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Chapter eight, “Infectious Intestinal Disease and Global Public Health,” explores the major challenges to and advances in the control of infectious intestinal diseases since 1970s, when new sets of actors took up the crusade against diarrheal diseases. Physicians and activists organized in response to a spike in infant deaths in the Global South linked to bottle-feeding. Nongovernmental agencies and national politicians encouraged behavioral change to end open defecation. Biomedical scientists developed additional vaccines against poliovirus and rotavirus. Epidemiologists threw new light on the global prevalence of diarrheal diseases and regional disparities in childhood survival rates. The new focus on biomedical interventions and programs of community- or national-level behavioral change constituted a new era in the control of infectious intestinal disease.
To determine current status, areas for improvement and effect of conflict on infant and young child feeding (IYCF) practices among internally displaced persons (IDP) in eastern Ukraine.
Design
Cross-sectional household survey, June 2015.
Setting
Kharkiv, Dnipropetrovsk and Zaporizhia oblasts (Ukrainian administrative divisions) bordering conflict area in Ukraine.
Subjects
Randomly selected IDP households with children aged <2 years registered with local non-governmental organizations. Questions based on the WHO IYCF assessment questionnaire were asked for 477 children. Mid-upper arm circumference was measured in 411 children aged 6–23 months.
Results
Exclusive breast-feeding prevalence for infants aged <6 months was 25·8 (95 % CI 15·8, 38·0) %. Percentage of mothers continuing breast-feeding when their child was aged 1 and 2 years was 53·5 (95 % CI 43·2, 63·6) % and 20·6 (95 % CI 11·5, 32·7) %, respectively. Bottle-feeding was common for children aged <2 years (68·1 %; 95 % CI 63·7, 72·3 %). Almost all infants aged 6–8 months received solid foods (98·6 %; 95 % CI 88·5, 99·9 %). Mothers who discontinued breast-feeding before their infant was 6 months old more often listed stress related to conflict as their primary reason for discontinuation (45·7 %) compared with mothers who discontinued breast-feeding when their child was aged 6–23 months (14·3 %; P<0·0001).
Conclusions
To mitigate the effects of conflict and improve child health, humanitarian action is needed focused on helping mothers cope with stress related to conflict and displacement while supporting women to adhere to recommended IYCF practices if possible and providing appropriate support to women when adherence is not feasible.
To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.
Design
Mothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying.
Setting
The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.
Subjects
Mothers (n 1776).
Results
Repeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001).
Conclusions
More frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed.
Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan.
Design
A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006–2007.
The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0–23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0–5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P < 0·001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P < 0·001).
Conclusions
The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.
To compare infant and young child feeding practices in children aged 0–23 months across nine East and Southeast Asian countries.
Design
Secondary analyses of cross-sectional data from available Demographic and Health Surveys (DHS; Indonesia, Philippines, Timor-Leste, Cambodia and Vietnam), Multiple Indicator Country Surveys (Lao People's Democratic Republic (Lao PDR) and Myanmar) and national nutrition surveys (Democratic People’s Republic of Korea (DPR Korea) and Mongolia) conducted between 2000 and 2005.
Setting
Seven countries from Southeast Asia and two from East Asia.
Subjects
Children aged 0–23 months with samples ranging from 826 to 5610 for DHS, and from 477 to 5860 for non-DHS data.
Results
More than 93 % of infants were ever breast-fed, and over 75 % were currently breast-fed except in the Philippines. Timely initiation of breast-feeding varied from 32 % in Indonesia to 46 % in Timor-Leste. Exclusive breast-feeding (EBF) rate in infants under 6 months of age ranged from 11 % in Myanmar to 60 % in Cambodia. EBF rates were also low in Vietnam (15·5 %) and Lao PDR (23 %), and varied between 30 % and 40 % in Indonesia, Philippines and Timor-Leste. The proportion of infants under 6 months of age who were given breast milk with non-milk liquids was high except in Indonesia and Timor-Leste. Bottle-feeding rates were lower in DPR Korea (3 %), Lao PDR (6 %) and Myanmar (6 %) and higher in the Philippines (49 %) and Mongolia (31 %). Timely complementary-feeding rate varied widely across countries (6–99 %).
Conclusions
All the countries studied should make greater efforts to improve timely initiation of breast-feeding and EBF for 6 months. Measures should be taken to reduce high bottle-feeding rate in the Philippines, Mongolia, Indonesia and Vietnam, and improve complementary-feeding rate in Lao PDR, Myanmar, DPR Korea and Philippines.
To assess rates of initiation of breast-feeding and exclusive breast-feeding within 2 months after delivery and to determine the factors influencing exclusive breast-feeding.
Design
A health worker-administered questionnaire survey was carried out during the time period 1 August–30 September 2005.
Setting
Immunisation clinics of Pokhara, a submetropolitan city in western Nepal.
Subjects
Three hundred and eighty-five mothers who had delivered a child within the previous 2 months.
Results
The rates of initiation within 1 h and within 24 h of delivery were 72.7 and 84.4%, respectively. Within 2 months after delivery, exclusive breast-feeding was practised by 82.3% of the mothers. Breast milk/colostrum was given as the first feed to 332 (86.2%) babies but 17.2% of them were either given expressed breast milk or were put to the breast of another lactating mother. Pre-lacteal feeds were given to 14% of the babies. The common pre-lacteal feeds given were formula feeds (6.2%), sugar water (5.9%) and cow's milk (2.8%). Complementary feeds were introduced by 12.7% of the mothers. By logistic regression analysis, friends' feeding practices, type of delivery and baby's first feed were the factors influencing exclusive breast-feeding practice of the mothers.
Conclusions
Despite the higher rates of initiation and exclusive breast-feeding, practices such as pre-lacteal feeds and premature introduction of complementary feeds are of great concern in this urban population. There is a need for promotion of good breast-feeding practices among expectant mothers and also the community, especially the families, taking into account the local traditions and customs.
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