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Multiprofessional training for breastfeeding management in primary care in the UK
Jennifer Ingram
International Breastfeeding Journal , 2006, DOI: 10.1186/1746-4358-1-9
Abstract: Six UK general practitioner (GP) practices were involved in a questionnaire survey of multiprofessional groups before and after an interactive training session. This focussed on managing and solving problems, particularly mastitis and nipple thrush. The questionnaire included 20 questions on attitudes to and knowledge of breastfeeding, and eight multiple-choice questions on breastfeeding management. Non-parametric statistics (Mann-Whitney, Kruskal-Wallis and Wilcoxon tests) were used to compare the groups and to explore changes in knowledge after training.Fifty primary care health professionals (29 GPs, 18 health visitors, 3 midwives) attended the sessions. There was an increase in scores relating to knowledge about breastfeeding after training, especially for the GPs and for those who did not have their own children. Health visitors improved their scores on recognition of the symptoms of poor attachment at the breast, and GPs showed greatest improvement in resolving sore nipples and recognising nipple thrush.Changes in practice were reported and positive comments made about involving GPs and health visitors together in practice-based education.Using an electronic teaching resource is feasible for updating the knowledge of the primary care team. It can help to improve breastfeeding expertise and advice about breastfeeding problem management.For many years UK government policy has been to increase rates of breastfeeding based on a strong evidence base of the health benefits conferred on mothers and children [1,2]. However, despite a series of initiatives by the Department of Health (DH) to promote breastfeeding, rates have increased only marginally in the past 20 years [3]. Increasing breastfeeding initiation and duration is one of the DH's national targets for improving the health of the population, as set out in the National Service Framework (NSF) for Children (Maternity)[4]. In the National Health Service (NHS) Priorities and Planning Framework 2003–6 Primary Car
A rapid ethnographic study of breastfeeding in the North and South of Italy
Sofia Quintero Romero, Rosa Bernal, Chiara Barbiero, Raquel Passamonte, Adriano Cattaneo
International Breastfeeding Journal , 2006, DOI: 10.1186/1746-4358-1-14
Abstract: The study was conducted in two regions of Italy, Friuli Venezia Giulia in the Northeast and Basilicata in the South. Two hundred and seventy-nine mothers of infants and children 6 to 23 months of age were interviewed using an 85-item questionnaire including closed and open questions on infant feeding experiences and beliefs, sources of information and support, reasons for intended and actual choices and practices, and some demographic and social variables. Face-to-face interviews were conducted between May 2001 and September 2002. Quantitative and qualitative methods were used for data analysis.The distribution of the mothers by age, education, employment and parity did not differ from that of the general population of the two regions. The reported rates of initiation and duration of breastfeeding were also similar: 95% started breastfeeding, exclusive breastfeeding was 32% at three and 9% at six months, with 64% and 35% of any breastfeeding, respectively. Some differences were reported in the rates of full breastfeeding, reflecting different ages of introduction of non-nutritive fluids. These, as well as nutritive fluids – including infant formula – and complementary foods, were introduced far too early. Advice on infant feeding was generally provided by health professionals and often was not based on up-to-date recommendations. Mothers were generally aware of the advantages of breastfeeding, but at the same time reported problems that they were not able to solve alone or through social and health system support. Most mothers would welcome the support of a peer counsellor. More mothers in Basilicata than in Friuli Venezia Giulia reported difficulties with breastfeeding related to returning to work and were not familiar with their rights on breastfeeding and maternity leave.Programmes for the protection, promotion and support of breastfeeding in these and similar regions of Italy should concentrate on better training of health professionals with regards to lactation
Duration of breastfeeding and its determinants in Bangladesh  [PDF]
Mazumder MS and Hossain MK
International Journal of Natural Sciences , 2012,
Abstract: The purpose of this study is to assess the duration of breastfeeding and the factors influencing the duration of breastfeeding in Bangladesh. A total of 4023 mother-child pairs were selected in the study from Bangladesh Demographic and Health Survey (BDHS) 2004. Survival analysis technique (Kaplan Meier, Life table and Cox proportional Hazards model) was employed to investigate the duration and predictor of breastfeeding. The observed mean and median durations of breast-feeding were 30.41 and 35.00 months respectively. Independent effects each of the study variables on duration of breastfeeding were estimated by using Cox's regression model which reveals that the duration of breastfeeding was positively associated with Place of residence, religion of mother and was negatively associated with age at marriage, delivery status, wealth index and maternal education. Younger mothers, mothers from Chittagong and Sylhet division, mothers and having husbands with secondary and higher education, urban mothers, caesarean-section births and Muslim mother were associated with lower duration of breastfeeding. Mothers should be informed about the maternal health benefit of breastfeeding including lactational amenorrhoea, which increases birth interval and maintains good health of the mothers.
Infant feeding practices and breastfeeding duration in Japan: A review  [cached]
Inoue Madoka,Binns Colin W,Otsuka Keiko,Jimba Masamine
International Breastfeeding Journal , 2012, DOI: 10.1186/1746-4358-7-15
Abstract: The Japanese health system places great emphasis on healthy development. However, the prevalence of Exclusive Breastfeeding at one month postpartum between 1980 and 2005 has remained unchanged, fluctuating between 42% and 49%. At the same time, the Any Breastfeeding prevalence has gradually increased from about 80% to 95%. In 2010, the latest national breastfeeding report showed that ‘exclusive’ and ‘any’ breastfeeding rates have improved. However, as the World Health Organization (WHO) definition of breastfeeding practices was not used in this study or in other national surveys, it is difficult to interpret these latest results. While the Japanese government has launched several promotion projects, there have been few studies and reviews of risk factors that influence breastfeeding duration. The objectives of this review were to summarise the factors that have influenced the duration of breastfeeding in Japan to provide information relevant to breastfeeding promotion programs. A search of electronic databases in Japanese and English was undertaken up to 2011. The inclusion criteria for this review were studies that focused on infant feeding practices and targeted Japanese mothers, fathers, or health professionals, but excluded mothers’ friends and peer groups. In total, 12 articles were selected for the final analysis. Smoking status, low birth weight of infants and maternal perceptions of insufficient breast milk supply were negative influences on breastfeeding duration, while support from husbands/partners is associated with continued breastfeeding. Some factors that have been found to be associated with breastfeeding in other countries, including maternal age, family income, maternal educational levels, and living with grandparents of infants have not been confirmed in Japan. While the national breastfeeding rates were higher than other countries of similar health status, inconsistent knowledge of breastfeeding benefits and inappropriate hospital practices remain in Japan may be associated with increased the use of infant formula and reduced breastfeeding duration. Most of the studies reviewed were cross-sectional in design, with only a limited number of cohort studies. Also many published studies used small sample sizes. Cohort studies of infant feeding practices with larger sample sizes are required to monitor trends in rates and risk factors for breastfeeding outcomes.
Factors associated to the duration of exclusive breastfeeding
Osorio Casta?o,Jhon Henry; Botero Ortiz,Beatriz Eugenia;
Investigación y Educación en Enfermería , 2012,
Abstract: objective. to identify the scientific evidence available on factors associated to the duration of exclusive breastfeeding. methodology. a systematic review without meta-analysis was performed. an electronic search strategy was conducted of primary articles published in medline, lilacs, scielo, and ovid from 1990 to 2010 in english, spanish, and portuguese. observational and intervention studies were included, which sought to identify factors associated to the duration of exclusive breastfeeding for at least three months. results. some 195 studies were identified, but only 18 complied with the inclusion and quality criteria. a total of 66.6% measured the prevalence of breastfeeding up to six months. fifty percent reported the use of a pacifier or baby bottle as the negative factor that most affects the duration of exclusive breastfeeding. some 44.4% mentioned as positive factors in the duration of exclusive breastfeeding: high levels of schooling, multiparity, exposure to a breastfeeding program, and low family income. conclusion. literature available provides information on the factors associated to the duration of exclusive breastfeeding, although the methodological heterogeneity of the studies did not permit evaluating the scientific evidence of the results discussed.
Duration of Breastfeeding in Children and Related Factors  [cached]
Hayrullah Alp
Güncel Pediatri , 2009,
Abstract: Aim: This study was conducted to identify the duration of breastfeeding and the factors effecting this in mothers admitted to a state hospital. Materials and Method: The study constituted a total of 600 mothers aged between 18-39 years, who had brought their term-born children to Konya, Saray nü State Hospital Department of Pediatrics for several causes. The study was assessed between 20 January and 15 April 2009 and prepared questionnaire forms have been filled by doctors and nurses using face-to-face interview method with mothers. Results: Median age of the mothers included in the study was 27,3±2,5 years and 96 of the mothers (16%) were between 18-23 years, 169 (28.6%) were between 24-29 years, 202 (33.66%) were between 30-35 years and 133 (22.16%) were between 36-39 years. Of the mothers, 73.33 percent were graduated from primary school, 60.16 percent had a medium monthly income and 73.36 percent had learned the benefits of breastfeeding from the doctors or nurses. The mean duration of breastfeeding increased with increasing mother’s age (in 18-23 age-group, 12.2±0.4 months; in 24-29 age-group, 13.1±0.1 months; in 30-35 age group 13.8±0.8 months; and in 36-39 age group 14.4±0.4 months), and the mean duration of breastfeeding in the monthly income of >2000 TL group was statistically significant than those of the other two income groups. Duration of breastfeeding increases with an increase in mother’s age, number of children, and monthly income of the family; level of education; and learning the benefits of breastfeeding from the doctors or nurses. Conclusion: Factors that affect the breastfeeding and the duration of breastfeeding should be considered for each society and then with the light of this information mothers must be instructed sufficiently for a long and ideal time of breastfeeding to form a healthy population. (Journal of Current Pediatrics 2009; 7: 45-52)
Estimating the duration of full breastfeeding with survival analysis procedure  [cached]
Singh G
Indian Journal of Community Medicine , 2007,
Abstract: Background: Full breastfeeding refers to exclusive breastfeeding, which is the practice of feeding only breast milk excluding water, breast milk substitutes, other liquids and solid foods. `Full breastfeeding for the first six months is the most appropriate infant feeding practice. The duration of full breastfeeding varies considerably among women belonging to different sections of the population. Objective: To estimate the probabilities at various time intervals for the duration of full breastfeeding. Study Design: A group of 102 women who were interviewed at immunization centre in Varanasi in 2004, where they came with their youngest child for vaccination. Women reporting continuance of full breastfeeding (31 %) on the date of interview were considered as censored cases. Survival analysis procedure using life table approach was applied. Result: The median duration of full breastfeeding was found 5.53 months: Relationship between duration of full breastfeeding and practice of breastfeeding (at fixed time or on demand) was also studied. The mean and median duration of full breastfeeding were observed higher in women feeding at fixed time than those on demand of the child, though by log-rank test the difference was found not statistically significant. Conclusions : The observed data do not provide sufficient evidence to establish a relationship between duration of full breast feeding and practice of breastfeeding.
Health professionals' advice for breastfeeding problems: Not good enough!
Lisa H Amir, Jennifer Ingram
International Breastfeeding Journal , 2008, DOI: 10.1186/1746-4358-3-22
Abstract: "Acute mastitis is an all too common disease which has not had the attention it deserves" [1] (p. 635).Mastitis is "an inflammatory condition of the breast, which may or may not be accompanied by infection" [2] (p. 1). Scott et al's paper recently published in the International Breastfeeding Journal shows that health professionals are still giving harmful advice to women with mastitis [3]. Ten percent of women were advised to stop breastfeeding and many were prescribed an inappropriate antibiotic [3]. In practice, we regularly hear stories from women with mastitis about incorrect advice they have been given by their health care providers: overuse of antibiotics, misuse of antibiotics (wrong medicine or wrong dose), advice to stop breastfeeding (either because of the mastitis or "concerns" regarding the effect of maternal medicines on the infant), or misplaced emphasis on maternal rest leading to skipping feeds overnight.Mastitis can be seen as an illustration of health professionals' management of wider breastfeeding issues. Mastitis is a problem experienced by 15 to 20% of breastfeeding women [3-5]; women find it distressing, both physically and emotionally [6,7]. Since it is not always caused by an infection, but may be the result of poor milk drainage, it may not require antibiotics (see Breastfeeding Network leaflet for self-help measures [8]). If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis?Mastitis is poorly researched:- compared to breastfeeding in general, there have been few papers on mastitis; a rough estimate using PubMed to search for "mastitis (limited to humans)" and for "breastfeeding" reveals 45 publications about mastitis and 247 about breastfeeding in 1977 (1:5.5) – 30 years later in 2007, there were 81 publications on mastitis and 1386 on breastfeeding (1:17.1);- there is no agreed definition or diagnostic criteria
Expanding public health professionals’ roles in promoting and supporting breastfeeding as optimal infant feeding: A pilot study with online tutorial implications  [PDF]
Amna Umer, Roger A. Edwards
Open Journal of Preventive Medicine (OJPM) , 2013, DOI: 10.4236/ojpm.2013.32025

Background: Their knowledge of preventive health, coupled with their dynamic roles in the community, puts public health professionals in a key position to expand their roles in the health promotion and support of breastfeeding as optimal infant feeding. This online tutorial was created to increase public health professionals’ knowledge about breastfeeding and to assess their attitudes in supporting healthy behaviors related to infant feeding as a health promotion strategy. Method: The study utilized an online breastfeeding tutorial based on the US Breast-feeding Committee recommendations for minimum breastfeeding knowledge for health professionals. Pre- and post-tutorial questionnaires assessed breastfeeding knowledge, and an attitudinal survey evaluated attitudes of public health professionals after the tutorial. Exposing public health students to this information can facilitate the early shaping of their attitudes and understanding about the importance of breastfeeding. Results: Fifty-two Northeastern University MPH students and alumni (62% response rate) completed the study. There was an overall gain in participants’ fundamental knowledge regarding breastfeeding as assessed by pre- (77%) to post-tutorial (97%) correct responses (p = 0.00001). The post-tutorial attitudinal survey showed that 92% of participants were comfortable in answering questions about breastfeeding as part of their professional responsibilities. Conclusion: This pilot study highlights the important role that a short online tutorial can play in expanding public health professionals’ knowledge about breastfeeding. Greater use of online methods can enhance awareness of critical health behaviors, such as breastfeeding, that have not received adequate attention in public health curricula. This pilot study provides the foundation for a larger study. Integration of breastfeeding into public health professionals’ core training could support broader social change.

Quantiles Regression Approach to Identifying the Determinant of Breastfeeding Duration  [PDF]
Mahdiyah,Wan Norsiah Mohamed,Kamarulzaman Ibrahim
Journal of Applied Sciences , 2008,
Abstract: In this study, quantiles regression approach is applied to the data of Malaysian Family Life Survey (MFLS), to identify factors which are significantly related to the different conditional quantiles of the breastfeeding duration. It is known that the classical linear regression methods are based on minimizing residual sum of squared, but quantiles regression use a mechanism which are based on the conditional median function and the full range of other conditional quantile functions. Overall, it is found that the period of breastfeeding is significantly related to place of living, religion and total number of children in the family.
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