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The article explores the association between maternal smoking and the duration of breastfeeding in very low birth weight preterm infants after discharge from a Neonatal Intensive Care Unit (NICU). The study conducted in Spain between 2018 and 2022 found that smoking mothers were significantly associated with a shorter duration of breastfeeding after discharge. The data suggest that reducing smoking could potentially increase breastfeeding rates in preterm infants post-discharge, highlighting the need for policies to support smoking mothers during and after NICU admission to enhance breastfeeding rates. [Extracted from the article]

The article titled "Business and Health: An Insidious Mix" explores the impact of commercial determinants of health on global health outcomes. It discusses the influence of factors like fossil fuels, deforestation, tobacco, and processed foods on premature death, disability, and loss of productivity. The article emphasizes the need to address these determinants in public health policies, purchasing policies, health information, and professional education. It suggests strategies such as advocating for public health policies, cross-jurisdictional activities, regulation, monitoring, and enforcement. The article concludes by highlighting the importance of addressing commercial determinants of health to promote health equity and social justice. The World Health Organisation (WHO) has released a guideline advising against the use of non-sugar sweeteners for weight control, stating that they do not contribute to weight loss and may have negative health effects. The WHO also discusses urban health, highlighting the unique challenges and opportunities for promoting health in urban areas. A study conducted in China examines how the marketing practices of commercial milk formula companies impact infant breastfeeding practices, suggesting that aggressive marketing tactics may discourage breastfeeding and promote formula feeding. [Extracted from the article]

This article discusses the significant impact that socioeconomic factors had on child health during the 20th century. It highlights the work of Cicely Delphine Williams, a Jamaican-born English pediatrician, who used local public health resources to improve maternal and child health in developing countries. Williams championed an integrated approach to child health, with a focus on promoting breastfeeding as the best infant feeding option. She also conducted research on kwashiorkor, a severe form of childhood malnutrition. Williams worked with limited resources and made healthcare accessible to poor people, saving countless lives and inspiring healthcare professionals worldwide. [Extracted from the article]

Ellyzabeth Sukmawati,1,&ast; Merry Wijaya,2,&ast; Dany Hilmanto3,&ast; 1Doctoral Program in Medical Sciences, Universitas Padjadjaran, Bandung, 40161, Indonesia; 2Medical Sciences, Universitas Padjadjaran, Bandung, 40161, Indonesia; 3Department of Child Health Sciences, Medical Sciences, Universitas Padjadjaran, Bandung, 40161, Indonesia&ast;These authors contributed equally to this workCorrespondence: Dany Hilmanto, Department of Child Health Sciences, Medical Sciences, Universitas Padjadjaran, Bandung, 40161, Indonesia, Email dany.hilmanto@unpad.ac.idObjective: The purpose of this research is to develop a participatory health cadre model to enhance exclusive breastfeeding coverage through initial stages using the Imogene King model.Methods: This study employs a mixed-methods approach with sequential exploratory designs. Qualitative research utilized in-depth interviews with informants including the head of the community health center, nutrition officers from the health center, the coordinator of Maternal and Child Health (MCH) midwives, village midwives, breastfeeding mothers, families of breastfeeding mothers, and health cadres. Quantitative research respondents consist of health cadres. The quantitative study utilizes a quasi-experimental method with a design paradigm known as the one-group pre and post-test design to measure health cadre perception on exclusive breastfeeding.Results: This study yields elements from Imogene King that form a participatory health cadre model to enhance exclusive breastfeeding coverage, consisting of interaction, perception, communication, transaction, role, growth and development, time, and space. Transactions represent the objective integration of the health cadre participation model, as demonstrated by the behavioral shifts observed in mothers regarding breastfeeding their infants. The t-test results indicate that exclusive breastfeeding monitoring training is effective and successful in enhancing exclusive breastfeeding coverage (Sig. value = 0.000 < 0.05). In addition, the effectiveness of exclusive breastfeeding monitoring training falls within the category of good or high.Conclusion: The research findings indicate the success of the participatory health cadre model in improving exclusive breastfeeding coverage.Keywords: breastfeeding promotion, community health interventions, Imogene King model, maternal and child health

Background: Poor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal–fetal/infant dyad benefits of innovation in therapeutic research and development. This mixed-methods systematic review synthesised factors affecting the participation of pregnant and lactating women in clinical trials, across all levels of the research ecosystem. Methods and findings: We searched 8 databases from inception to 14 February 2024 to identify qualitative, quantitative, and mixed-methods studies that described factors affecting participation of pregnant and lactating women in vaccine and therapeutic clinical trials in any setting. We used thematic synthesis to analyse the qualitative literature and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. We compared quantitative data against the thematic synthesis findings to assess areas of convergence or divergence. We mapped review findings to the Theoretical Domains Framework (TDF) and Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to inform future development of behaviour change strategies. We included 60 papers from 27 countries. We grouped 24 review findings under 5 overarching themes: (a) interplay between perceived risks and benefits of participation in women's decision-making; (b) engagement between women and the medical and research ecosystems; (c) gender norms and decision-making autonomy; (d) factors affecting clinical trial recruitment; and (e) upstream factors in the research ecosystem. Women's willingness to participate in trials was affected by: perceived risk of the health condition weighed against an intervention's risks and benefits, therapeutic optimism, intervention acceptability, expectations of receiving higher quality care in a trial, altruistic motivations, intimate relationship dynamics, and power and trust in medicine and research. Health workers supported women's participation in trials when they perceived clinical equipoise, had hope for novel therapeutic applications, and were convinced an intervention was safe. For research staff, developing reciprocal relationships with health workers, having access to resources for trial implementation, ensuring the trial was visible to potential participants and health workers, implementing a woman-centred approach when communicating with potential participants, and emotional orientations towards the trial were factors perceived to affect recruitment. For study investigators and ethics committees, the complexities and subjectivities in risk assessments and trial design, and limited funding of such trials contributed to their reluctance in leading and approving such trials. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people. Conclusions: This systematic review highlights diverse factors across multiple levels and stakeholders affecting the participation of pregnant and lactating women in clinical trials. By linking identified factors to frameworks of behaviour change, we have developed theoretically informed strategies that can help optimise pregnant and lactating women's engagement, participation, and trust in such trials. Using a mixed-methods approach, Mridula Shankar and colleagues investigate the reasons why those who are pregnant and breastfeeding are under-represented in clinical trials. Author summary: Why was this study done?: Pregnant and lactating women and people are routinely excluded from participating in drug and vaccine clinical trials, resulting in limited options for prevention and treatment of medical conditions. Challenges to including pregnant and lactating women and people in clinical research have been identified at multiple levels of the research and health systems, but the full range of barriers and facilitators to participation are not well known. What did the researchers do and find?: We conducted a mixed-methods systematic review and identified 60 research articles from 27 countries on the views and experiences of pregnant and lactating women's participation in clinical research, from the perspectives of cisgender women, family and community members, health workers, and people involved in the conduct of clinical research. Using a thematic synthesis approach, we identified barriers affecting participation including women having a limited appetite for risk during pregnancy and lactation, concerns about women's bodily autonomy during pregnancy, and challenges in obtaining ethical approval for clinical research with pregnant women. We also identified facilitators of participation including the potential for personal health benefits, expectations of higher quality care, trust in the medical and research systems, and strong teamwork between researchers and health workers. What do these findings mean?: Our findings demonstrate the need for multipronged strategies to address barriers and reinforce facilitators across the various levels of the research and health systems. The actions that are needed to overcome these barriers and reinforce facilitators must be discussed, prioritised, and adapted to specific contexts. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people. [ABSTRACT FROM AUTHOR]

Background: Mothers are recommended to breastfeed their children but can find it challenging and experience breastfeeding problems. Qualified breastfeeding counselling from healthcare professionals can help mothers master breastfeeding, but there is a need to explore mothers' lived experiences with receiving breastfeeding counselling. We aimed to reveal breastfeeding mothers' experiences with receiving breastfeeding counselling from midwives and public health nurses (PHNs) to provide a deeper insight into the phenomenon of breastfeeding counselling, which may improve breastfeeding counselling in practice. Methods: A qualitative design with a hermeneutic phenomenological approach was used. Individual interviews of 11 breastfeeding mothers from Norway were conducted from September 2021 to 2022. Van Manen's guided existential inquiry guided the reflective process to provide deeper insights into the phenomenon of breastfeeding counselling. Results: The study captured the meaning of breastfeeding mothers' lived experiences with breastfeeding counselling. Three themes and eight sub-themes were found. Breastfeeding was at stake for the mothers because breastfeeding could be reduced or stopped, and qualified breastfeeding counselling from midwives and PHNs was essential for them to establish and continue breastfeeding. They needed to be perceived as both breastfeeding mothers and as women with their own needs to master everyday life during the breastfeeding period. Conclusions: This study offers insights to midwives, PHNs and others offering breastfeeding counselling by facilitating an understanding of being a breastfeeding mother receiving breastfeeding counselling. Qualified breastfeeding counselling and a trusting relationship with midwives and PHNs are essential for mothers to establish and continue breastfeeding, while deficient counselling may cause breastfeeding difficulties. Mothers need to be treated as whole and competent persons to avoid objectification and fathers/partners need to be included in breastfeeding counselling. The 'Baby-Friendly Hospital Initiative' should be continued, and guidelines should align with the mothers' need to incorporate breastfeeding into their daily lives during the breastfeeding period. [ABSTRACT FROM AUTHOR]

Background and Objective: Early discharge from the Newborn Nursery has been associated with an increased risk for readmission, especially for hyperbilirubinemia. During COVID-19, early discharge policies were enacted at our hospital, allowing prospective data collection to evaluate if early discharge resulted in increased readmission for hyperbilirubinemia. Methods: Prospective observational data was abstracted from the electronic medical record in a New York State hospital with 2400 deliveries/year. Only babies >36 weeks gestation, born by NSVD, and admitted to the general Nursery were included. Data was analyzed for early discharge at =36 and =48 hours. Results: During the COVID-19 study period (January 2020-June 2021), 1714 babies met inclusion criteria. Five hundred seventyeight (34%) of patients were discharged =36 hours and 1225 (71%) =48 hours. For newborns discharged =36 hours, there were 5 RA (0.9%), which was significantly less than 28 (2.5%) discharged >36 hours [OR 0.35(0.13, 0.90) (p=0.03)]. Twenty newborns (1.6%) discharged =48 hours were readmitted compared to 13 (2.3%) discharged >48 hours [OR 0.61(0.31, 1.23) (p=0.17)]. Conclusion: Early discharge was not associated with increased readmissions for hyperbilirubinemia with early discharges at =36 and 48 hours. [ABSTRACT FROM AUTHOR]

Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come. [ABSTRACT FROM AUTHOR]

Background/Aims Exclusive breastfeeding duration remains suboptimal among Chinese mothers. Understanding the factors that influence exclusive breastfeeding is essential for developing targeted interventions to promote breastfeeding practices. This study aimed to identify determinants of exclusive breastfeeding in the first 6 months after birth in Xuzhou City, China. Methods This prospective study enrolled 178 mothers, using structured questionnaires for data collection. Subsequent analysis used multiple linear regression to explore factors associated with exclusive breastfeeding duration. Results On average, participants exclusively breastfed for 67 days. Influencing factors included breastfeeding intention, perception of insufficient milk and maternity leave. Conclusions Targeted interventions have the potential to prolong exclusive breastfeeding duration, such as ensuring women develop accurate perceptions of their breast milk supply and extending maternity leave. Implementing these interventions is crucial to achieving the target of 6 months of exclusive breastfeeding, consequently contributing to optimal health benefits for mother-infant dyads in China. [ABSTRACT FROM AUTHOR]

U.S. breastfeeding outcomes consistently fall short of public health targets, with lower rates among rural and low-income people, as well as participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The U.S. Department of Agriculture funded a subset of local WIC agencies in Minnesota to implement Breastfeeding Peer Counseling Programs (BFPCs) aimed at improving breastfeeding rates. We examined the impact of BFPCs on breastfeeding rates among WIC participants in Greater Minnesota (outside the Minneapolis–St. Paul metropolitan area). We used data from the Minnesota WIC Information System for the years 2012 through 2019 to estimate the impact of peer counseling on breastfeeding duration using difference-in-differences models. Additionally, we examined results among rural counties and assessed the possibility of spillover effects by stratifying whether a county without BFPCs bordered one with BFPCs. Availability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects. BFPCs had a significant positive impact on breastfeeding duration. Findings indicate an opportunity for improving rural breastfeeding rates through increased funding for WIC BFPCs. [ABSTRACT FROM AUTHOR]

This article discusses the development and implementation of a graphic novel tool called U = U (Undetectable = Untransmittable) in Lesotho to address the unique needs of adolescents and youth living with HIV (AYLHIV). The tool was created by the Elizabeth Glaser Pediatric AIDS Foundation's Committee of African Youth Advisors (CAYA) in partnership with researchers at the University of Cape Town. The tool consists of three stories that explore U = U in the context of romantic partnerships, sero-discordant couples, and pregnant young women. Youth ambassadors in Lesotho have used the tool in peer support groups and individual counseling sessions, finding it useful and relevant in addressing misconceptions and empowering AYLHIV. Suggestions for improvement include translating the stories into Sesotho and adding more diversity in the stories. Overall, the tool shows promise in promoting U = U and supporting AYLHIV in Lesotho. [Extracted from the article]

Purpose: Infantile colic diagnostic criteria were established by Rome IV. A universally accepted management remains to be established. We aimed to evaluate diagnostic criteria, management strategies, and perceived regional prevalence of infantile colic in Pakistan, as well as its effect on physicians and parents. Methods: A questionnaire was distributed amongst 1,256 physicians. Results: We received 800 replies. Wessel and Rome IV criteria were used by most physicians for diagnosis; however, the response "any infant who cries a lot" was selected by older physicians (48% of those over 60 years), physicians in rural areas (32%), physicians practicing in private clinics (27%), and general physicians (30%). Estimated prevalence of infantile colic ranges from 21-40%. Reassurance was the most widely recommended management strategy followed by herbal teas (51%), switching to a different formula (49%), probiotics (28%) and antibiotics (26%), discontinuation of breastfeeding (14%), elimination of dairy products from the breastfeeding mothers' diet (6%), and the administration of colic drops (1%). Most physicians considered the negative impact of colic on their personal lives and the parents as mild-to-moderate. Notably, 38% of percent of physicians routinely screened for maternal depression, and 45% of physicians were aware of the association between infantile colic and shaken baby syndrome. Conclusion: Most physicians in Pakistan diagnose and manage infantile colic according to the established guidelines. However, the guidelines pertaining to treatment planning are not followed. Educational efforts directed toward general physicians and doctors practicing in rural areas and clinics must be implemented to avoid unnecessary testing and treatment burden. [ABSTRACT FROM AUTHOR]

People living with hepatitis C virus infection in the United States have low breastfeeding initiation rates. OBJECTIVE: To evaluate breastfeeding initiation rates among people living with and without hepatitis C virus (HCV) infection during pregnancy and to identify characteristics associated with breastfeeding initiation. METHODS: We conducted a cross-sectional analysis of individuals who had a live birth in the United States from 2016 to 2021 using the National Center for Health Statistics birth certificate data. We grouped participants by whether they had HCV infection during pregnancy. Using propensity-score matching, we assessed the association between breastfeeding initiation before hospital discharge , defined as neonates receiving any parental breast milk or colostrum, and HCV infection during pregnancy in a logistic regression model. We also assessed factors associated with breastfeeding initiation among those with HCV infection. RESULTS: There were 96,896 reported cases (0.5%) of HCV infection among 19.0 million births that met inclusion criteria during the study period. Using propensity-score matching, we matched 87,761 individuals with HCV infection during pregnancy with 87,761 individuals without HCV infection. People with HCV infection during pregnancy were less likely to initiate breastfeeding compared with those without HCV infection (51.5% vs 64.2%, respectively; odds ratio 0.59, 95% CI, 0.58–0.60, P <.001). Characteristics associated with higher rates of breastfeeding initiation among individuals with HCV infection included a college degree (adjusted odds ratio [aOR] 1.22, 95% CI, 1.21–1.24); self-identified race or ethnicity as Native Hawaiian or Pacific Islander (aOR 1.22, 95% CI, 1.06–1.40), Asian (aOR 1.09, 95% CI, 1.06–1.13), or Hispanic (aOR 1.09, 95% CI, 1.08–1.11); private insurance (aOR 1.07, 95% CI, 1.06–1.08); nulliparity (aOR 1.09, 95% CI, 1.08–1.10), and being married (aOR 1.08, 95% CI, 1.07–1.09). Characteristics associated with not breastfeeding before hospital discharge included receiving no prenatal care (aOR 0.81, 95% CI, 0.79–0.82), smoking during pregnancy (aOR 0.88, 95% CI, 0.88–0.89), and neonatal intensive care unit admission (aOR 0.92, 95% CI, 0.91–0.93). CONCLUSION: Despite leading health organizations' support for people living with HCV infection to breastfeed, our study demonstrates low breastfeeding initiation rates in this population. Our findings highlight the need for tailored breastfeeding support for people with HCV infection and for understanding the additional effects of human immunodeficiency virus (HIV) co-infection, HCV treatment, and concurrent substance use disorders on breastfeeding initiation. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effects of a mobile-based breastfeeding promotion program (M-BFGDM) that helps mothers with gestational diabetes. Methods: Forty-seven mothers participated in the study, of whom 22 were in the experimental group and 25 in the control group. To verify the effects, a lag design before and after the non-equivalence control group was used. The data collection for the experimental group was done before and after the intervention. Results: In the results, breastfeeding knowledge showed a significant difference in the interaction between measurement period and group (χ² = 8.14, p = .017), whereas breastfeeding intention did not show a significant difference in the interaction (χ² = 4.73, p = .094). There was no difference in self-efficacy interaction (F = 0.13, p = .856). The breastfeeding method showed no difference in interaction (F = 0.04, p = .952), whereas cross-analysis showed a significant difference in breastfeeding practice rate between the experimental group and the control group at 1 month postpartum (χ² = 7.59, p = .006). Conclusion: A mobile-based breastfeeding promotion program was developed and applied for gestational diabetic mothers, resulting in an increase in breastfeeding knowledge and an improvement in breastfeeding practice rate one month after childbirth. In addition, M-BFGDM managed to create a breastfeeding practice environment with fewer time and place restrictions. A program study that complements motivation is needed to improve breastfeeding in pregnant diabetic mothers in the future. [ABSTRACT FROM AUTHOR]

This article explores the correlation between breastfeeding and oral development, as viewed by lactation consultants. The survey conducted by the Association of Lactation Professionals India (ALPI) provides insights into the understanding and communication of lactation care providers regarding breastfeeding's impact on oral health. The article emphasizes the significance of collaboration between lactation care providers and pediatric dentists to ensure comprehensive care for infants and improve overall health outcomes. It also highlights the various benefits of breastfeeding for both the mother and the infant's health. The article raises questions about the training and knowledge of lactation care providers on the relationship between breastfeeding and oral development, as well as their comfort level in discussing this relationship with their patients. The article suggests that an interprofessional relationship between lactation care providers and pediatric dentists can be beneficial for infants' oral health. The survey aims to evaluate the perception of lactation consultants in India on the relationship between breastfeeding and oral development, focusing on concerns such as malocclusion, breathing patterns, tethered oral tissues, and dental caries. The survey was conducted among members of ALPI, and the responses were collected anonymously. This study examines the training and knowledge of lactation care providers (LCPs) on the relationship between breastfeeding and oral development. The data was collected through surveys and analyzed using statistical software. The results show that LCPs receive training on this topic and feel comfortable discussing it with their patients. However, there is a need for collaboration between LCPs and pediatric dentists to [Extracted from the article]

Objective: Demand for breastfeeding medicine specialists has increased alongside the recognition of breastfeeding's importance and complexities. In response, Cleveland Clinic Children's established a breastfeeding medicine clinic in 2022. This survey aimed to identify the needs of providers to define impactful quality improvement initiatives. Methods: An anonymous survey was sent in May 2022 to all providers caring for breastfeeding dyads at Cleveland Clinic. Basic statistical analyses were performed on the data. Results: In all, 126 providers completed the survey (31.0% response rate). Provider-reported patient breastfeeding difficulties included latch issues (86.0%), nipple pain (73.0%), and undersupply (64.0%). Provider needs included access to lactation consultants (66.0%), patient education (58.0%), and a breastfeeding physician (56.0%). Provider-reported patient misconceptions and provider misconceptions were also reported. Conclusions: The survey identified opportunities for supporting patients and providers by establishing a breastfeeding medicine clinic and highlighted the underestimation of breastfeeding difficulties by both providers and patients. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of evidence or practice guidelines surrounding safe and effective breast pump use. Many lactation personnel feel ill-prepared when troubleshooting pumps. There is an emerging need for skills and understanding on breast pumps and their association with lactation problems. Methods: A review of literature, current professional practice, and clinical experience was used to gain perspective on the current state of breast pump safety and use. Results: More mothers are using breast pumps to initiate, stimulate, or maintain their milk supply. Gaps were identified surrounding breast pump safety and effectiveness. The breast pump market is lucrative and is being flooded with new and "better" pumps at a rapid rate. Pump testing for safety and effectiveness is suboptimal. An increase in breast injuries, illness, and milk supply issues is emerging in clinical practice. There are currently no consistent standards for optimal pressures, cycling, or flange fit. Conclusions: Pumps are a viable option for mothers and can play a role in lactation continuation. Lactation personnel must have competent knowledge and skills to help mothers use pumps safely and effectively. [ABSTRACT FROM AUTHOR]

Background and Objectives: Early discharge after childbirth has led to a rise in neonatal readmission, thereby becoming a major concern in recent decades. Our research aimed to identify the risk factors and incidence of neonatal readmission and explore preventive measures. Materials and Methods: Our study at the Clinical Hospital of Pediatrics in Ploiești, Romania, included 108 neonates admitted during the neonatal period. Results: This accounted for 2.06% of all admissions (5226). The most prevalent cases were malnutrition (25%), fever (20.3%), and bronchiolitis (17.5%). Diarrhea and infectious gastroenteritis were also observed (14.8%), along with acute rhinoconjunctivitis (9.2%) and late-onset sepsis (3.7%). No deaths were recorded. The most significant characteristics identified were number of children (p < 0.001) and age at maternity discharge (p < 0.001). By following the prevention rules, malnutrition, feeding errors, and infections can be avoided. This includes practicing proper hand hygiene for both mothers and medical staff, as well as educating and demonstrating to mothers the benefits of breastfeeding. In addition, all newborns discharged from the maternity ward would benefit from follow-up at 7–10 days of life. Conclusions: Our results confirm the effectiveness of a multidisciplinary team and endorse the promotion of breastfeeding. Implementing quality control measures and regularly evaluating the surveillance program will help improve its effectiveness. [ABSTRACT FROM AUTHOR]

Most health care providers in Lagos State, Nigeria are private and are not required to offer breastfeeding counseling to women. From May 2019-April 2020, Alive & Thrive implemented a multicomponent breastfeeding promotion intervention in private health facilities in Lagos that included training and support to implement the Baby-Friendly Hospital Initiative and provide breastfeeding counseling and support to pregnant women and lactating mothers in person and on WhatsApp. We conducted a mixed methods process evaluation in 10 intervention and 10 comparison private health facilities to examine the feasibility and acceptability of integrating the intervention into routine health services. We conducted in-depth interviews with 20 health facility owners/managers and providers, 179 structured observations of health providers during service provision to pregnant and lactating women and 179 exit interviews with pregnant and lactating women. The in-depth interviews were transcribed and analyzed thematically. The structured observations and exit interviews were summarized using descriptive and inferential statistics. The in-depth interviews indicated that almost all health facility owners/managers and providers at the intervention health facilities had generally positive experiences with the intervention. However, the health providers reported implementation barriers including increased workload, use of personal time for counseling on WhatsApp, and some mothers' lack of access to WhatsApp support groups. Observations suggested that more breastfeeding counseling occurred at intervention compared with comparison health facilities. Third trimester exit interviews showed that 86% of women in the intervention health facilities were very confident they could carry out the breastfeeding advice they received, compared to 47% in the comparison health facilities. Our research suggests that provision of breastfeeding counseling and support through private health facilities is feasible and acceptable, but service delivery challenges must be considered for successful scale-up. [ABSTRACT FROM AUTHOR]

Background: Despite the benefits of breastfeeding (BF), rates remain lower than public health targets, particularly among low-income Black populations. Community-based breastfeeding peer counselor (BPC) programs have been shown to increase BF. We sought to examine whether implementation of a BPC program in an obstetric clinical setting serving low-income patients was associated with improved BF initiation and exclusivity. Methods: This is a quasi-experimental time series study of pregnant and postpartum patients receiving care before and after implementation of a BPC program in a teaching hospital affiliated prenatal clinic. The role of the BPC staff included BF classes, prenatal counseling and postnatal support, including in-hospital assistance and phone triage after discharge. Records were reviewed at each of 3 time points: immediately before the hire of the BPC staff (2008), 1-year post-implementation (2009), and 5 years post-implementation (2014). The primary outcomes were rates of breastfeeding initiation and exclusivity prior to hospital discharge, secondary outcomes included whether infants received all or mostly breastmilk during inpatient admission and by 6 weeks post-delivery. Bivariable and multivariable analyses were utilized as appropriate. Results: Of 302 patients included, 52.3% identified as non-Hispanic Black and 99% had Medicaid-funded prenatal care. While there was no improvement in rates of BF initiation, exclusive BF during the postpartum hospitalization improved during the 3 distinct time points examined, increasing from 13.7% in 2008 to 32% in 2014 (2009 aOR 2.48, 95%CI 1.13–5.43; 2014 aOR 1.82, 95%CI 1.24–2.65). This finding was driven by improved exclusive BF for patients who identified as Black (9.4% in 2008, 22.9% in 2009, and 37.9% in 2014, p = 0.01). Conclusion: Inpatient BF exclusivity significantly increased with the tenure of a BPC program in a low-income clinical setting. These findings demonstrate that a BPC program can be a particularly effective method to address BF disparities among low-income Black populations. [ABSTRACT FROM AUTHOR]

Background: In 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes). Methods: This study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' 'intrapartum care model, or the control group, which received the' 'hospital's routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear. Results: The average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05). Conclusion: The intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures. [ABSTRACT FROM AUTHOR]

Background: Globally, prematurity is the primary factor behind the mortality of children under the age of 5 years, resulting in approximately 1 million children dying annually. The World Health Organization (WHO) recommends Skin-to-Skin Contact (SSC) as part of routine care for preterm infants. Evidence shows that SSC reduces mortality, possibly by improving thermoregulation, facilitating the earlier initiation of breastfeeding and reducing the risk of nosocomial infection. An educational program for implementing SSC has been demonstrated to enhance the knowledge and practice of parents and nurses in intensive care units. This study, the first of its kind in the North West Province (NWP), aims to identify the essential components of an educational program for implementing SSC for premature infants in intensive care units. Objective: This paper presents an integrative literature review that critically synthesizes research-based literature on essential components of an educational program for implementing SSC for preterm infants in intensive care units. Methods: A comprehensive search of electronic databases, such as CINAHL, MEDLINE, PsycINFO, ProQuest and Health Source: Nursing/Academic Edition and Health Source-Consumer Edition, was conducted using different keywords and references lists from the bibliography. Results: Twelve articles relevant to this review were identified, read and synthesized to answer the research question. Three essential components emerged from the findings of this review, namely (1) the necessity of policy and role players for implementing SSC, (2) the availability of education and training, and (3) counseling and support for parents of preterm infants. Conclusions: The outcomes of this study have the potential to facilitate the implementation and expansion of SSC in intensive care units. This could aid program implementers, policymakers, and researchers to implement and scale up this important tool in intensive care units. [ABSTRACT FROM AUTHOR]

Background: Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation's recommendation of two years. This is particularly true for low-income women (LIW). They often face additional socio-structural barriers that encourage early discontinuation and are inadequately supported by current healthcare interventions. Teleinterventions are flexible and widely used following the global pandemic and increase maternal autonomy over intervention delivery. They show promise in improving other maternal conditions in LIW, including postpartum depression. Teleinterventions can increase breastfeeding rates in the wider maternal population, however their efficacy for this underserved population has not yet been systematically assessed. This meta-analysis aimed to identify if teleinterventions increase 'exclusive' or 'any' breastfeeding by LIW in HIC at 1-, 3–4, and 6-months postpartum. Methods: We searched five online databases for randomised controlled trials assessing breastfeeding teleinterventions for LIW in HIC. Risk ratios (RR) were used to calculate the average effect of teleinterventions on 'any' and 'exclusive' breastfeeding at at 1-, 3–4, and 6-months postpartum using random effects meta-analysis. Study bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), and outcome quality was evaluated against GRADE criteria. Results: Nine studies met inclusion criteria: six providing telephone calls, two text messages and one an online support group. All the studies were conducted in the United States, with small sample sizes and a high risk of bias. Pooled results indicate teleinterventions modestly increase 'any' and 'exclusive' breastfeeding at all time points, with a statistically significant increase in 'exclusive' breastfeeding after 3–4 months (RR 1.12, 95% CI [1.00,1.25]). At 3–4 months teleinterventions providing peer support were more effective than educational teleinterventions at promoting any and exclusive breastfeeding. Evidence for all outcomes were rated 'low' or 'very low' quality using the GRADE tool, mainly due to high attrition and low power. Conclusions: Despite insufficient high-quality research into breastfeeding teleinterventions for LIW, our results suggest teleinterventions may improve exclusive and any breastfeeding. Given breastfeeding is particularly low in LIW population from HIC, our findings are promising and require further exploration by larger, methodologically sound trials in other HIC. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization and United Nations Children's Fund recommend exclusive breastfeeding (EBF) for the first six months of an infant's life. Although evidence suggests that maintaining breastfeeding has positive impacts on glucose and lipid metabolism in postpartum women with a history of gestational diabetes mellitus (GDM), no study has investigated whether such effects differ between breastfeeding intensities. This study aimed to evaluate the impact of maintaining breastfeeding on prediabetes, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) six months postpartum in women with GDM. This study also examined the potential variations in glucometabolic outcomes between EBF at six months and partial breastfeeding at six months. Methods: This prospective cohort study included 130 women with recent GDM who experienced live births between 7 September 2020 and 31 January 2023 at a university hospital in Bangkok, Thailand. All the women were free of T2DM and MetS at baseline (six weeks postpartum). We followed up these women six months postpartum to assess their breastfeeding practices (EBF at six months, partial breastfeeding at six months, or not maintaining breastfeeding) and evaluate their progression to prediabetes, T2DM, and MetS. Maintaining breastfeeding was defined as breastfeeding for six months. EBF was determined using the "recall since birth" method. Results: Of the 130 participants included, the rates of prediabetes, T2DM, and MetS six months postpartum were 33% (n = 43), 2% (n = 3), and 17% (n = 22), respectively. In the unadjusted model, maintaining breastfeeding was associated with a reduction in the risks of prediabetes and MetS but not T2DM. After adjusting for potential confounders, maintaining breastfeeding was a significant protective factor only for prediabetes. The adjusted risk ratios and 95% confidence intervals were 0.54 (0.29, 0.99) for prediabetes and 0.47 (0.19, 1.06) for MetS. When EBF at six months and partial breastfeeding at six months were separately analyzed, the risks of prediabetes and MetS differed between the two groups. In the EBF at six months-to-partial breastfeeding at six months comparison, the adjusted risk ratios (95% confidence intervals) of prediabetes and MetS were 0.46 (0.22, 0.97) vs. 0.79 (0.25, 2.49) and 0.34 (0.11, 0.99) vs. 0.69 (0.22, 2.07), respectively. Conclusions: Maintaining breastfeeding reduced the risk of prediabetes and MetS, but not of T2DM, six months postpartum; these effects were significant only with EBF. These findings indicate that supporting maternal efforts to practice EBF for six months may improve women's health after GDM. Trial registration: Thai Clinical Trials Registry Registration No. TCTR20200902003. Date of registration: September 2, 2020. Date of initial participant enrollment: September 7, 2020. [ABSTRACT FROM AUTHOR]

Background: Depression is one of the most common mental disorders in the postpartum period. Depression can decrease self-efficacy in breastfeeding by reducing the mother's self-confidence. Considering the conflicting results regarding the relationship between postpartum depression and breastfeeding self-efficacy, this systematic review was conducted to investigate the relationship between breastfeeding self-efficacy and postpartum depression. Method: In this systematic review, published articles in PubMed, Scopus, Web of Sciences, Cochrane Library, and Google Scholar databases were searched using English keywords "Self-efficacy, breastfeeding, breastfeeding Self-efficacy, depression, postpartum depression" without publication date limit. Data analysis was done with employing STATA14 software. Heterogeneity was assessed using I2 index which was 0%. Therefore, the fixed effects method was used to combine the data and perform meta-analysis. Result: The results of the meta-analysis showed that based on the fixed effect method, depression was associated with decreased breastfeeding self-efficacy on the first day (SMD = 0.62, 95%CI: -0.830, -0.41, p = 0.0001) and on the third day (SMD = 0.84, 95% CI: -0.55,1.14, p = 0.0001). The Begg and Manzumdar test revealed no publication bias, with p = 0.317. Conclusion: Postpartum depression may be associated with a decrease in the mother's breastfeeding self-efficacy and placing mother in a condition to pay low attention to her maternal role. Therefore, healthcare providers should provide adequate support according to the needs of mothers and develop diagnostic and treatment protocols to improve the level of maternal health. [ABSTRACT FROM AUTHOR]

Background: The gut microbiota is a key determinant of long-term health. Promoting maternal health literacy may enhance children well-being. Aim of the present study was to assess gut microbiota-related health literacy of Italian women and identify potential gaps in awareness. Methods: A cross-sectional survey study was conducted using an online questionnaire (17 questions) on determinants and long-term impact of infant gut microbiota. The survey targeted Italian pregnant women and mothers of children under 2 years old, and was distributed through various social media channels between September 28th and November 15th, 2022. A total score was calculated as the sum of positive answers. Data on demographics, pregnancy status, and pre-existing knowledge of the infant gut microbiota were also collected. Descriptive and inferential statistics were applied. Results: The questionnaire was completed by 1076 women. Median total score was 9 [7–11]. The 81.7% of respondents declared prior knowledge of the gut microbiota. The internet was among the most commonly cited primary sources of information. Independent predictors of total score were having a university degree (B = 0.656, p = 0.002) and prior knowledge (B = 2.246, p < 0.001). Conversely, older age was associated with lower total scores (B = -0.092, p < 0.001). The least known determinants of infant gut microbiota were gestational BMI, prematurity, mode of delivery and NICU stay. Pregnant women failed to recognize the role of breastfeeding in the development of infant gut microbiota more frequently than non-pregnant women. The 97.5% of participants reported increased interest in the gut microbiota, with heightened interest associated with prior knowledge. Conclusions: Our study revealed a moderate level of knowledge about infant gut microbiota among respondents, emphasizing the positive impact of prior knowledge on understanding and interest. Targeted educational interventions are needed to address awareness gaps, especially concerning the influence of breastfeeding on infant gut microbiota. Healthcare providers have the potential to enhance women's knowledge and awareness of this topic. [ABSTRACT FROM AUTHOR]

Transmission through breastfeeding accounts for more than half of the unacceptably high number of new paediatric HIV infections worldwide. We hypothesised that, in addition to maternal antiretroviral therapy (ART), extended postnatal prophylaxis with lamivudine, guided by point-of-care assays for maternal viral load, could reduce postnatal transmission. We did a phase 3, open-label, randomised controlled trial at four health-care facilities in Zambia and four health-care facilities in Burkina Faso. Mothers with HIV and their breastfed infants without HIV attending the second visit of the Expanded Programme of Immunisation (EPI-2; infant age 6–8 weeks) were randomly assigned 1:1 to intervention or control groups. In the intervention group, maternal viral load was measured using Xpert HIV viral load assay at EPI-2 and at 6 months, with results provided immediately. Infants whose mothers had a viral load of 1000 copies per mL or higher were started on lamivudine syrup twice per day for 12 months or 1 month after breastfeeding discontinuation. The control group followed national guidelines for prevention of postnatal transmission of HIV. The primary outcome assessed by modified intention to treat was infant HIV infection at age 12 months, with HIV DNA point-of-care testing at 6 months and at 12 months. This trial is registered with ClinicalTrials.gov (NCT03870438). Between Dec 12, 2019 and Sept 30, 2021, 34 054 mothers were screened for HIV. Among them, 1506 mothers with HIV and their infants without HIV, including 1342 mother and infant pairs from Zambia and 164 from Burkina Faso, were eligible and randomly assigned 1:1 to the intervention (n=753) or control group (n=753). At baseline, the median age of the mothers was 30·6 years (IQR 26·0–34·7), 1480 (98·4%) of 1504 were receiving ART, and 169 (11·5%) of 1466 had a viral load ≥1000 copies/mL. There was one case of HIV transmission in the intervention group and six in the control group, resulting in a transmission incidence of 0·19 per 100 person-years (95% CI 0·005–1·04) in the intervention group and 1·16 per 100 person-years (0·43–2·53) in the control group, which did not reach statistical significance (p=0·066). HIV-free survival and serious adverse events were similar in both groups. Our intervention, initiated at EPI-2 and based on extended single-drug postnatal prophylaxis guided by point-of-care maternal viral load could be an important strategy for paediatric HIV elimination. The EDCTP2 programme with the support of the UK Department of Health & Social Care. [ABSTRACT FROM AUTHOR]

A breastfeeding‐friendly city is one where there is an enabling environment to support breastfeeding throughout the first 2 years or more of a child's life. Indicators of a breastfeeding‐friendly city have yet to be identified. What are the indicators or criteria used to define breastfeeding friendliness in a geographic area such as a city and the settings within, which we have classified as community, healthcare and workplace? Three major databases and grey literature were searched. Records were screened to identify publications describing criteria such as indicators or descriptions of a breastfeeding‐friendly setting, defined as 'criteria‐sets'. These criteria‐sets were then categorized and summarized by settings. The search up to 2 September 2021 found 119 criteria‐sets from a range of settings: geographic locations (n = 33), community entities (n = 24), healthcare facilities (n = 28), workplaces (n = 28) and others (n = 6). Overall, 15 community, 22 healthcare and 9 workplace related criteria were extracted from the criteria‐sets. Criteria that were consistently present in all settings were policy, training & education, skilled breastfeeding support and physical infrastructure. Some criteria‐sets of geographic locations contained criteria only from a single setting (e.g., the presence of breastfeeding‐friendly cafes). Criteria‐sets were present for all settings as defined in this review, but few were actual indicators. Specifically, there were no existing indicators of a breastfeeding‐friendly city. Several common components of the criteria‐sets were identified, and these could be used in developing indicators of a breastfeeding‐friendly city. Future studies should determine which of these are important and how each can be measured. Key messages: There were many different criteria used to describe a breastfeeding‐friendly setting, including cities, but few were actual measurable indicators.Several common criteria were identified such as policy, training & education, skilled breastfeeding support, and physical infrastructure.These could be further developed into indicators of a breastfeeding‐friendly city. [ABSTRACT FROM AUTHOR]

Background: Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers' perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China. Methods: This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, "village doctors", and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed. Results: Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers' lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers' housing situation, mothers' mobility, and cultural barriers were discussed. Conclusions: The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China's Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide. [ABSTRACT FROM AUTHOR]

As noted by Knaak, information provided to parents about infant feeding in recent decades has become 'more a tool for persuasion than a tool for education.' Some health professionals advocate that providers and information for new and expecting parents emphasise the 'risks of formula feeding' rather than 'benefits of breastfeeding.' Limited systematic research suggests this shift is not changing parental behaviour. The present study assesses the degree to which 'risk' language appears in online breastfeeding promotional materials published by governmental health departments in the US Over 200 documents and webpages promoting breastfeeding were analysed for inclusion of 'risk' language. About 30 per cent of agencies and 13 per cent of documents and webpages promoting breastfeeding were found to contain such language. Materials published by nongovernmental entities (linked through agency sites) were significantly more likely to include risk language compared to governmental sites. This assessment provides context for the existing discourse regarding promotion of breastfeeding by emphasising health risks. The significance of these findings for respectful advocacy is discussed. [ABSTRACT FROM AUTHOR]

Background. The positive deviance approach has been used to identify infant and young child feeding (IYCF) practices associated with a reduction in stunting, but this research is limited in South Africa (SA). Objective. To identify strategies among positive deviant (PD) caregivers of non-stunted children aged 6 - 18 months that influence infant and young child feeding (IYCF) practices and raise well-nourished children in two informal settlements in Harrismith. Methods. This study employed a mixed-method design using a PD approach. Demographic questionnaires were administered to 28 purposefully sampled caregiver-child pairs to determine caregiver, child and household characteristics. Socioeconomic scores were obtained from these interviews and used to select six PD and six non-positive deviant (NPD) caregivers for semi-structured qualitative interviews between March and June 2019. Results. Nutritional PD behaviours included consuming 'flesh foods' (meat) more often and practising responsive feeding and family eating. Non-nutritional PD behaviours included coping strategies involving health-seeking behaviour, financial strategy and social capital of caregivers. All caregivers displayed poor breastfeeding practices and an early introduction of solid foods. Primary healthcare nurses were reported to frequently provide breastfeeding advice from outdated prevention of mother-to-child transmission policy. Conclusions. Poor IYCF practices highlight the need for continued advocacy and promotion of IYCF in SA. Nutritional PD behaviours are key to health promotional messages relayed within the local community where the research was conducted. The presence of nutritional and non-nutritional PD behaviours highlights the need for a multi-sectoral response to addressing stunting and improving IYCF practices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes mellitus (GDM) is unclear. RESEARCH DESIGN AND METHODS: We included 15,146 parous women with type 2 diabetes from the Nurses' Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD) (myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models. RESULTS: We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, with pooled aHR of 0.68 (95% CI 0.54–0.85) for >18 months versus 0 months and 0.94 (0.91–0.98) per 6-month increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88–0.97]) but not with stroke (0.96 [0.91–1.02]) per 6-month increment in breastfeeding. Among women with GDM history, >18 months versus 0 months of breastfeeding was associated with an aHR of 0.49 (0.28–0.86) for total CVD. CONCLUSIONS: Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is an absolute necessary intervention for childhood survival. WHO/UNICEF have given utmost emphasis on first 1000 days of life comprising of 270 days in-utero and the first two years post birth as most vital period for nutritional interventions. [1] Infant and Young Child Feeding (IYCF) is a set of renowned and usual recommendations for appropriate feeding of new-born and children below two years of age. Aims & Objectives: To assess the awareness, perception and practices, regarding breast-feeding and IYCF practices among mothers of children up to 2 years, in two districts of Central India. Settings and Design: Cross Sectional Study. Materials and Methods: This Cross-sectional study was carried out in two districts of Central India from January 2021 to December 2021. The study subjects included 400 mothers of babies less than two years old, who had given consent. Interpersonal interview using a pre-designed semi-structured questionnaire was carried out. Data was collected, compiled and analysed using SPSS 25.0 (Trial Version). Result: Only (58.60%) of respondents were completely knowledgeable about exclusive breastfeeding, the value of colostrum feeding, the advantages of breastfeeding (81.69%), and its early onset (64.75%), duration (71.25%), and frequency (74.50%). However, 50.25% of women lacked understanding about the ideal positioning and attachment of the infant to the breast. Conclusion: All beneficiaries should be shown demonstrations of all IYCF practices. Family members should also be counselled and encouraged to support IYCF practices. [ABSTRACT FROM AUTHOR]

Aim: Implementing the Baby‐Friendly Hospital Initiative (BFHI) programme has been fraught with challenges globally. The study aimed to assess the implementation of the BFHI and breastfeeding practices in healthcare facilities in Ogun State, Nigeria. Methods: It was a questionnaire‐based cross‐sectional study carried out between August and October 2019 among 100 healthcare workers and 110 mothers from health facilities in Ijebu‐Ode Local Government Area of Ogun State, Nigeria. Results: Nearly two‐thirds (61.0%) of the healthcare workers were community health workers while the others were nurses. Less than a quarter (23.8%) of the healthcare workers had ever attended breastfeeding educational programmes since they started working. About half of the healthcare workers had good knowledge, attitude and practice of BFHI. Nurses had a significantly better practice of BFHI than community health workers. Understaffing was a major limitation to the implementation of BFHI. The mothers had an exclusive breastfeeding rate of 47%. Conclusion: The knowledge, attitude, and practice of BFHI were suboptimal and the exclusive breastfeeding rate among the mothers was low. There is a need to improve staff strength, training and re‐training of staff, as well as regular monitoring and evaluation of healthcare facilities on the implementation of BFHI. [ABSTRACT FROM AUTHOR]

For several decades, international organizations and experts have emphasized the importance of protection, support and promotion of breastfeeding (PSPB). With the rapidly changing societal, political and economic environment in recent years and the increasing digitalization of modern life, both new challenges and new opportunities for positive impact are emerging in many areas, including in the field of PSPB. Based on research and analysеs of the situation at national, regional and global levels, a number of policies have been developed to outline the parameters of the necessary measures in different sectors of the health and social services systems to support parents with regard to breastfeeding. International models have been already implemented in some national policies and there are good examples of their positive effect on breastfeeding indicators in these countries. Current trends are the subject of growing research interest and the results of new studies provide a rationale for updating and expanding PSPB policies. This review aims to provide an overview of the background and evolution of existing international policies in the area of PSPB and to trace their recent developments, and to present the results of some key studies relevant to the current global situation in the field. A documentary method is used for the information collection. [ABSTRACT FROM AUTHOR]

Black recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have low breastfeeding rates. The aim of this pilot study was to determine if prenatal education by a breastfeeding peer counselor in an academic obstetric clinic is feasible and could improve WIC-eligible participants' breastfeeding self-efficacy and in-hospital breastfeeding rates. Pregnant participants (N = 57) were randomized into either an intervention group, which spoke briefly with a breastfeeding peer counselor immediately after their clinic appointment, or a comparison group, which received usual prenatal obstetric care only. Integrating a breastfeeding peer counselor into an academic obstetric clinic proved feasible and improved the intervention group's overall pre- to postscores on the Breastfeeding Self-Efficacy Scale. This small pilot study showed no significant difference in in-hospital exclusive breastfeeding rates between the groups. [ABSTRACT FROM AUTHOR]

In this guest editorial, Dr. James Lothian, husband of Dr. Judith Lothian, longtime associate editor of the Journal of Perinatal Education shares his insights on what guided Judy's thinking and how she went about doing research. These reflections are a welcome addition to the legacy that Judy Lothian left behind as a scholar, teacher, wife, mother, and dear friend. [ABSTRACT FROM AUTHOR]

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Context/Background: Rearing practices are a major determinant of nutritional and health status of infants. Infant Care Practices has more impact on Child Survival. Therefore these practices need to be better understood Aims/Objectives: The objective of the study is to assess the feeding and child rearing practices among mothers in the study area. Methodology: A cross sectional descriptive study was conducted among 110 mothers of 6 months to two year children attending Government Medical College in Thiruvannamalai using a Semi structured Questionnaire. Analysis of collected data was done using Microsoft Excel and SPSS software. Results: Only 43.6% of mothers exclusively breastfeed their child and 33.6% of mothers had given prelacteal feeds to the newborn. Bottle feeding was practiced by 71.7% of mothers. About 68.2% of mothers applied kajal to the eyes of children.All the mothers utilised Health care services during illness of the children. Maternal education improves the weaning and immunisation practices and found statistically significant (p < 0.05) Conclusions: Faulty child rearing practices need to be corrected either through health education, hands on training of mothers and counselling by healthcare professionals in order to improve the health status of infants. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding is pivotal for the health and development of infants and offers numerous benefits to mothers. However, unique cultural beliefs and practices, particularly among Muslim communities, can significantly influence breastfeeding behaviors. This study sought to elucidate the factors influencing exclusive breastfeeding among Thai Muslim mothers. The sample was 168 postpartum Muslim mothers from well-baby clinics in southern Thailand, selected through multi-stage random sampling. Data were collected from June to December 2022 employing the Demographic Data Form, Infant Feeding Intentions Scale, Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale, Breastfeeding Self-Efficacy Scale -Short Form, Maternal Health Literacy Scale, Islamic Belief Scale, Exclusive Breastfeeding Social Support, and Breastfeeding Practices Questionnaire. Data were analyzed using descriptive statistics, Spearman rank's correlation, and binary logistic regression analysis. The study found that the rate of exclusive breastfeeding among Thai Muslim mothers at six months postpartum was 54.8%. Notably, breastfeeding self-efficacy emerged as the sole predictor of exclusive breastfeeding, accounting for 11% of the variance in this practice. These findings underscore the critical role of breastfeeding self-efficacy in promoting exclusive breastfeeding. It is recommended that nurses and healthcare professionals develop culturally tailored support programs that enhance breastfeeding self-efficacy, aligned with Islamic beliefs, to improve breastfeeding practices among Muslim mothers. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of the "Ten Steps to Successful Breastfeeding" in Hungary and identified possible associations of the steps with breastfeeding. Our quantitative, cross-sectional research was conducted anonymously online in Hungary with a self-administered questionnaire in 2021. Targeted sampling was used, with biological motherhood and having at least one child no older than 60 months as inclusion criteria (n = 2008). The implementation of the "Ten Steps to Successful Breastfeeding" was analyzed separately for breastfeeding and non-breastfeeding mothers. A breastfeeding mother was defined as breastfeeding for at least six months. Descriptive statistics, χ2 test, and t-test were calculated with SPSSv25 (p < 0.05). No significant differences were found between breastfeeding and non-breastfeeding mothers in terms of supplementary feeding at the advice of a health professional (p = 0.624) and in terms of assistance with breastfeeding or suggested breastfeeding positions during hospitalization (p = 0.413). Significant differences were found for receiving breastfeeding-friendly recommendations by staff (p = 0.006), valuing breastfeeding (p < 0.001), skin-to-skin contact within 1 h (p = 0.002), receiving supplementary feeding (p < 0.001), rooming-in (p < 0.001), responsive feeding, recognizing hunger signs (p < 0.001), pacifier/bottle use (p < 0.001), and availability of breastfeeding support (p = 0.005). Significant differences were observed between breastfeeding and non-breastfeeding subsamples regarding the implementation of baby-friendly steps (p < 0.001). Breastfeeding mothers experienced the implementation of more baby-friendly steps and a higher rate of breastfeeding, while there was no significant difference in the duration of exclusive (p = 0.795) and partial breastfeeding (p = 0.250) based on the results. We concluded that exposure to the Baby-Friendly Hospital Initiative may be associated with increased 6-month breastfeeding but may not influence longer durations. [ABSTRACT FROM AUTHOR]

Background: The dysphoric milk ejection reflex (D-MER) is a reflex that causes temporary discomfort during milk ejection. D-MER develops due to the effects of hormones involved in lactation, and it has been reported that it is a physiological symptom different from postpartum depression, but the actual situation is unknown in Japan. Methods: This study was conducted using a self-administered, anonymous survey of mothers of children who had undergone health checkups at three years of age at five health centers in Kagoshima city and aimed to clarify the reality and perceptions of mothers regarding D-MER. The survey period was from May to September, 2022. The questionnaires were distributed to 389 mothers, and 216 (55.5% recovery rate) responses were received, of which 202 (valid response rate 93.5%) were included in the analysis. Results: Regarding the experience of D-MER, 202 mothers in the study population had given birth to a total of 403 children and experienced D-MER when breastfeeding 62 children (15.4%). Of the 202 mothers included in the analysis, 47 (23.3%) answered that they had experienced D-MER with at least one child while breastfeeding. Sixty-six mothers (32.7%) knew about D-MER. Compared to those who had not experienced D-MER, those who had experienced D-MER had significantly higher scores on the items related to having had trouble breastfeeding (odds ratio (OR]: 3.78; 95% confidence interval (CI]: 1.57, 9.09) and knowing about D-MER (OR 2.41; 95% CI 1.20, 4.84). Regarding symptoms, irritability (n = 24, 51.1%), anxiety (n = 22, 46.8%), and sadness (n = 18, 38.3%) ranked high. Coping strategies included distraction, focusing on the child, and, in some cases, cessation of breastfeeding. Thirty mothers (63.8%) answered that they did not consult anyone, citing reasons such as a belief that no one would be likely to understand their symptoms, and that they could not sufficiently explain their symptoms. Conclusion: The low level of awareness of D-MER suggests that it is necessary to inform and educate mothers and the public about the physiological symptoms of D-MER. Moreover, it is necessary to listen to the feelings of mothers with D-MER and support them in coping with their symptoms. [ABSTRACT FROM AUTHOR]

Background: The promotion of breastfeeding is an important strategy to prevent neonatal death and improve maternal and infant health. But Chinese efforts to improve breastfeeding practices have not been particularly effective. There is still a long way to go to achieve the national health development goals. We aimed to explore the maternal demand for breastfeeding guarantee policy in China and to determine the impact of a range of socio-demographic and neonatal-related variables on breastfeeding guarantee policy demand. Methods: The study was carried out in the Obstetrics and Gynecology hospital of Shanghai, one of China's earliest provincial and municipal maternal and child health care institutions. From June to November 2021, 1,292 women were recruited for the cross-sectional study in child health clinic. We collected relevant socio- demographic and neonatal-related data. Maternal breastfeeding needs were measured through a self-designed questionnaire on breastfeeding guarantee policy demands of mothers. Results: The mean score of breastfeeding guarantee policy demand was 4.42 ± 0.51. There were statistically significant differences in the effects of maternal age, education level, family income per capita (Yuan), medical payment type, baby age, work status, and current feeding methods on the demand for breastfeeding guarantee policies (P < 0.05). Multiple linear regression analyses showed that higher education level (B = 4.437, P < 0.001), baby age (B = 2.150, P = 0.002), and current feeding methods (B = 2.754, P = 0.005) were significantly associated with a higher demand for a breastfeeding guarantee policy, the effect of medical payment type is the most influencing factor (B = −7.369, P < 0.001). Conclusions: The maternal needs for breastfeeding guarantee policy are multi-faceted and urgent. In the process of improving and implementing policies, the government and relevant departments should take into account the actual needs of women who have different education levels, baby ages, family economics, and feeding methods. [ABSTRACT FROM AUTHOR]

Background: When children are diagnosed of cancer, parents face varied financial issues. Among some of the identifiable factors that cause financial challenges among breastfeeding mothers include the high cost of childhood cancer care. The high cost of childhood cancer care could impede the sustainability of access to prompt care. There is paucity of literature on the financial burdens faced by breastfeeding mothers with children diagnosed with cancer in Ghana. Therefore, this study sought to explore the financial burden faced by mothers with breastfeeding children diagnosed with cancer. Methods: The study employed qualitative exploratory descriptive design. One-on-one interviews were conducted among 13 mothers with breastfeeding children diagnosed of cancer. Permission was sought for data to be recorded, transcribed concurrently and inductive content analysis done. Results: Three main themes emerged after data analysis: High cost (sub-themes; expensive medications, laboratory investigation fees, and cost of mothers' feeding), Public support (sub-themes; appeal for funds, national health insurance scheme) and Self-financing (loans, personal savings). Most of the breastfeeding mothers narrated that high cost of childhood cancer care generated financial distress to them. They shared that the cost involved in purchasing their children's cancer medications, paying for laboratory investigations and feeding themselves to produce adequate breastmilk to feed their children were challenging. Some of the mothers self-financed the cost of their children's cancer care through loans and personal savings. Conclusion: Government and other stakeholders should allocate annual budget and funds towards childhood cancer care to lessen the financial burden breastfeeding mothers caring for children with cancer experience. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding initiation and continuation rates are shaped by complex and interrelated determinants across individual, interpersonal, community, organisational, and policy spheres. Young mothers, however, face a double burden of stigma, being perceived as immature and incompetent in their mothering and breastfeeding abilities. In this study, we aimed to understand the experiences of young mothers who exclusively breastfed for six months and beyond and explore their experiences of stigma and active resistance through social media. Methods: In 2020, in-depth telephone interviews about breastfeeding experiences were conducted with 44 young mothers under age 25 in Aotearoa New Zealand who breastfed for six months or longer. Participants were recruited via social media. Interviews were audio-recorded, transcribed and analysed thematically. Results: Analysis yielded four themes on young mothers' negotiation of breastfeeding and support. The first three themes revealed young mothers' encounters with socio-cultural contexts. They faced negative judgments about maturity and competence, adverse guidance to supplement or cease breastfeeding, and an undermining of their breastfeeding efforts. The fourth theme showed how young mothers sought alternative support in online environments to avoid negative interactions. Online spaces provided anonymity, convenience, experiential knowledge and social connections with shared values. This facilitated identity strengthening, empowerment and stigma resistance. Conclusion: Our research highlights the importance of online communities as a tool for young mothers to navigate and resist the societal stigmas surrounding breastfeeding. Online spaces can provide a unique structure that can help counteract the adverse effects of social and historical determinants on breastfeeding rates by fostering a sense of inclusion and support. These findings have implications for the development of breastfeeding promotion strategies for young mothers and highlight the potential of peer support in counteracting the negative impacts of stigma. The research also sheds light on the experiences of young mothers within the health professional relationship and the effects of stigma and cultural health capital on their engagement and withdrawal from services. Further research should examine how sociocultural barriers to breastfeeding stigmatise and marginalise young mothers and continue to reflect on their socio-political and economic positioning and how it can exacerbate inequities. [ABSTRACT FROM AUTHOR]