Employers’ perspective of workplace breastfeeding support in Karachi,Pakistan: a cross-sectional study

Background

Breastfeeding is considered to be an important measure to achieve optimum health outcomes for children, women’s return to work has frequently been found to be a main contributor to the early discontinuation of breastfeeding. The aim of the study is to assess workplace breastfeeding support provided to working mothers in Pakistan.

Method

A workplace based cross-sectional survey was conducted from April through December 2014. Employers from a representative sample of 297 workplaces were interviewed on pre-tested and structured questionnaire. The response rate was 93.7 %. Prevalence of workplace breastfeeding facilities were assessed in the light of World Alliance for Breastfeeding Action (WABA) guidelines.

Results

Among non-physical facilities, all workplaces offered 3 months paid maternity leave, 45 % of the sites were offering task adjustment to mothers during lactation period. Only 15 % of the sites were offering breastfeeding breaks to working mothers. Physical facilities that include a breastfeeding corner, refrigerator for storing breast milk, breast milk pump and nursery for childcare were provided in less than 7 % of the sites. Multinational organizations provided better support compared to national organizations.

Conclusion

Support for continuation of breastfeeding by working women at workplaces is inadequate; hence, women discontinue breastfeeding earlier than planned. Policies need to be developed and enforced, employers and employees need to be educated and supportive environment needs to be created to encourage and facilitate breastfeeding friendly worksite environment.

     

Postpartum women’s perception of antenatal breastfeeding education: a descriptive survey

Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered nurses and nurse technicians (i.e. unit of analysis) on July 2016 (n = 529) and post-training between March and April 2017 (n = 211). A 19-item telephone questionnaire assessed providers’ general knowledge about breastfeeding, breastfeeding benefits and clinical aspects of breastfeeding, clinical ability to solve problems and abilities to overcome breastfeeding challenges. The effects of the training were assessed through a propensity score matching (PSM) stratified by types of providers (i.e. physicians, registered nurses, nurse technicians). The PSM analysis showed significant improvements among all providers in the general knowledge about breastfeeding (around 20 percentage points [pp]) and knowledge about breastfeeding benefits (approximately 50 pp). In addition, physicians improved their knowledge about clinical aspects of breastfeeding (7 pp), while registered nurses improved in their ability to solve breastfeeding problems (14 pp) and in helping mothers overcome breastfeeding challenges (12 pp). Promoting a breastfeeding enabling environment in Mexico to improve breastfeeding rates will require improving the knowledge and skills of healthcare providers. While a semi-virtual training showed large improvements in knowledge, developing skills among providers may require a more intensive approach.     

Mothers’ experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: a mixed-method study

Background

After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age?<?37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers’ experiences of the proactive and reactive telephone support.

Methods

This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student’s t-test and the chi-square test.

Results

Proactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme ‘Empowered by proactive support’. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; ‘Duality of reactive support’.

Conclusion

There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it.

Trial registration

NCT01806480 on 5 March 2013.

     

Measurement of breastfeeding initiation: Ethiopian mothers’ perception about survey questions assessing early initiation of breastfeeding

Background

Although breastfeeding is almost universal in Ethiopia, only 52% newborns benefited from early initiation in 2011. Early initiation is one of the recommended interventions for saving newborn lives but its potential seems not yet realized for Ethiopian newborns and there is a need for continued efforts to increase coverage. To do so, it is also relevant to focus on consistent and accurate reporting of coverage in early initiation.WHO recommends the question “how long after birth did you first put [name] to the breast?” in order to assess coverage in early initiation. It is designed to measure the time after birth when the mother attempted to initiate breastfeeding regardless of whether breast milk had arrived or not. However, it is unclear how mothers perceive this question and what their responses of time refer to. In this study, we assessed Ethiopian mothers’ perception about the question assessing early initiation.

Methods

Cognitive interviews were conducted between April and May 2013 with eligible mothers in Basona and Debrebirhan woredas (districts), 120 km away from Addis Ababa, Ethiopia.

Results

A total of 49 mothers, most from Basona (n =?36) and the rest from Debrebirhan woredas (n =?13) were interviewed. No probes or follow on questions were required for mothers to understand what the WHO recommended question was about. However, further probing was needed to ascertain what maternal responses of time refer to. Accordingly, mothers’ response about the timing of early initiation was related to the first time the newborn received breast milk rather than their first attempt to initiate breastfeeding. In addition, considerable probing was required to approximate and code responses of time based on the WHO coding format because some mothers were unable to assess time in minutes or hours.

Conclusion

The existing question is not adequate to identify intended attempts of mothers to initiate breastfeeding. We recommend revising the question as “how long after birth did you first put [name] to the breast even if your breast milk did not arrive yet?” Standard probes or follow on questions are required to avoid subjective interpretation of the indicator.

     

Towards a new system of costs reimbursement in Dutch long-term care facilities: a confidence-building development?

Against the background of an increasingly ageing society, the Dutch government is redefining its role with regard to providing and financing care for the elderly. This results in restricting the benefits of the Exceptional Medical Expenses Act (AWBZ) to the care for severely dependent elderly - especially old people with dementia - who are in need of long term care that cannot be ensured on the market. In accordance with this policy, geriatric rehabilitation and (medical) care aimed at recovery will be transferred to the basic health insurance. One of the steps towards this restricted coverage of the AWBZ is the introduction of a new, but questionable method of costs reimbursement. Not only does this method lack transparency, it also entails the use of time-consuming, inefficient and bureaucratic questionnaires with a doubtful reliability. The question is raised whether this procedure is a right and trustworthy step to ensure the quality of care for dependent elderly.     

Fetal and neonatal mortality: a matter of care? Report of a survey in Cura?ao,Netherlands Antilles.

A detailed clinicopathological analysis of 223 consecutive fetal and neonatal deaths was carried out in Curaçao during 1984 and 1985; this included careful histological examination of 210 infants (94%). The crude death rate was 34.2 per 1000 total births. Malformation was the principal cause of death in 28 cases, antepartum haemorrhage in 19, hypertension in 25, and asphyxia in 35. Death was caused by problems of preterm birth in 68 cases. No specific cause could be found for 34 deaths. Improvement in the quality of obstetric care might substantially reduce both fetal and neonatal death rates.     

Process-oriented training in breastfeeding for health professionals decreases women’s experiences of breastfeeding challenges

Background

The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women’s satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months.

Methods

An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n?=?540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n?=?162) started before the intervention was initiated. Data for control group B (n?=?172) were collected simultaneously with the intervention group (IG) (n?=?206). Women were also divided into two groups depending on whether they exclusive breastfed?<?3 months or?≥?3 months.

Results

Women in IG were more satisfied with the breastfeeding counselling (p?=?0.008) and felt the breastfeeding counselling was more coherent (p?=?0.002) compared to control groups, when exclusive breastfeeding was?<?3 months. In addition fewer women in the IG, among the group exclusively breastfeeding?<?3 months, had problems with insufficient breast milk compared to the control groups (p?=?0.01).

Conclusion

A process-oriented training for health professionals in support influenced women’s ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting?≥?3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration?<?3 months.

Trial registration

ACTRN12611000354987

     

Hunters’ preferences for engaging in control programs of introduced Eastern cottontails in Italy: a factorial survey approach

In Europe, invasive alien mammals are often controlled by voluntary hunters. However, no research investigated if control operations could be entirely performed by volunteers, nor how to maximize their recruitment. By using the Eastern cottontail (Sylvilagus floridanus) in Central Italy as a case study, we carried out a factorial survey over a sample of hunters (n =?134), exploring which attributes influenced their hypothetical participation to control programs for cottontails. Hunters were more willing to engage in control schemes if these included shooting sessions, not trapping. Moreover, they would have been more prone to control cottontails if they had received evidence of cottontail impacts over native wildlife or local crops. The geographical scale of the management plan and its goals and required efforts did not have any effect over the evaluation of management scenarios. As many European control schemes for invasive alien mammals are carried out in contexts where shooting is unfeasible, like urbanized neighborhoods, our findings show that agencies cannot entirely rely on volunteers and they should complement their limitations with full-time staff. Moreover, if wildlife agencies want to recruit volunteers, they should provide adequate information about the environmental and social impacts of invasive alien mammals.     

Development of livestock production in the tropics: farm and farmers’ perspectives

Because of an increasing demand for animal-source foods, an increasing desire to reduce poverty and an increasing need to reduce the environmental impact of livestock production, tropical farming systems with livestock must increase their productivity. An important share of the global human and livestock populations are found within smallholder mixed-crop–livestock systems, which should, therefore, contribute significantly towards this increase in livestock production. The present paper argues that increased livestock production in smallholder mixed-crop–livestock systems faces many constraints at the level of the farm and the value chain. The present paper aims to describe and explain the impact of increased production from the farm and farmers’ perspective, in order to understand the constraints for increased livestock production. A framework is presented that links farming systems to livestock value chains. It is concluded that farming systems that pass from subsistence to commercial livestock production will: (1) shift from rural to urban markets; (2) become part of a different value chain (with lower prices, higher demands for product quality and increased competition from peri-urban producers and imports); and (3) have to face changes in within-farm mechanisms and crop–livestock relationships. A model study showed that feed limitation, which is common in tropical farming systems with livestock, implies that maximum herd output is achieved with small herd sizes, leaving low-quality feeds unutilised. Maximal herd output is not achieved at maximal individual animal output. Having more animals than required for optimal production – which is often the case as a larger herd size supports non-production functions of livestock, such as manure production, draught, traction and capital storage – goes at the expense of animal-source food output. Improving low-quality feeds by treatment allows keeping more animals while maintaining the same level of production. Ruminant methane emission per kg of milk produced is mainly determined by the level of milk production per cow. Part of the methane emissions, however, should be attributed to the non-production functions of ruminants. It was concluded that understanding the farm and farmers’ perceptions of increased production helps with the understanding of productivity increase constraints and adds information to that reported in the literature at the level of technology, markets and institutions.     

Towards the quantitative characterisation of piglets’ robustness to weaning: a modelling approach

Weaning is a critical transition phase in swine production in which piglets must cope with different stressors that may affect their health. During this period, the prophylactic use of antibiotics is still frequent to limit piglet morbidity, which raises both economic and public health concerns such as the appearance of antimicrobial-resistant microbes. With the interest of developing tools for assisting health and management decisions around weaning, it is key to provide robustness indexes that inform on the animals’ capacity to endure the challenges associated with weaning. This work aimed at developing a modelling approach for facilitating the quantification of piglet resilience to weaning. A total of 325 Large White pigs weaned at 28 days of age were monitored and further housed and fed conventionally during the post-weaning period without antibiotic administration. Body weight and diarrhoea scores were recorded before and after weaning, and blood was sampled at weaning and 1 week later for collecting haematological data. A dynamic model was constructed based on the Gompertz–Makeham law to describe live weight trajectories during the first 75 days after weaning, following the rationale that the animal response is partitioned in two time windows (a perturbation and a recovery window). Model calibration was performed for each animal. Our results show that the transition time between the two time windows, as well as the weight trajectories are characteristic for each individual. The model captured the weight dynamics of animals at different degrees of perturbation, with an average coefficient of determination of 0.99, and a concordance correlation coefficient of 0.99. The utility of the model is that it provides biologically meaningful parameters that inform on the amplitude and length of perturbation, and the rate of animal recovery. Our rationale is that the dynamics of weight inform on the capability of the animal to cope with the weaning disturbance. Indeed, there were significant correlations between model parameters and individual diarrhoea scores and haematological traits. Overall, the parameters of our model can be useful for constructing weaning robustness indexes by using exclusively the growth curves. We foresee that this modelling approach will provide a step forward in the quantitative characterisation of robustness.     

Prevalence of breastfeeding in a baby-friendly pediatric practice in Trieste,Italy: follow up to 36 months of age

Preeclampsia is a global health problem and it is the main cause of maternal and perinatal morbidity and mortality. Breastfeeding has been reported to be associated with lower postpartum blood pressure in women with gestational hypertension. However, there is no published data on the role that breastfeeding might play in preventing preeclampsia. The aim of the current study was to investigate if breastfeeding was associated with preeclampsia in parous women. A case-control study was conducted in Saad Abualila Maternity Hospital in Khartoum, Sudan, from May to December 2019. The cases (n = 116) were parous women with preeclampsia. Two consecutive healthy pregnant women served as controls for each case (n = 232). The sociodemographic, medical, and obstetric histories were gathered using a questionnaire. Breastfeeding practices and duration were assessed. A total of 98 (84.5%) women with preeclampsia and 216 (93.1%) women in the control group had breastfed their previous children. The unadjusted odds ratio (OR) of preeclampsia (no breastfeeding vs breastfeeding) was 3.55, 95% confidence interval (CI) 1.64,7.70 and p value = 0.001 based on these numbers. After adjusting for age, parity, education level, occupation, history of preeclampsia, history of miscarriage, body mass index groups the adjusted OR was 3.19, 95% CI 1.49, 6.82 (p value = 0.006). Breastfeeding might reduce the risk for preeclampsia. Further larger studies are required.     

Reconstructing feminist perspectives of women’s bodies using a globalized view: The changing surrogacy market in Japan

This paper aims to evoke an alternative viewpoint on surrogacy, moving beyond popular Western feminist beliefs on the practice, by introducing the history and current context of East Asian surrogacy. To elaborate a different cultural perspective on surrogacy, this paper first introduces the East Asian history of contract pregnancy systems, prior to the emergence of the American invention of ‘modern’ surrogacy practice. Then, it examines Japanese mass media portrayals of cross-border surrogacy in which white women have become ‘convenient’ entities. The results of the analysis show how Japanese culture has adopted a rhetoric about the use of white women as convenient surrogate mothers in the global commercial surrogacy market. An essential aspect of surrogacy is the premise that a woman’s reproductive function should be accessible to others. Past discussions among feminists have neglected this important point. Moreover, they share the assumption that white surrogacy clients are exploiters, who take advantage of women of colour as surrogate mothers. The current situation in Asia flips this perspective—with white women regarded as easier targets for exploitation by wealthy people of colour. For Asian clients, Westerners can be easily regarded as ‘others’ whom they can use for their reproductive needs. In today's globalized era, the surrogacy industry is no longer for affluent Westerners only. Considering this change, it is crucial to discuss surrogacy issues by reconstructing feminist perspectives with a globalized view, to help protect women’s bodies, regardless of nationality, ethnicity, skin colour, or religion.     

Causes of mortality in a Geoffroy’s cat population—a long-term survey using diverse recording methods

We present quantitative data on the impact of different causes of mortality in a Geoffroy’s cat (Leopardus geoffroyi) population inhabiting a protected area and adjacent cattle ranches in central Argentina. Between December 2000 and January 2009, we used three methods to collect data on causes of mortality in both the park and the ranches: (1) information obtained from 35 radio-collared Geoffroy’s cats monitored from 1 to 19 months; (2) a systematic survey of the areas to find non-collared dead animals; and (3) interviews of qualified informants. Deaths of radio-collared individuals in the park were due to predation by puma (Puma concolor) or starvation, whereas deaths in the ranches were attributed to starvation and predation by domestic dogs. The death of eight emigrant cats was attributed mainly to poaching. Cause of death of 39 non-collared Geoffroy’s cats was determined; deaths in the ranches were mainly due to predation by domestic dogs and poaching, whereas deaths in the park were attributed to predation by puma, poaching, and vehicle collision. Grouping all sources of information, human-related mortality accounted for most (62%) of Geoffroy’s cat deaths recorded during this study, with poaching and predation by dogs being the main causes of mortality. This study in Geoffroy’s cats is the first long-term survey of causes of mortality for a population of a small felid species in South America.     

Comparative morphology of photoreceptors in free-living plathelminths — a survey

In free-living Plathelminthes, the best-known photoreceptors are pigment-cup ocelli, eyes formed of one or several pigmented supportive cells into whose cup-shaped cavity project the light-sensitive elements of one or several sensory cells. Besides these, so-called Sehkolben, photoreceptors lacking pigment granules, are found in some species. Sensory cells in plathelminth photoreceptors most commonly use microvilli as the light-sensitive organelles, but some use cilia and combinations of microvilli and cilia. Lamellate ciliary bodies with cilia whose membranes are strongly flattened and rolled and pericerebral ciliary aggregations with interwoven cilia protruding into an intracellular cavity are likely photoreceptors in that they show amplification of membrane likely to bear photoreceptive pigments. Cells with ballooned cilia and tubular vacuoles are other differentiations to which light-sensitivity has been attributed. A variety of structures serve as lenses, all usually formed from parts of the pigment cell.     

Doctors’ versus patients’ global assessments of treatment effectiveness: empirical survey of diverse treatments in clinical trials

Objective To examine whether doctors’ global assessments of treatment effects agree with patients’ global assessments.Design Survey of trials included in systematic reviews of treatments for diverse conditions.Data sources Cochrane database of systematic reviews.Data extracted Data on patients’ global assessments and on doctors’ global assessment for the same treatment against the same comparator.Main outcome measures Relative odds ratio (ratio of odds ratios of global improvement with the experimental intervention versus control according to doctors compared with patients), and improvement rates according to doctors and patients.Results Doctors’ global assessments were compared with patients’ global assessments for 63 different treatment comparisons (240 trials) in 18 conditions. The summary relative odds ratio across the comparisons was not significant (0.98, 95% confidence interval 0.88 to 1.08; I²=0%, 95% confidence interval 0% to 30%). In 62 of the 63 comparisons the effects of treatment rated by patients and by doctors did not differ beyond chance, but for single comparisons the confidence intervals were large. Rates of improvement on average did not differ between doctors’ assessments and patients’ assessments (summary relative odds ratio 0.98, 0.88 to 1.06; I²=0%, 0% to 24%).Conclusion Doctors’ global assessments of the effects of treatments are on average similar to those of patients.