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      Infant feeding practices and determinants of poor breastfeeding behavior in Kinshasa, Democratic Republic of Congo: a descriptive study

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          Abstract

          Background

          Although breastfeeding is almost universally accepted in the Democratic Republic (DR) of Congo, by the age of 2 to 3 months 65% of children are receiving something other than human milk. We sought to describe the infant feeding practices and determinants of suboptimal breastfeeding behaviors in DR Congo.

          Methods

          Survey questionnaire administered to mothers of infants aged ≤ 6 months and healthcare providers who were recruited consecutively at six selected primary health care facilities in Kinshasa, the capital.

          Results

          All 66 mothers interviewed were breastfeeding. Before initiating breastfeeding, 23 gave their infants something other than their milk, including: sugar water (16) or water (2). During the twenty-four hours prior to interview, 26 (39%) infants were exclusively breastfed (EBF), whereas 18 (27%), 12 (18%), and 10 (15%) received water, tea, formula, or porridge, respectively, in addition to human milk. The main reasons for water supplementation included “heat” and cultural beliefs that water is needed for proper digestion of human milk. The main reason for formula supplementation was the impression that the baby was not getting enough milk; and for porridge supplementation, the belief that the child was old enough to start complementary food. Virtually all mothers reported that breastfeeding was discussed during antenatal clinic visit and half reported receiving help regarding breastfeeding from a health provider either after birth or during well-child clinic visit. Despite a median of at least 14 years of experience in these facilities, healthcare workers surveyed had little to no formal training on how to support breastfeeding and inadequate breastfeeding-related knowledge and skills. The facilities lacked any written policy about breastfeeding.

          Conclusion

          Addressing cultural beliefs, training healthcare providers adequately on breastfeeding support skills, and providing structured breastfeeding support after maternity discharge is needed to promote EBF in the DR Congo.

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          Most cited references 10

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          Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year.

          Our goal was to determine why women stop breastfeeding at various times during their infant's first year. We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers approximately 2, 3, 4, 5, 6, 7, 9, 10 1/2, and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding. The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%-55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of or = 9 months of age. Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.
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            Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds.

            The definition of clinically significant hypoglycemia remains one of the most confused and contentious issues in contemporary neonatology. In this article, some of the reasons for these contentions are discussed. Pragmatic recommendations for operational thresholds, ie, blood glucose levels at which clinical interventions should be considered, are offered in light of current knowledge to aid health care providers in neonatal medicine. Future areas of research to resolve some of these issues are also presented.
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              Maternal perceptions of insufficient milk supply in breastfeeding.

              Improving the duration of exclusive breastfeeding is a national and international priority. Insufficient milk supply is one of the most commonly cited reasons for early cessation or decreased exclusivity in women who have initiated breastfeeding. This paper is an integrative review of current research pertaining to perceived insufficient milk (PIM). CINAHL, MEDLINE, and PubMed were searched combining "human milk" and "milk supply" and "perceived milk supply." Articles were limited to original research studies related to healthy, full-term breastfeeding dyads conducted over the past 10 years. Critical review indicated robust findings, limitations, and gaps in this body of literature. A lot of women discontinue breastfeeding during the first few weeks of the post-partum period because of PIM and approximately 35% of all women who wean early report PIM as the primary reason. Many women utilize infant satisfaction cues as their main indication of milk supply and many researchers, clinicians, and breast-feeding women do not evaluate actual milk supply. The relationships between PIM and socioeconomic or demographic variables as well as early breastfeeding behaviors have not been adequately addressed in the literature. Recommendations include improvement of maternal education about behaviors to ensure adequate supply, assessment of milk supply, and infant cues as well as further research into the root causes of PIM. Practitioners involved with maternal child health can improve their care of women and infants by understanding the subjective nature and questionable accuracy of PIM and changing assessment of milk supply.
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                Author and article information

                Contributors
                Journal
                Int Breastfeed J
                Int Breastfeed J
                International Breastfeeding Journal
                BioMed Central
                1746-4358
                2013
                1 October 2013
                : 8
                : 11
                Affiliations
                [1 ]College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH, USA
                [2 ]Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
                [3 ]School of Public Health, The University of Kinshasa, Kinshasa, DR, Congo
                [4 ]Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill NC, USA
                [5 ]School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
                Article
                1746-4358-8-11
                10.1186/1746-4358-8-11
                3850507
                24083882
                Copyright © 2013 Yotebieng et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Research

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