Newborns were bathed immediately (82.1%) after delivery as the vernix was considered 'dirty looking' (78.5%), and it was felt it should be removed. To foster muscle relaxation (80.2%) and strengthen the bones (43.0%), daily massage was universally practiced, mustard oil (75.9%) being the most frequently used lubricant. Risky feeding practices such as giving prelacteals (55.0%) or supplementary feeds (71.3%), or delaying first feed (30.9%) were common. During the neonatal period, breast milk was the preferred feed (98.6%); however, honey (28.7%), ghutti (27.8%) and water (11.8%) were also given in order to 'reduce colic' or 'act as a laxative', which were perceived health benefits mentioned by mothers and traditional birth attendants. Ethnicity and birth attendant at delivery were strong predictors for women who gave prelacteals (after adjusting for education, socioeconomic status and facility delivery). Although administration of colostrum as the first feed was relatively common in this setting, the predominance of other risky traditional newborn care practices stresses the need for promoting health education programs on improving newborn care practices.     

Factors affecting newborn care practices in Bangladesh

Newborn care is of immense importance for the proper development and healthy life of a baby. Although child and infant mortality in South Asia has reduced substantially, the rate of neonatal mortality is still high, although these deaths can be prevented by adopting simple interventions at the community level. The aim of the study was to identify the associated factors which affect newborn care practices. Data for the study were drawn from the Bangladesh Demographic and Health Survey 2007, in which 6150 mothers were considered. The mean age of the mothers was 18 (±3.2) years. A little over 62% of the pregnant women received at least one antenatal check-up during the entire period of their pregnancy. About 70% of deliveries were conducted at home either by unskilled family members or by relatives. A clean instrument was used for cutting the cord of 87% of the newborn babies, while about 34% of them were reported to have had their first bath immediately after delivery. Initiation of breast feeding immediately after birth was practised in only about 19% of the cases. Compared with mothers with no education, those with secondary or higher levels were associated with clean cord care [odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.0, 1.9] and early breast feeding [OR = 1.6, 95% CI 1.2, 2.2]. The study revealed an urgent need to educate mothers, and train traditional birth attendants and health workers on clean delivery practices and early neonatal care. Increasing the number of skilled birth attendants can be an effective strategy to increase safe delivery practices, and to reduce delivery complications.     

母亲母乳喂养知识和信念对婴儿喂养方式影响的研究

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

Factors associated with maternal knowledge of newborn care among hospital-delivered mothers in Sri Lanka

The aim of this study was to assess mothers' knowledge on newborn care as well as factors associated with poor knowledge. A cross-sectional study sampled 446 mother-newborn pairs from five hospitals in the Puttalam district of Sri Lanka by stratified random sampling. Maternal knowledge on newborn care was assessed using a questionnaire with 50 statements via exit interview. A knowledge score was created by allocating 1 point for each correct response, which was dichotomised as 'satisfactory' or 'poor' by the median score. Only 21.7% correctly answered that 'surgical spirit' (70% isopropyl alcohol) should not be applied on the umbilical stump. More than 90% of mothers knew about breastfeeding on demand, the advantages of colostrum and the duration of exclusive breastfeeding. Except for a few conditions, mothers demonstrated a satisfactory knowledge in recognising danger signs of the newborn. According to multivariate analysis, primiparae (odds ratio (OR)=2.31; 95% CI 1.53-3.50), unemployed women (OR=3.31; 95% CI 1.89-5.80) and those with delayed antenatal booking visits (OR=2.02; 95% CI 1.26-2.23) were more likely to have poor knowledge. In conclusion, mothers had a satisfactory level of knowledge about breastfeeding and recognition of danger signs, but knowledge about care of the umbilical cord was poor. Maternal education programmes should place more emphasis on first-time mothers, unemployed women and those with delayed booking visits.     

Getting out of the house: the challenges mothers face when their children have long-term care needs

In most industrialised countries, the care needs of those who are sick, disabled and frail are increasingly met in peoples' homes. One of the implications of this shift in the site of care is that individuals with long-term care needs and their family care providers experience social and spatial isolation. Many are housebound and most face considerable challenges in getting out of the house. This paper illuminates these challenges as they are experienced by mothers of children with long-term care needs, and the resulting isolation and disconnection that they experience. Eleven semistructured interviews were conducted in two regions of Ontario, Canada. Grounded theory informed the analysis of the mothers' accounts of their experiences of getting out of the house. The present findings are derived from a larger investigation of the meanings and experiences of the home as a place of caring for families with children who have long-term care needs. Secondary analysis of the data found that three main challenges restricted the mothers' abilities to leave their houses. Mothers experienced difficulties getting out of the house when they attempted to leave with the child, and when the child was left with an alternative care provider. Physical challenges were associated with the work and planning required in moving the child's equipment and supplies, meticulous planning of the outing within the daily schedule, and navigating barriers in the built and natural environments. Social challenges reflected the lack of people within the mothers' social network of family and friends who have the knowledge and expertise to care for the child. Service challenges resulted from the gaps between the policies and practices of paid respite, and the conditions that must be satisfied in order for mothers to be able and/or willing to leave the house. The authors also examined the reasons why some of the mothers worked from home, and the strategies that they used to get out of the house for employment. In this paper, the authors discuss each challenge, and how it contributes to the mothers' social and spatial isolation. The mothers' experiences elucidate the differences between living in a community and being part of a community. The consequences of the isolation on mothers' daily lives are not recognised in home and community care policy. The suggestions that are put forward concerning paid respite have relevance for home and community care policy and practice.     

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

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

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

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

 

     

社区产后访视健康教育对母乳喂养的影响

目的:通过社区产后访视健康教育知识宣传让产妇和家属了解和接受母乳喂养知识和技能,提高母乳喂养率.方法:社区产后访视人员在产妇及新生儿出院后3天、28天各进行上门访视一次,先了解产妇及新生儿健康状况、母乳喂养知识了解程度和喂养技能掌握情况,再根据当前存在的问题给予纠正.对可能发生的问题给予预防措施指导.利用健康教育宣传母乳喂养知识,使产妇及家属了解和接受母乳喂养知识.结果:社区产后访视健康教育宣传指导使产妇及家属接受和正确实施母乳喂养,从而提高了母乳喂养率.结论:社区产后访视利用健康教育宣传和指导母乳喂养知识和技能对提高母乳喂养率有很大的促进作用.     

The Stability of Maternal Interpretation of Infant's Facial Expressions During Pre-and Postnatal Period and Its Relation to Prenatal Attachment

The study explores maternal ability to perceive and interpret infant's emotional expressions during prenatal and postnatal period. One hundred forty-nine women participated in this study. Women were recruited randomly for the study at their third trimester of pregnancy by midwives or health visitors from the district mother care centres. The IFEEL-Picture, a projective test was used to assess maternal perception and interpretation of infant emotion during third trimester of pregnancy and early postnatal period. In addition, the expectant women completed a self-administered questionnaire PAI #opPrenatal Attachment Inventory#cp measuring prenatal attachment towards their unborn baby. The results revealed that mothers interpreted infant emotions overwhelmingly in positive terms in both periods. Significant positive correlations between the two assessments suggest consistency in maternal interpretation of infant emotions. Moreover, results showed that the primipara mothers used the category joy more often in prenatal assessment than the multipara mothers. Whereas, the primipara mothers used the category fear was less often in postnatal assessment. The result thus is indicating for the importance of the current context of experience. However, mothers who were classified as medium attached used the category interest significantly more often in both assessment periods, whereas those who were classified as low used the category content more often in both period, suggests that women do have some representation of infant's emotions even before the birth of their own child.     

以家庭为中心的产科服务新模式的临床效果评价

目的:评价以家庭为中心的产科服务新模式(FCMC)的临床效果。方法:选择完全采用FCMC模式的产妇320例为研究组,按照传统产科服务模式进行分娩的产妇3613例为对照组,比较两组产妇的分娩情况和母乳喂养成功率。结果:研究组阴道分娩成功率和母乳喂养成功率明显高于对照组(P<0.05);研究组产程中社会因素剖宫产率、急产率和新生儿窒息发生率均明显低于对照组(P<0.05);研究组初产妇第一产程、第二产程、总产程、经产妇总产程均明显短于对照组(P<0.05)。结论:FCMC模式对降低难产率和提高产科质量均有积极作用。     

Newborn Care Practices in Urban Slums of Lucknow City, UP

Objectives:

To study the knowledge and practices related to newborn care in urban slums of Lucknow city, UP, and to identify critical behaviors, practices, and barriers that influence the survival of newborns.

Materials and Methods:

A cross-sectional study in urban slums of Lucknow city, UP, included 524 women who had a live birth during last 1 year preceding data collection. Data were analyzed using statistical software SPSS 10.0 for windows.

Results:

Study findings showed that about half of the deliveries took place at home. Majority (77.1%) of the mothers believed that baby should be bathed with warm water and dried with clean cloth and 79.7% mothers practiced it. Only 36.6% mothers initiated breast-feeding within 1 h of birth and 30.2% initiated after 1 day. The mothers who have not given colostrum to their baby, in majority the reason was customs.

Conclusion:

In majority of cases, correct knowledge and correct practices regarding newborn care were lacking among mothers and this should be promoted through improved coverage with existing health services.     

Parent education for kindergarten mothers: Needs assessment and predictor variables

This study investigated present methods of parent education in the kindergartens, mother's level of and need for knowledge about child development areas, and the variables that related to mothers' needs in these areas. The subjects of this study were 80 teachers and 67 mothers of 21 kindergartens in Seoul, Korea. The instruments were two questionnaires on a 4-point Likert scale. The questionnaire for mothers was composed of 117 items, and that for teachers was of 14 items. The results showed that (1) The most common type of parent education was teacher-parent conference and newsletter (2) Among the six general areas, mothers had most knowledge about modification of child behavior, but their most felt need was knowledge about child development (3) Need assessment based on item analysis revealed, in descending order, felt need for knowledge about creative development, observation techniques, social development, safety and first-aid, and ways to stimulate educational motivation, and (4) The variables that predicted mothers' felt needs were the birth order of the child, mother's experience in parent education, family cohesion, adaptability, and communication.     

Pediatric adherence: perspectives of mothers of children with HIV

This study approached pediatric adherence practices from the perspective of mothers of children with HIV in the USA. The study aimed to articulate what is involved in the daily life experience of giving or supervising a child's HIV medication (i.e., adherence practices) in order to clarify, in more dynamic terms than is often found in adherence research, what promotes or impedes adherence. A team-based qualitative analytic approach was used to analyze the narrative responses of 71 maternal caregivers of children with HIV to interview questions regarding the activities and stresses of caring for a child with HIV. Four themes of dealing with medication on a daily basis that impacted mothers' adherence practices emerged from the analysis: (1) Mothers' attitudes and feelings related to adherence practices. (2) The impact of the medications on adherence practices. (3) Interactions of mothers and children related to adherence practices. (4) Developmental issues and responsibility for medication adherence. These themes, taken together, demonstrate the contextual and longitudinal factors that impact adherence and illustrate the complexity of influences on adherence practices. We found that adherence practices were impacted in a positive way by mothers' commitment to adherence, and in a negative way by feelings of stigma and guilt, by the effects of bereavement on children and by children adopting their mothers' attitudes about medications. The interactive process of giving medication was shaped by children's behavior, mothers' developmental expectations for children, and, for mothers with HIV, their adherence for themselves. We found that pediatric adherence often came at a cost to the caregiving mother's well-being.     

Perception of the mothers concerning the received social support in home care to the premature children

This study of qualitative approach aimed at knowing the perception of mothers of premature newborn concerning the social support received in the home care. The sample included 12 mothers of premature, older than 20 years, in the coverage area of Family Health Units of Passo Fundo-RS. The data were collected through semi-structured interview, genogram and echomap. The thematic analysis evidenced the grandmothers as builders and maintaining of the social nest; the discouragement of the abandonment; the safe base; and the social inclusion promoted by the friends. The social support not supplied is centered in the care to the newborn and in the activities of the home. This way, the mothers' perception reveals a predominant intrafamiliar support, whose expansion would allow configuring a more effective social net for the strengthness of the maternal care.     

Breast feeding and smoking hygiene: major influences on cotinine in urine of smokers'' infants.

The determinants of urine cotinine levels were studied in a group of 101 infants aged 3 months, including 79 infants whose mothers were current smokers. At a pre-arranged home visit the infants' mothers completed an interviewer-administered questionnaire, and samples of maternal urine and breast milk and infants' urine were collected. Cotinine and nicotine levels were determined by gas-liquid chromatography. Infant urine cotinine levels ranged from 0 to 140 micrograms/l (0-1120 ng cotinine/mg creatinine). A linear dose response relation between mother's smoking rate and infant urine cotinine level was observed among breast-fed infants (r = 0.79, p less than 0.001). The relation was weaker among infants fed by both breast and bottle (r = 0.56, p = 0.01) and was not apparent among bottle-fed infants (r = 0.15, p = 0.16). In addition to mode of feeding and mother's smoking rate, mother's smoking "hygiene" (assessed by the reported frequency of smoking while feeding and with infant in same room) was independently associated with infant urine cotinine level. Father's smoking pattern and exposure to smoke outside the household did not relate significantly to infant cotinine levels. We conclude that when mothers smoke, breast feeding is the principal determinant of cotinine in infants' urine. It is likely that most of this cotinine comes from cotinine in mothers' breast milk, but further research is needed to establish how much nicotine is ingested by breast-fed infants of mothers who smoke, and to investigate possible health effects.     

A child-to-child programme in rural Jamaica

A child-to-child programme was carried out in six rural schools in Jamaica. School children in grades 4 and 5 were taught concepts of nutrition, environmental and personal hygiene, and child development. The children were encouraged to take messages home to their parents and improve the care of their younger siblings. Four hundred and twenty-three children and 90 mothers and guardians from four of the project schools were evaluated and compared with 199 children and 47 parents from two control schools. The project children showed higher scores on a test of knowledge in the topics at the end of the year. They also improved in some practices at home. The mothers improved in knowledge in some areas but not in their practices. We consider the results sufficiently encouraging to justify incorporating the programme into the country's education curriculum for primary schools.     

母亲KAP模式干预对婴幼儿缺铁性贫血的影响研究

摘要:目的　了解母亲KAP（知识、态度、行为）对缺铁性贫血婴幼儿的影响,为防治婴幼儿缺铁性贫血提供理论依据。方法　对2013年3月-2014年8月武汉市儿保门诊首次进行规范化健康体检的1858例6月龄至36月龄婴幼儿抽取血红蛋白检测并对其母亲进行问卷调查,了解母亲KAP水平,予以教育指导及知识、态度、行为干预后再次进行KAP问卷调查。结果　婴幼儿缺铁性贫血发生率31.3％。母亲中普遍存在缺铁性贫血知识欠缺,对铁缺乏及其引起的疾病等知识贫乏,喂养行为不科学,尤其在母乳喂养、合理添加辅食、系统学习科学育儿知识等方面掌握明显不足,造成婴幼儿缺铁性贫血的发生。而对母亲进行喂养方式、食物提供及健康教育指导后,婴幼儿缺铁性贫血情况明显改善,婴幼儿缺铁性贫血发生率17.5％。结论　应开展多层面的婴幼儿缺铁性贫血知识专项宣传,提高母亲对贫血的认知水平,从饮食理念、饮食行为、饮食态度等方面改善母亲的喂养习惯,并要求其长期保持,以此逐步地养成其良好的饮食习惯,降低婴幼儿缺铁性贫血发生率。     

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

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