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Achieving optimal exclusive breastfeeding (EBF) remains a challenge. Because intention is a precursor of practice, we examined factors associated with EBF intention during pregnancy in two rural sub-districts of Kishoreganj district, Bangladesh. We studied 2,400 pregnant women in their third trimester (26-32 weeks gestation). We assessed knowledge (6 items, scale range 0-6), attitudes (15 items, scale range 15-75) and self-efficacy (6 items, scale range 6-30) by interview using a standardized questionnaire. 83.9% of pregnant women reported EBF intention. Mean breastfeeding knowledge was 3.5 (SD 1.3), mean attitude was 55.8 (SD 8.1) and mean self-efficacy was 25.6 (SD 3.4). Knowledge was associated with EBF intention (OR 2.47, 95% CI 1.74, 3.51), attitudes toward EBF (OR 1.68, 95% CI 1.31, 2.16) and self-efficacy (OR 1.72, 95% CI 1.23, 2.40) were independently associated with EBF intention in the model in which all three constructs were entered simultaneously. Receipt of breastfeeding counseling during pregnancy and being literate were each associated with EBF knowledge and EBF intention (all p < 0.05). Increasing maternal knowledge, positive attitudes, and self-efficacy regarding EBF were associated with prenatal EBF intention. These results reinforce the importance of appropriate counseling to increase EBF prevalence. Keywords Exclusive breastfeeding * Knowledge * Attitude * Self-efficacy * Intention * Time management * Privacy, Introduction Despite extensive literature documenting the importance of breastfeeding for infant health [1-7] and the World Health Organization (WHO) and UNICEF recommendations to exclusively breastfeed infants for their first 6 [...]

Objective: To determine the association between household food security and infant complementary feeding practices in rural Bangladesh.Design: Prospective, cohort study using structured home interviews during pregnancy and 3 and 9 months after delivery. We used two indicators of household food security at 3-months' follow-up: maternal Food Composition Score (FCS), calculated via the World Food Programme method, and an HHFS index created from an eleven-item food security questionnaire. Infant feeding practices were characterized using WHO definitions.Setting: Two rural sub-districts of Kishoreganj, Bangladesh.Subjects: Mother-child dyads (n 2073) who completed the 9-months' follow-up.Results: Complementary feeding was initiated at age ≤4 months for 7 %, at 5-6 months for 49 % and at ≥7 months for 44 % of infants. Based on 24 h dietary recall, 98 % of infants were still breast-feeding at age 9 months, and 16 % received ≥4 food groups and ≥4 meals (minimally acceptable diet) in addition to breast milk. Mothers' diet was more diverse than infants'. The odds of receiving a minimally acceptable diet for infants living in most food-secure households were three times those for infants living in least food-secure households (adjusted OR=3·0; 95 % CI 2·1, 4·3). Socio-economic status, maternal age, literacy, parity and infant sex were not associated with infant diet.Conclusions: HHFS and maternal FCS were significant predictors of subsequent infant feeding practices. Nevertheless, even the more food-secure households had poor infant diet. Interventions aimed at improving infant nutritional status need to focus on both complementary food provision and education. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the relationships between maternal breast-feeding intention, attitudes, self-efficacy and knowledge at 7 months’ gestation with exclusive or full breast-feeding at 3months postpartum.DesignProspective cohort study with structured home interviews during pregnancy and 3 months after delivery.SettingTwo rural sub-districts of Kishoreganj district, Bangladesh.SubjectsMother–infant dyads.ResultsOver 80 % of 2178 pregnant women intended to exclusively breast-feed (EBF). Maternal positive attitudes, self-efficacy and knowledge about breast-feeding were positively associated with EBF intention (all P<0·05). All mothers except one reported initiating breast-feeding and 99·6 % of children were still breast-fed at 3 months. According to 24 h dietary recalls, we categorized 985 (45·2 %) infants as EBF at 3 months (47·8 % among mothers with EBF intention; 31·7 % among mothers with no EBF intention; P<0·05) and 551 (25·3 %) infants as predominantly breast-fed at 3 months (24·2 % among mothers with EBF intention; 30·8 % among mothers with no EBF intention; P<0·05). Prenatal EBF intention was associated with EBF (OR=1·48, 95 % CI 1·14, 1·91) and with full breast-feeding (OR=1·34, 95 % CI 1·04, 1·72) at age 3 months. EBF at age 3months was not associated with maternal breast-feeding knowledge, attitudes or self-efficacy.ConclusionsDespite widespread expressed maternal EBF intention and universal breast-feeding initiation, prevalence of both exclusive and full breast-feeding at 3months remains lower than WHO recommendations. EBF intention predicts breast-feeding behaviours, suggesting the importance of prenatal counselling to improve infant feeding behaviours. [ABSTRACT FROM AUTHOR]

Background: Since 2000, only a few countries have substantially reduced the burden of anemia among women 15-49 y of age. The Exemplars in Anemia Reduction among Women of Reproductive Age (WRA) studied the determinants of success among these countries., Objectives: To describe the methodology used to determine the factors associated with anemia reduction in high-performing countries, with the aim to guide policy and programmatic decisions in other countries with similar sociodemographic and health indices., Methods: This article describes the process used to identify countries with exemplary reduction in WRA anemia burden, compared with their peers. We describe the Exemplars in Global Health methodology, the mixed-methods approach used to identify and quantify the macro- and microlevel characteristics associated with anemia burden decline among WRA. Quantitative analyses include descriptive and equity analyses, multivariate linear regression, and Oaxaca-Blinder decomposition analysis. Qualitative analyses include in-depth interviews and focus group discussions with national, subnational, and community stakeholders, as well as review of programs and policies with the potential to impact women's health and/or nutrition, enacted in the countries over the last 20 y. A technical advisory group oversaw all research activities., Results: We identified 5 countries, namely, Mexico, Pakistan, Philippines, Uganda, and Senegal, as anemia exemplars, after considering the magnitude of anemia decline between 2000 and 2018, availability of ≥2 nationally representative anemia surveys, geographical diversity to account for the complex etiology of anemia, regional representation, and logistics of in-country work., Conclusions: Exemplars in Anemia Reduction among WRA seeks to create awareness of how little anemia prevalence has changed globally and aims to inform and spur global efforts for improving women's health and nutrition., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)