International Breastfeeding Journal最新文献

Background: Breast milk is the ideal and complete food for infants. Demographic, social, economic and clinical factors affect exclusive breastfeeding (EBF). Identifying and understanding these factors can improve breastfeeding success. This study systematically reviews and analyzes the predictors of EBF.

Methods: This study is a systematic review and meta-analysis. we searched electronic databases including PubMed/MEDLINE, Web of Science, PsycINFO, Cochrane, Scopus, EMBASE, Google Scholar, SID, and Magiran. we examined articles published between 2000 to 2023 using keywords like "risk factors", "related factors", "predictive factors", "exclusive breastfeeding ", and "women". The review included observational studies. Two reviewers independently selected the studies extracted data. Quality assessment was based on the Newcastle-Ottawa Scale. The association between predictive factors and breastfeeding was combined in a meta-analysis using a restricted maximum likelihood method (REML). Heterogeneity was quantified using I² and investigated through meta-regression, subgroup, and sensitivity analyses, while publication bias was assessed via a funnel plot.

Result: Thirty eight articles were included in this review. Predictive factors in EBF were categorized into seven groups: mother's awareness of breastfeeding benefits, support received in breastfeeding and child-rearing, early breastfeeding after birth, mother's education level, annual income, mother's age, and prenatal care. Nineteen articles with a sample size of 70,183 were included in the meta-analysis. Results showed that a mother's awareness of breastfeeding benefits increases the odds of EBF by 2.70 times, support in child-rearing by 2.57 times, early breastfeeding (< 24 h) by 1.853 times, higher education level by 1.44 times, self-efficacy by 1.067, multiparity ≥ 2 by 1.50 times, having upper-middle annual income was associated with 28.3% higher than odds of EBF (95% CI 1.68, 1.54), female sex of infant by 1.07 times, and one to three antenatal visits by 0.108 times, (95% CI 1.27, 4.18). In normal vaginal delivery (NVD), the odds increased 2.22 fold, all statistically significant (95% CI 0.91, 5.43).

Conclusion: The maternal awareness of the benefits of breastfeeding, maternal support, early breastfeeding, high education level, and improved family economic conditions are associated with EBF. Therefore, improving the educational, social, and economic levels of mothers improves EBF.

Systematic review registration: PROSPERO CRD42023483049.

Background: Globally, 15 - 20% of all live births are low birthweight (LBW) newborns, and many mothers with LBW newborns experience feeding difficulties. Efforts to understand and mitigate the barriers to breastfeeding among this vulnerable group are urgently needed.

Methods: Mother-newborn pairs were recruited from eight facilities from the government's Saving Little Lives initiative in Amhara Region, Ethiopia. We conducted a qualitative study using in-depth interviews among 30 mothers of LBW newborns (10 with very low birthweight [VLBW, < 1500 gm]; eight with LBW [< 2000 gm] who experienced breastfeeding difficulties, and 12 without difficulties). Data was collected from June to July 2022. The interviews were thematically analyzed to describe the breastfeeding experience, barriers, and facilitators for mothers with and without feeding difficulties.

Results: Despite strong plans to exclusively breastfeed during pregnancy, many mothers of LBW newborns had difficulties initiating and continuing breastfeeding after delivery. Self-reported insufficient milk, suboptimal breastfeeding support in hospitals, prolonged mother-newborn separation in Neonatal Intensive Care Units (NICUs), and limited knowledge of effective feeding techniques were the most common barriers. Further, mothers with multiple births reported greater feeding difficulties; they were more likely to adopt formula feeding compared to those with single births. The primary facilitators of LBW breastfeeding were the synergy between health workers and mothers, mothers' peer counseling, and family support. However, health worker support varied widely across facilities.

Conclusion: The findings from this study provide contextual insights into maternal LBW breastfeeding barriers and facilitators of successful and sustained breastfeeding. For example, creating NICU expectations to minimize maternal-newborn separation, targeting newborns' feeding support for mothers with VLBW newborns and/or multiple births, and designing a standardized protocol for LBW nutritional support to guide health worker support are critically needed.

Background: The World Health Organization recommends Donated Human Milk as the first option if maternal milk is unavailable. In this research, the researchers intend to obtain a set of in-depth information about the experiences of mothers and healthcare workers of human milk bank.

Methods: A content analysis method was used to carry out this meta-synthesis. The modified PECO-S method was used to determine the inclusion criteria. A comprehensive search without a time limit for studies was performed using "milk bank" and related combined keywords. A combination of electronic and manual searches of several databases, including PubMed, Scopus, Science Direct, Embase, Web of Science, and ProQuest, was performed. First, the titles and abstracts were examined by two reviewers. Two researchers used the Joanna Briggs Institute tool to evaluate the quality of the studies. All findings of eligible studies were considered, and the open coding was used for data analysis. The codes were extracted from each article's text. Finally, the concepts were coded again to obtain the themes.

Results: Relevant qualitative studies were reviewed, and a total of 36 articles were subjected to meta-synthesis. The total number of participants included in the studies was 1,389, ranging in age 14-45 years. From the total of 134 extracted codes, 25 subcategories, eight categories, and four main themes were obtained: a) Donating milk, reviving two lives, b) Empathy and all-round support necessary to promote milk donation, c) Receiving donated milk: the paradox of choosing health or disease, and d) Development and facilitation of the infrastructure required to improve milk donation and receiving services.

Conclusions: Based on the study results on the experience of milk donation, educational programs can be designed to encourage milk donation. Empathy and support for encouraging milk donation should be provided at the family, community, and healthcare system. Incorrect beliefs lead to hesitation in accepting donated milk. Health policymakers need to implement actions to correct these negative beliefs. The development and facilitation of milk bank infrastructure are essential for improving milk bank services. It is necessary to update the awareness of community and facilitate the use of milk bank services.

Background: Although breastfeeding provides well-documented benefits for both mothers and infants, breastfeeding rates remain suboptimal in many countries. Despite most women initiating breastfeeding, a significant proportion cease within the first six months, falling short of the recommendations by health authorities. Previous studies have primarily focused on sociodemographic or health-system-related factors; however, the influence of maternal emotional status and infant characteristics has received comparatively less attention. A more integrative approach is needed to understand the complex interplay of factors influencing breastfeeding initiation, early cessation, and duration. This study aims to examine how maternal sociodemographic characteristics, prenatal lifestyle habits, emotional well-being during the perinatal period, and infant characteristics contribute to breastfeeding decisions, early cessation, and duration.

Methods: A longitudinal cohort study followed 397 mother-infant dyads in Tarragona (Spain) from pregnancy through the child's fourth year. The study was conducted between years 2014 and 2021. During pregnancy, we assessed maternal sociodemographic characteristics, health habits, lifestyle factors, and emotional status. At 40 days postpartum, infant temperament was assessed using the Early Infant Temperament Questionnaire. Additional variables were collected throughout the perinatal period, including mode of birth, breastfeeding initiation, early cessation, and total duration of breastfeeding.

Results: Non-smoking during pregnancy (OR:0.239; CI 95%:0.128-0.445) and higher emotional stability in the third trimester (OR:1.066; CI 95%:1.001-1.134) were associated with the decision to initiate breastfeeding. Conversely, lower infant birth weight (OR:0.999; CI 95%:0.998-1.000), lower postpartum emotional stability (OR:0.913; CI 95%:0.840-0.992), and lower infant rhythmicity (OR:0.621; CI 95%:0.386-0.998) were related early cessation of breastfeeding within during the firsts 40 days postpartum. Longer breastfeeding duration was predicted by older maternal age (β:0.370; CI 95%:0.020-0.720), maternal cultural background (β:5.086; CI 95%:0.759-9.413), higher emotional stability (β:0.474; CI 95%:0.074-0.875), infant rhythmicity (β:2.568; CI 95%:0.350-4.784) and infant mood (β:2.915; CI 95%:0.399-5.431).

Conclusion: These findings emphasize the importance of maternal emotional health during the perinatal period and the influence of early infant temperament on breastfeeding outcomes. Interventions aimed at supporting breastfeeding should integrate psychological support for mothers and consider infant behavioral characteristics. A more holistic and personalized approach could improve breastfeeding rates and better align maternal intentions with breastfeeding experiences.

Background: Increasing breastfeeding rates among Aboriginal and Torres Strait Islander (hereafter, respectfully Aboriginal) infants could improve health outcomes that disproportionately affect Aboriginal children into adulthood. This study was undertaken with mothers birthing Aboriginal children in Adelaide, Australia. The study sought to: understand their perceptions, motivations, influences and experiences around breastfeeding; explore factors affecting the ability to breastfeed; perceptions of alternative feeding options; and experiences of care to support breastfeeding.

Methods: Semi-structured Research Yarning interviews were conducted between November 2020 and May 2022 with 30 mothers who birthed an Aboriginal baby within metropolitan Adelaide, Australia, within the previous 18 months. Women were invited to participate if they were enrolled in a larger cohort study known as the Aboriginal Families and Baby Bundles Study, or had antenatal care from the local Aboriginal community controlled health service, were aged 16 and over, and were involved in feeding the child since birth. Three female Aboriginal researchers undertook the Yarning interviews, which were transcribed and analysed thematically.

Results: Participants demonstrated a strong desire to breastfeed and described a range of factors impacting on their ability to establish or maintain breastfeeding. The role of healthcare providers was key to breastfeeding success with participants reporting both positive and negative care experiences. Participants described supportive experiences as those where non-judgemental care was provided that was tailored to their needs, included Aboriginal staff, and provision of continuity of care. Mothers described negative effects of their experiences of racism and ageism (young mothers) from care providers.

Conclusions: Aboriginal women expressed a range of challenges to sustaining breastfeeding that could be addressed by increased investment in provision of timely, non-judgemental postnatal care tailored to their social and cultural needs, including access to specialised lactation care in the hospital and including facilitated continuation of successful breastfeeding at home.

Background: Breastfeeding is described as a cost-effective strategy to improve child survival, growth and development, and reduce the risk of non-communicable diseases later in life. This study aims to provide national estimates for the six breastfeeding indicators set by the World Health Organization and United Nations Children's Fund (WHO/UNICEF) in the Kingdom of Saudi Arabia (KSA) and identify factors associated with inadequate breastfeeding practices in the country.

Methods: A national cross-sectional survey was conducted in KSA's five regions between May and December 2023. Birth registry data were used to randomly select the study sample (n = 9242) Infant and Young Children (IYC) below 24 months of age. Data was collected via phone-based interviews with mothers as main respondents. The 24-h recall approach was used to collect information about the current infant feeding practices.

Results: Results showed that the prevalence of early initiation of breastfeeding (EIBF) and exclusive breastfeeding for the first two days (EBF2D) were 43.4% and 31.3%, respectively. Exclusive breastfeeding (EBF) under six months and mixed milk feeding (MixMF) were reported by 15.5% and 34.9% of mothers, respectively. Only 5.8% of infants aged 5-5.9 months were exclusively breastfed. The prevalence of continued breastfeeding (CBF) in the total sample of mothers was 19.6% and that of ever breastfeeding (EvBF) was 89.3%. Based on multiple logistic regression analyses, lower odds of meeting the breastfeeding indicators were noted amongst IYC of Saudi nationality, first-borns, or those born prematurely or by Cesarean section. Maternal employment/student status was associated with higher odds of MixMF.

Conclusions: This study provided national estimates for the breastfeeding indicators that may serve as a baseline for future surveys, and identified population groups that are at higher risk of inadequate breastfeeding practices. The findings should guide the development of culturally appropriate interventions aimed at protecting, promoting and supporting EIBF and EBF in the hospital, after discharge and during six months after birth, and to raise awareness around the importance of CBF.

Background: The existing literature on breastfeeding in public has primarily concentrated on societal perceptions. However, women are the central figures in breastfeeding in public spaces. In particular, first-time breastfeeding mothers may feel incapable of breastfeeding or may have different perceptions of breastfeeding based on what they see or hear around them. Breastfeeding in public places may be difficult for these mothers. Therefore, it is essential to examine the perceptions of first-time breastfeeding mothers regarding breastfeeding in public to gain a better understanding of their thoughts and concerns, and to identify the factors influencing breastfeeding practices, particularly in public.

Methods: This study was conducted to examine the views, feelings, and thoughts of first-time mothers regarding breastfeeding in public. This qualitative descriptive study was conducted using in-depth, semi-structured interviews at Kahramanmaras Sütcü İmam University Health Practice and Research Hospital in Türkiye between May and September 2024. All interviews were audio-recorded and transcribed. In analysis, the researchers followed Colaizzi's seven-step analysis method and identified and organized clusters of themes from the statements in the transcribed interviews. The MAXQDA software was used for coding and identifying relationships between themes and sub-themes.

Results: Data saturation was reached with 34 participants. The analysis revealed four primary themes and 13 subthemes that represented the views, feelings, and thoughts of first-time mothers: (1) Confronting breastfeeding in public; (2) Challenging emotions related to breastfeeding in public; (3) Demotivating factors for breastfeeding in public; (4) Needs related to breastfeeding in public. The acceptability of breastfeeding in public varied among the participants, with negative narratives being more prevalent. A significant number of participants expressed a desire to avoid societal condemnation, viewing breastfeeding without a cover as improper. Additionally, certain culturally specific beliefs were identified as barriers to breastfeeding in public.

Conclusions: This study found that first-time mothers' views, feelings and thoughts about breastfeeding in public were influenced by the community's attitude. Additionally, the findings underscored the crucial role of culturally specific beliefs in shaping mothers' motivation to breastfeed in public. Therefore, proactive interventions targeting both new mothers and their environment are essential to change mothers' negative perceptions of breastfeeding in public.

Background: Appropriate and timely nutrition during infancy constitutes a critical window of opportunity to ensure proper growth and development. Despite the established benefits of breastfeeding (BF), the proportions of breastfed infants remain disappointingly low in countries of the Gulf Cooperation Council (GCC). Using the Theory of Planned Behavior (TPB), this systematic review aims at examining infant feeding intentions, attitudes, subjective norms, perceived behavioral control and beliefs towards BF amongst women in various countries of the GCC.

Methods: Pertinent data were obtained through a search of peer-reviewed studies published between 2012 and 2024. A total of 12 electronic databases have been searched.

Results: A total of 101 studies were retained. The largest number of studies was from the Kingdom of Saudi-Arabia (80 studies). The results were mapped across the five TPB constructs: intention, subjective norms, attitude, perceived behavioural control and beliefs. Findings showed that, although the intention to BF was high, the intention to exclusively BF was considerably lower. BF was found to align well with the religious norms and social expectations in countries of the GCC. However, factors such as shyness, embarrassment and reticence over BF in public and pumping at work were reported by various studies. There was a negative attitude towards the suitability of BF for working mothers and it was common for women to consider that formula feeding and BF provide equal benefits. Perceived behavior control towards exclusive BF and the sufficiency of breast milk supply was identified as low in several studies, particularly amongst primigravida women and mothers of twins. Women believed that BF in public may expose them to the "evil eye" and that BF may lead to breast sagging.

Conclusions: By identifying opportunities and gaps under each of the TPB constructs, the results of this review may assist in the development of future culture-specific interventions aimed at BF promotion in countries of the region. These include multi-level interventions encompassing the educational system, the media and social media, in addition to community and hospital-based interventions. The results also call for the development of policies tailored to the identified factors in each of the TPB constructs.

Background: Human milk harbors diverse bacterial communities that contribute to infant health. Although pumping and storing milk is a common practice, the viable bacterial composition of pumped milk and the impact of storage practice on these bacteria remains under-explored. This metagenomic observational study aimed to characterize viable bacterial communities in freshly pumped human milk and its changes under different storage conditions.

Methods: In 2023, twelve lactating mothers from the CELSPAC: TNG cohort (Czech Republic) provided freshly pumped milk samples. These samples were stored under various conditions (refrigeration for 24 h, 48 h, or freezing for six weeks) and treated with propidium monoazide (PMA) to selectively identify viable cells. The DNA extracted from individual samples was subsequently analyzed using 16S rRNA amplicon sequencing on the Illumina platform.

Results: The genera Streptococcus, Staphylococcus, Diaphorobacter, Cutibacterium, and Corynebacterium were the most common viable bacteria in fresh human milk. The median sequencing depth and Shannon index of fresh human milk samples treated with PMA (+ PMA) were significantly lower than in untreated (-PMA) samples (p < 0.05 for all), which was true also for each time point. Also, significant changes in these parameters were observed between fresh human milk samples and their paired frozen samples (p < 0.05), while no differences were found between fresh human milk samples and those refrigerated for up to 48 h (p > 0.05). Of specific genera, only + PMA frozen human milk samples showed a significant decrease in the central log-ratio transformed relative abundances of the genera Diaphorobacter and Cutibacterium (p < 0.05) in comparison to + PMA fresh human milk samples.

Conclusions: The study demonstrated that the bacterial profiles significantly differed between human milk samples treated with PMA, which represent only viable bacteria, and those untreated. While storage at 4 °C for up to 48 h did not significantly alter the overall diversity and composition of viable bacteria in human milk, freezing notably affected both the viability and relative abundances of some bacterial genera.

Background: Early initiation of breastfeeding, defined as breastfeeding within one hour of birth, halves the risk of neonatal mortality, establishing it as a crucial outcome component in various interventions implemented across South Asian countries. However, the overall effect of these interventions remain unexamined. Therefore, this study seeks to address this knowledge gap by evaluating the overall effect of these interventions on maternal early initiation of breastfeeding practice.

Methods: A systematic literature search was performed to identify randomised controlled trials conducted in South Asia focusing on early initiation of breastfeeding as an outcome variable. The interventions identified were categorized into behavioral, mobile health (mHealth), health system strengthening, and nutritional interventions. Random effects meta-analysis was conducted to estimate the pooled effect of interventions and effectiveness by intervention categories. Heterogeneity was explored by sub-group and meta-regression analyses. The risk of bias and strength of evidence were assessed by Cochrane's RoB2 assessment tool and GRADE criteria, respectively.

Results: We included 22 articles published, representing 19 unique interventions, from a pool of 2,524 screened records for review and narrative synthesis. Among these, 19 articles were eligible for meta-analysis. The pooled relative risk (RR) of early initiation of breastfeeding among mothers in the intervention groups, as compared to their counterparts, was 1.55 (95% CI: 1.24, 1.95; I² = 99.56; p < 0.001). Interventions targeted health system strengthening represented stronger effect than other types of interventions. The overall strength of evidence was moderate.

Conclusion: The overall intervention effect appeared efficacious in improving maternal early initiation of breastfeeding practice in South Asia, providing valuable insights for policymakers to develop contextually feasible strategies.