A Geospatial Analysis of the Impact of the Baby-Friendly Hospital Initiative on Breastfeeding Initiation in North Carolina.
J Hum Lact. 2018 Jul 01;:890334418776645
Authors: Liberty AL, Wouk K, Chetwynd E, Ringel-Kulka T
BACKGROUND: Significant disparities in breastfeeding support and practice exist in North Carolina. The Baby-Friendly Hospital Initiative is a worldwide intervention that encourages birth facilities to adopt specific practices in support of breastfeeding. Research aim: This study aimed to evaluate the impact of the Baby-Friendly Hospital Initiative on breastfeeding initiation in North Carolina, with special attention to rural areas.
METHODS: To better understand disparities in breastfeeding initiation across North Carolina, we conducted a secondary analysis of birth certificate data from 2011 to 2014. Univariate and multivariate logistic regression models were used to estimate the association between breastfeeding initiation and (a) birth at a Baby-Friendly hospital and (b) maternal residence in a county with a Baby-Friendly hospital. Model residuals were aggregated by county and analyzed for spatial autocorrelation.
RESULTS: Birth at a Baby-Friendly hospital was associated with increased odds of breastfeeding initiation, adjusted odds ratio = 1.7, 95% confidence interval [1.65, 1.89]. Model residuals showed significant clustering by county, with some rural areas' rates systematically overestimated. Whereas presence of a Baby-Friendly hospital in a mother's community of residence was not associated with increased initiation, birth at a Baby-Friendly hospital was associated with smaller disparities in initiation between rural and urban births.
CONCLUSION: Birth at a Baby-Friendly hospital is associated with improved breastfeeding initiation and reduced disparities in initiation between rural and urban counties in North Carolina.
PMID: 30005171 [PubMed - as supplied by publisher]
The time is now: closing the pediatric treatment gap and building resilience among female sex workers and their children.
AIDS. 2018 Jul 12;:
Authors: Ficht AL, Komba A, Bisimba J, Mlanga E, Dastur S, Wheeler T, Srivastava M
Motherhood is common among female sex workers (FSWs) and many have at least one biological child; with low contraceptive use and high burden of unintended pregnancy, they have poor reproductive outcomes and avoidable mother-to-child transmission risk. Globally, there are 2.1 million children living with HIV and antiretroviral treatment coverage is dismally low at 43%. Without timely diagnosis and treatment, half of all children born with HIV will die by the age of two. By integrating services for key populations and their children, prevention of mother-to-child transmission of HIV uptake among FSW mothers and early infant diagnosis can improve and therefore reduce transmission of HIV.This field note addresses the needs of FSWs and their children and advocates for programs to develop and scale-up comprehensive, integrated, stigma-free services for this vulnerable population. Sensitive, confidential, child-friendly, tailored services that protect FSWs while addressing their children are essential to saving these young lives and breaking the transmission cycle of the virus. By siloing programs that neglect children of FSWs, we are missing opportunities and existing entry points to take an innovative, holistic, family approach to care, support, and treatment services that could improve outcomes. Given the high prevalence of HIV in FSWs and other stigmatizing factors which affect access to services, children of FSWs can no longer afford to be left behind and the time is now to prioritize them in current and future HIV programming.
PMID: 30005005 [PubMed - as supplied by publisher]
Assessment of facility readiness for implementing the WHO/UNICEF standards for improving quality of maternal and newborn care in health facilities - experiences from UNICEF's implementation in three countries of South Asia and sub-Saharan Africa.
BMC Health Serv Res. 2018 Jul 09;18(1):531
Authors: Manu A, Arifeen S, Williams J, Mwasanya E, Zaka N, Plowman BA, Jackson D, Wobil P, Dickson K
BACKGROUND: There is a global drive to promote facility deliveries but unless coupled with concurrent improvement in care quality, it might not translate into mortality reduction for mothers and babies. The World Health Organization published the new "Standards for improving quality of care for mothers and newborns in health facilities" but these have not been tested in low- and middle-income settings. UNICEF and its partners are taking the advantage provided by the Mother and Baby Friendly Hospital Initiative in Bangladesh, Ghana and Tanzania to test these standards to inform country adaptation. This manuscript presents a framework used for assessment of facility quality of care to inform the effect of quality improvement interventions.
METHODS: This assessment employed a quasi-experimental design with pre-post assessments in "implementation" and "comparison" facilities-the latter will have no quality improvement interventions implemented. UNICEF and assessment partners developed an assessment framework, developed uniform data collection tools and manuals for harmonised training and implementation across countries. The framework involves six modules assessing: facility structures, equipment, drugs and supplies; policies and guidelines supporting care-giving, staff recruitment and training; care-providers competencies; previous medical records; provider-client interactions (direct observation); and client perspectives on care quality; using semi-structured questionnaires and data collectors with requisite training. In Bangladesh, the assessment was conducted in 3 districts. In one "intervention" district, the district hospital and five upazilla health complexes were assessed. similar number of facilities were assessed each two adjoining comparison districts. In Ghana it was in three hospitals and five health centres and in Tanzania, two hospitals and four health centres. In the latter countries, same number of facilities were selected in the same number of districts to serve for comparison. Outcomes were structured to examine whether facilities currently provide services commensurate with their designation (basic or comprehensive emergency obstetric and newborn care). These outcomes were stratified so that they inform intervention implementation in the short-, medium- and long-term.
CONCLUSION: This strategy and framework provides a very useful model for supporting country implementation of the new WHO standards. It will serve as a template around which countries can build quality of care assessment strategies and metrics to inform their health systems on the effect of QI interventions on care processes and outcomes.
PMID: 29986692 [PubMed - in process]
Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices.
Public Health Nutr. 2018 Jul 05;:1-9
Authors: Flaherman VJ, Chan S, Desai R, Agung FH, Hartati H, Yelda F
OBJECTIVE: Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals.
DESIGN: Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis.
SETTING: Indonesian provinces of Jakarta, Banten and West Java.
SUBJECTS: Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents.
RESULTS: Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme.
CONCLUSIONS: Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.
PMID: 29973298 [PubMed - as supplied by publisher]
Adolescent deliveries in rural Cameroon: comparison of delivery outcomes between primipara and multipara adolescents.
BMC Res Notes. 2018 Jul 03;11(1):427
Authors: Njim T, Agbor VN
OBJECTIVE: Adolescent pregnancies are high risk and deliveries in this age group are usually associated with adverse outcomes. The perception that multiparous adolescents have better delivery outcomes than primiparous counterparts is not uncommon. We sought to determine if multiparous adolescents were precluded from having adverse delivery outcomes when compared to primiparous adolescents. The data used for the analysis is a side product from a published project aimed at mapping the epidemiology of adolescent deliveries in the Oku health district.
RESULTS: From an 8-year (2009-2016) retrospective register analysis of data from two primary healthcare facilities in the Oku health district-a rural area in Cameroon, the prevalence of multiparous adolescent deliveries was 21.5% (78/363). After multivariable analyses, and adjusting for age, sex of baby, gestational age, marital status and HIV status, primiparous adolescents were more likely to have low birth weight infants (LBW) (OR: 3.2; 95% CI 1.1, 9.7; p = 0.04) when compared with multiparous adolescents. Though primiparous adolescents were more likely to have LBW infants than multiparous adolescents, this group of mothers are generally ill-equipped to handle pregnancies and adolescent-friendly programs are necessary to decrease the associated burden.
PMID: 29970162 [PubMed - in process]
Global implications of the new WHO and UNICEF implementation guidance on the revised Baby-Friendly Hospital Initiative.
Matern Child Nutr. 2018 Jul;14(3):e12637
Authors: Aryeetey R, Dykes F
Although breastfeeding confers both short- and long-term benefits for children and their mothers, breastfeeding practice remains suboptimal, globally. In addition to barriers including misperceptions and inappropriate marketing of breast milk substitutes, inadequate support for breastfeeding remains a challenge in many settings. To improve access to appropriate health system support, the World Health Organization (WHO) has reviewed the Baby-Friendly Hospital Initiative (BFHI), which ensures provision of optimal clinical care and support to mothers and their infants. This review has resulted in revision of the Ten Steps to Successful Breastfeeding, which form the core standards of (BFHI). These now consist of critical management procedures to support breastfeeding (Steps 1 and 2) and key clinical practices to support breastfeeding (Steps 3-10). In Step 1, there is now specific emphasis on compliance with the WHO Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions as well as on internal monitoring. There are also significant position shifts like the recommendation to "Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers," which is a departure from the earlier position of avoiding reference to these technologies. These revisions require countries and states to revise activities and tools for their local situation but without compromising the standards.
PMID: 29952432 [PubMed - in process]
Prevalent infant feeding practices among the mothers presenting at a tertiary care hospital in Garhwal Himalayan region, Uttarakhand, India.
J Family Med Prim Care. 2018 Jan-Feb;7(1):45-52
Authors: Rathaur VK, Pathania M, Pannu C, Jain A, Dhar M, Pathania N, Goel R
Introduction: There is paucity of studies on infant feeding practices from the rural areas of garhwal Himalayas of the state of uttarakhand. The present study was designed to assess the infant feeding practices in Garhwal region. Infant feeding practices have significant implications on a child's health. Early nutritional status especially during the first year of life has been shown to have a significant effect on child health and development. Optimal infant feeding practices are crucial for nutritional status, growth, development, health, and ultimately the survival of infants and young children. The study of infant feeding practices is essential before formulation of any interventional programme.
Settings and Design: A study was conducted in HNB Base Hospital and Teaching Institute with the aim to assess the infant feeding practices and the prevalence of malnutrition in the study population reporting at the hospital in garhwal region of uttarakhand.
Methods and Material: This is an observational cross sectional study. 275 infants were included in the study. After taking informed consent, case study forms were filled by interviewing the infants' mothers. Weight, length and head circumference of each infant was also measured. The information thus obtained was compiled, tabulated and analysed statistically.
Results: The study findings revealed that 46.4% infants in the age group 0-5 months were breastfed within 1 hour of birth. 52.8% infants aged 0-5 months of were exclusively breastfed. 33.6% infants in age group 0-5 months received prelacteal feeds. 53.12% infants in age group 6-8 months received solid, semi-solid or soft food, in addition to breast milk. 53.33% infants were partially or fully bottle fed. Age appropriate feeding was found in 56% infants. The percentage of wasting, stunting and underweight in 0-5 months was 33.6%,30.4% and 36.8% respectively . The percentage of wasting, stunting and underweight in 6-11 months was 28%, 26.5% and 30.7% respectively. There appeared to be an association between longer duration of exclusive breastfeeding and lower prevalence of stunting and underweight at 6 months of age.
Conclusions: This study shows that undesirable infant feeding practices are still prevalent in the community. Lower prevalence of stunting and underweight was observed in infants with longer duration of exclusive breastfeeding. A comprehensive plan to address the problems in infant feeding should be formulated. Antenatal counselling of mothers should be done. Revitalization of the Baby Friendly Hospital Initiative(BHFI) in health facilities is recommended.
PMID: 29915732 [PubMed]
Breast-Feeding Friendly, but Not Formula Averse.
Pediatr Ann. 2017 Nov 01;46(11):e402-e408
Authors: Lewis J
Breast-feeding is the optimal source of newborn nutrition in term infants and is associated with multiple short- and long-term health benefits. Establishment of breast-feeding may be difficult in a small subset of mothers, which can lead to adverse consequences in the newborn. Some of the consequences of suboptimal nutritional provision to the newborn, such as severe hyperbilirubinemia and breast-feeding-associated hypernatremic dehydration, can have devastating and long-lasting sequelae. Timely identification of mothers and newborns at risk for developing these complications is necessary to avoid significant morbidity and mortality. In these cases, the judicious use of formula supplementation may be considered. However, more studies are necessary to develop comprehensive formula supplementation criteria and guidelines for pediatric medical providers. [Pediatr Ann. 2017;46(11):e402-e408.].
PMID: 29131919 [PubMed - indexed for MEDLINE]