Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

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Abstract

Objective

To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes.

Design

Cross-sectional observational study.

Setting

150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific.

Participants

1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017.

Main outcome measures

Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation.

Results

Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose–response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30–59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60–89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF.

Conclusion

EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.

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Most cited references 23

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Early initiation of breastfeeding: a systematic literature review of factors and barriers in South Asia

Indu K. Sharma, Abbey Byrne (2016)

Background Early or timely initiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition however remains low in South Asia and the factors and barriers warrant greater consideration for improved action. This review synthesises the evidence on factors and barriers to initiation of breastfeeding within 1 h of birth in South Asia encompassing Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Methods Studies published between 1990 and 2013 were systematically reviewed through identification in Academic Search Complete, CINAHL, Global Health, MEDLINE and Scopus databases. Twenty-five studies meeting inclusion criteria were included for review. Structured thematic analysis based on leading frameworks was undertaken to understand factors and barriers. Results Factors at geographical, socioeconomic, individual, and health-specific levels, such as residence, education, occupation, income, mother’s age and newborn’s gender, and ill health of mother and newborn at delivery, affect early or timely breastfeeding initiation in South Asia. Reported barriers impact through influence on acceptability by traditional feeding practices, priests’ advice, prelacteal feeding and discarding colostrum, mother-in-law’s opinion; availability and accessibility through lack of information, low access to media and health services, and misperception, support and milk insufficiency, involvement of mothers in decision making. Conclusions Whilst some barriers manifest similarly across the region some factors are context-specific thus tailored interventions are imperative. Initiatives halting factors and directed towards contextual barriers are required for greater impact on newborn survival and improved nutrition in the South Asia region. Electronic supplementary material The online version of this article (doi:10.1186/s13006-016-0076-7) contains supplementary material, which is available to authorized users.

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Infant feeding and feeding transitions during the first year of life.

Jeremy B. Fein, Blake K. Scanlon, L Grummer-Strawn (2008)

Infancy is a time of rapid transition from a diet of virtually nothing but milk (either breast milk or infant formula) to a varied diet from nearly all food groups being consumed on a daily basis by most infants. Despite various recommendations about infant feeding, little is known about actual patterns of feeding among US infants. This article documents transitions in infant feeding patterns across the first year of life and determinants of key aspects of infant feeding. Using data from the Infant Feeding Practices Study II, we analyzed responses to a 7-day food-recall chart that was administered every month. The sample size declined from 2907 at birth to 1782 at 12 months of age. Although 83% of survey respondents initiated breastfeeding, the percentage who breastfed declined rapidly to 50% at 6 months and to 24% at 12 months. Many of the women who breastfed also fed their infants formula; 52% reported that their infants received formula while in the hospital. At 4 months, 40% of the infants had consumed infant cereal, 17% had consumed fruit or vegetable products, and <1% had consumed meat. Compared with infants who were not fed solid foods at 4 months, those who were fed solid foods were more likely to have discontinued breastfeeding at 6 months (70% vs 34%) and to have been fed fatty or sugary foods at 12 months (75% vs 62%). Supplementing breast milk with infant formula while infants were still in the hospital was very common. Despite recommendations that complementary foods not be introduced to infants aged 4 months or younger, almost half of the infants in this study had consumed solid foods by the age of 4 months. This early introduction of complementary foods was associated with unhealthful subsequent feeding behaviors.

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Baby Friendly Hospital Practices: Cesarean Section is a Persistent Barrier to Early Initiation of Breastfeeding

Heather J. Rowe-Murray, Jane Fisher (2002)

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Glob Health

Journal ID (iso-abbrev): BMJ Glob Health

Journal ID (hwp): bmjgh

Journal ID (publisher-id): bmjgh

Title: BMJ Global Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2059-7908

Publication date Collection: 2020

Publication date (Electronic): 6 August 2020

Volume: 5

Issue: 8

Electronic Location Identifier: e002581

Affiliations

[1 ] departmentMaternal, Child Health and Quality and Safety , World Health Organization Regional Office for the Western Pacific , Manila, Philippines

[2 ] departmentMaternal and Child Health Division , Ministry of Health of Solomon Islands , Honiara, Solomon Islands

[3 ] departmentDisease Prevention and Control Bureau , Department of Health , Manila, Philippines

[4 ] departmentDepartment of Medical Service , Mongolia Ministry of Health , Ulaanbaatar, Mongolia

[5 ] departmentDepartment of Health Care and Rehabilitation , Ministry of Health, Lao People's Democratic Republic , Vientiane, Lao People's Democratic Republic

[6 ] departmentDepartment of Population and Family Health Services , Government of Papua New Guinea National Department of Health , Port Moresby, National Capital District, Papua New Guinea

[7 ] departmentDepartment of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London, UK

[8 ] departmentDivision of Global Health Policy and Research , National Center for Global Health and Medicine , Shinjuku-ku, Tokyo, Japan

[9 ] departmentNeonatal Department , Da Nang Hospital for Women and Children , Da Nang, Viet Nam

[10 ] departmentDepartment of Maternal and Child Health , Government of Viet Nam Ministry of Health , Hanoi, Viet Nam

[11 ] departmentDepartment of Maternal Child Health and Nutrition , World Health Organization Country Office for Philippines , Manila, Philippines

[12 ] departmentDepartment of Maternal and Child Health , Office of the WHO Representative in Papua New Guinea , Port Moresby, Papua New Guinea

[13 ] departmentDepartment of Maternal and Child Health , WHO Representative Office Cambodia , Phnom Penh, Cambodia

[14 ] Kalusugan ng Mag-Ina (KMI; translation - Health of Mother and Child) , Quezon City, Philippines

[15 ] departmentDepartment of Maternal and Child Health , Office of the WHO Representative in Laos PDR , Vientiane, Lao People's Democratic Republic

[16 ] International Consultant , Martha’s Vineyard, Massachusetts, USA

[17 ] departmentDepartment of Maternal and Child Health , Office of the WHO Representative in Viet Nam , Hanoi, Viet Nam

[18 ] departmentNational Maternal and Child Health Center , Royal Government of Cambodia Ministry of Health , Phnom Penh, Cambodia

[19 ] departmentDepartment of Communicable Diseases Control , Royal Government of Cambodia Ministry of Health , Phnom Penh, Cambodia

[20 ] departmentDepartment of Maternal and Child Health , Office of the WHO Representative in Solomon Islands , Honiara, Solomon Islands

[21 ] departmentNational Center for Women and Children’s Health, Child Health Care Department , Chinese Center for Disease Control and Prevention , Beijing, China

[22 ] departmentDepartment of Health Systems , Office of the WHO Representative in China , Beijing, China

[23 ] departmentDepartment of Maternal and Child Health , Office of the WHO Representative in Mongolia , Ulaanbaatar, Mongolia

[24 ] departmentUnder-Secretary of State for Health , Royal Government of Cambodia Ministry of Health , Phnom Penh, Cambodia

Author notes

[Correspondence to ] Dr Howard Lawrence Sobel; sobelh@ 123456who.int

Article

Publisher ID: bmjgh-2020-002581

DOI: 10.1136/bmjgh-2020-002581

PMC ID: 7412588

PubMed ID: 32764149

SO-VID: 725ccbb1-b42d-4354-be64-70c776ea7c0e

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 03 April 2020

Date revision received : 27 May 2020

Date accepted : 18 June 2020

Custom metadata

special-feature unlocked

Keywords: child health,maternal health,paediatrics,public health,cross-sectional survey

Data availability:

Keywords: child health, maternal health, paediatrics, public health, cross-sectional survey

Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

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Abstract

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusion

Related collections

Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 23

Early initiation of breastfeeding: a systematic literature review of factors and barriers in South Asia

Infant feeding and feeding transitions during the first year of life.

Baby Friendly Hospital Practices: Cesarean Section is a Persistent Barrier to Early Initiation of Breastfeeding

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