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Journal of Tropical Pediatrics. 2007 Apr; 53(2):125-130.Health experts worldwide recognize breastmilk as the superior infant food. Recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) identify exclusive breastfeeding for the first half-year of life and continuation of breastfeeding into toddlerhood as offering maximum protection from illness, providing a substrate for immunological protection. Data from developed countries identify increasing morbidity and mortality rates for infants who have never received breastmilk in life and demonstrate that infants benefit from exclusive breastfeeding, especially, in areas of severe poverty. Preterm infants, most at risk for morbidity and mortality in developing countries, are identified as needing their own mother's milk for survival. Exclusive feeding of own mothers' milk (OMM) is associated with improved infant survival; however, inadequate maternal milk volume (MMV) often necessitates adding artificial feedings or exogenous substances to OMM. The objective of this study was to compare mean daily MMV for mothers of premature or sick infants in special care nurseries (SCN) using one of three methods of OMM expression: electric breast pump, non-electric pedal breast pump, and hand (manual) expression. We studied 65 mothers whose infants were cared for in two SCN in Africa (Kenya and Nigeria) and were unable to feed directly at the breast. In this randomized trial, mothers were randomly assigned to one of three milk expression groups at birth. MMV, the dependent variable, was measured for an average of 8.7 days. MMV for the electric and pedal pump and hand milk expression was 578 ± 228 ml (n = 22), 463 ± 302 ml (n = 24) and 323 ±199 ml (n = 19), respectively. Data were evaluated using a one-way ANOVA (p = 0.014). The Tukey revealed significant differences (p<0.01) between electric breast pump expression and hand expression but not between the electric and pedal pump or the pedal pump and hand expression. Findings revealed greater MMV with electric breast pumps than hand-expression for mothers of infants in African nurseries. This data has important implications for international policy if exclusive OMM feeding is to be achieved for the vulnerable infant. Funded by West Virginia University Department of Research and Graduate Studies HSC Grant # 2U023U; Non-monetary donations of breast pumps and breast pump kits were made by Medela. (author's)
Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
International Breastfeeding Journal. 2006 Mar 9; 1(1):2.To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workershad concerns about early cessation of breastfeeding. Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions. (author's)
Feeding of nonbreastfed children from 6 to 24 months of age: Conclusions of an informal meeting on infant young child feeding organized by the World Organization, Geneva, March 8-10, 2004.
Food and Nutrition Bulletin. 2004; 25(4):403-406.According to current United Nations recommendations, infants should be exclusively breastfed for the first six months of life and thereafter should receive appropriate complementary feeding with continued breastfeeding up to two years or beyond. However, there are a number of infants who will not enjoy the benefits of breastfeeding in the early months of life or for whom breastfeeding will stop before the recommended period of two years or beyond. A group that calls for particular attention consists of the infants of mothers who are known to be HIV positive. To reduce the risk of HIV transmission, it is recommended that when it is acceptable, feasible, affordable, sustainable, and safe, these mothers give replacement feeding from birth. Otherwise, they should breastfeed exclusively and stop as soon as alternative feeding options become feasible. Another group includes those infants whose mothers have died, or who for some reason do not breastfeed. (excerpt)
Lancet. 2006 Nov 25; 368(9550):1868-1869.Exclusive breastfeeding for 6 months is the normal way to feed all infants. The new WHO growth reference released in April, 2006, is based on breastfed infants under optimum conditions. The sample is highly selected for the factors likely to promote growth in breastfed infants, and less than 10% of those initially surveyed were included in the final study. Most mothers and health professionals are concerned about their infants' growth, particularly for the first 6 months. If they believe their infants are not growing adequately, they are more likely to introduce supplementary foods, including "top-ups" with infant formula or even switching to formula completely. "Insufficient milk" is the most common reason for the early cessation of breastfeeding and mothers often self-diagnose this on the basis of perceived slower growth. (excerpt)
Weaning practices of the Makushi of Guyana and their relationship to infant and child mortality: A preliminary assessment of international recommendations.
American Journal of Human Biology. 2006 May-Jun; 18(3):312-324.The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life, primarily because of potential immunological benefits which are deemed to outweigh nutritive costs for infants. This recommendation is controversial, as studies of the relationship between the term of EBF and infant and child health have produced conflicting results. The purpose of this paper is to evaluate the relationship between the term of EBF and infant and child mortality among a group of swidden-horticulturalists in lowland South America. Consistent with the WHO, we hypothesized that EBF < 6 months will compromise the survival of the infant or child. This relationship was assessed via recall data generated in 2001 in structured interviews with 60 Makushi Amerindian women in Guyana's North Rupununi region. The data were analyzed with t-tests, Fisher's exact test, and logistic regression. The results do not support our hypothesis; the term of EBF is not found to be related to infant or child mortality. This is surprising given the potential for contamination in nonbreast-milk foods in this environment. Notably, this is occurring among mothers who are not energetically stressed. We propose that the apparent lack of benefit of EBF = 6 months is due to insufficient energy supply from breast milk alone, which may predispose the child to morbidity when subsequently stressed. This study concurs with others which revealed no significant benefits to the infant of EBF > 6 months, and the recognition that universal recommendations must be situated within local ecological contexts. (author's)
Indian Journal of Community Medicine. 2006 Jun; 31(2):65.WHO and other international agencies has recommended that mother should breast feed the children exclusively for 4-6 month from birth and continue breast feeding along with appropriate supplemental food up to second year. Breast feeding should be initiated within an hour of birth instead of waiting several hours as is often customary. Although there is little milk at that time, it helps to establish feeding and a close mother-child relationship, known as "bonding". A community based study was conducted in the area of Experimental Teaching Health Sub Centres, Mati and Banthra under the Rural Health Training Centre, Sarojini Nagar, Department of community Medicine, K, G. Medical University, Lucknow. 200 lactating mothers were interviewed using a pre tested proforma to collect information regarding sociodemographic characteristics, current feeding practices, time of initiation of breast feeding and colostrum given to the new borns. (excerpt)
Technical updates of the guidelines on Integrated Management of Childhood Illness (IMCI): evidence and recommendations for further adaptations.
Geneva, Switzerland, WHO, 2005.  p.It is over seven years since IMCI has been introduced and much has been learnt through the adaptation and implementation processes in countries. The Department of Child and Adolescent Health and Development (CAH) and other institutions have undertaken work to evaluate the evidence base for the technical guidelines of the IMCI strategy. Research results are emerging with potential implications for updating the technical guidelines of IMCI. In 2001 CAH, jointly with Roll Back Malaria, organized a technical consultation to examine the evidence base for the IMCI strategy for the management of malaria and other febrile illnesses including measles and dengue haemorrhagic disease. This international consultation came up with recommendations to improve the guidelines, as well as specific recommendations for operational research. Following the technical consultation, CAH held a series of meetings within the Department at HQ in addition to consultations with regional office staff where the updating process was discussed. In 2004 it was recommended that CAH finalize the IMCI updates on the basis of the best available evidence and country programme feedback, prioritizing those updates most likely to reduce child mortality. (excerpt)
Health Care for Women International. 2005 Aug; 26(7):534-554.In this article, we examine the National Breastfeeding Policy in Nigeria, the extent to which the law guarantees and protects the maternity rights of the working mother, and the interplay between the law and the National Breastfeeding Policy. Our aim is to make people aware of this interplay to lead to some positive efforts to sanitize the workplace and shield women from some of the practices against them in employment relations in Nigeria as well as encourage exclusive breastfeeding by employed mothers. We conclude that the provisions of the law in this regard are not in accord with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the 6 months as propagated by Baby Friendly Hospital Initiative (BFHI) and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations. We, therefore, suggest a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations. It is hoped that such laws will not only limit some of the practices against women in employment but also will encourage and promote exclusive breastfeeding behaviour by employed mothers. (author's)
Nutritional Surveillance Project Bulletin. 2001 Jul; (6):1-4.The transition from being exclusively breast-fed to eating the same food as the family is crucial in the life of a young child. The World Health Organization and UNICEF recommend that infants should be exclusively breast-fed for the first 6 months of life and that breastfeeding should continue well into the second year of life. From 6 months of age infants should be given frequent small complementary meals that are rich in micronutrients, protein and energy. Findings from the Nutritional Surveillance Project indicate that, while breastfeeding is sustained, infants are rarely given foods containing micronutrients and protein, even when these foods are available in the household. This suggests that there is potential to improve infants’ diets by making better use of the foods already available in the household. Breast-milk and a good mixture of well-prepared family food can meet the needs of young children during this vulnerable time. (author's)
Washington, D.C., Pan American Health Organization [PAHO], Division of Health Promotion and Protection, Food and Nutrition Program, . 37 p.Adequate nutrition during infancy and early childhood is fundamental to the development of each child’s full human potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development. Longitudinal studies have consistently shown that this is the peak age for growth faltering, deficiencies of certain micronutrients, and common childhood illnesses such as diarrhea. After a child reaches 2 years of age, it is very difficult to reverse stunting that has occurred earlier. The immediate consequences of poor nutrition during these formative years include significant morbidity and mortality and delayed mental and motor development. In the long-term, early nutritional deficits are linked to impairments in intellectual performance, work capacity, reproductive outcomes and overall health during adolescence and adulthood. Thus, the cycle of malnutrition continues, as the malnourished girl child faces greater odds of giving birth to a malnourished, low birth weight infant when she grows up. Poor breastfeeding and complementary feeding practices, coupled with high rates of infectious diseases, are the principal proximate causes of malnutrition during the first two years of life. For this reason, it is essential to ensure that caregivers are provided with appropriate guidance regarding optimal feeding of infants and young children. (excerpt)
New York, New York, UNICEF, 1999 Aug.  p.If every baby were exclusively breastfed from birth, an estimated 1.5 million lives would be saved each year. And not just saved, but enhanced, because breastmilk is the perfect food for a baby's first six months of life - no manufactured product can equal it. Virtually all children benefit from breastfeeding, regardless of where they live. Breastmilk has all the nutrients babies need to stay healthy and grow. It protects them from diarrhoea and acute respiratory infections - two leading causes of infant death. It stimulates their immune systems and response to vaccinations. It contains hundreds of health-enhancing antibodies and enzymes. It requires no mixing, sterilization or equipment. And it is always the right temperature. Children who are breastfed have lower rates of childhood cancers, including leukaemia and lymphoma. They are less susceptible to pneumonia, asthma, allergies, childhood diabetes, gastrointestinal illnesses and infections that can damage their hearing. Studies suggest that breastfeeding is good for neurological development. And breastfeeding offers a benefit that cannot be measured: a natural opportunity to communicate love at the very beginning of a child's life. Breastfeeding provides hours of closeness and nurturing every day, laying the foundation for a caring and trusting relationship between mother and child. (excerpt)
Length of exclusive breastfeeding: linking biology and scientific evidence to a public health recommendation.
Journal of Nutrition. 2000; 130:1335-1338.The objective of this commentary is to briefly review key issues related to i) the uses of energy balance vs. growth to determine the recommended length of extended breast feeding; ii) the merits as well as criticisms of the most recent scientific evidence on its recommended length; and iii) the conceptual and practical issues in using this information to make a public health recommendation. (excerpt)
Optimal duration of exclusive breast feeding in low income countries. Six months as recommended by WHO applies to populations, not necessarily to individuals [editorial]
BMJ. British Medical Journal. 2002 Nov 30; 325(7375):1252-1253.The recent policy debate considered whether a single age—for example, 6 months—would be appropriate as a global recommendation or if an age range would accommodate individual and regional variability better. It is important to separate recommendations for populations from those for individuals. A WHO expert consultation recommended exclusive breast feeding for six months, emphasising that this recommendation applies to populations while recognising that some mothers will be unable to, or choose not to, follow it. In our view this recommendation is appropriate given the available evidence. A recommendation for an age range would be open to misinterpretation and commercial pressure from the infant formula industry. Evidence shows that exclusive breast feeding for six months is feasible and is acceptable to mothers in low income countries, as shown by the success of programmes promoting exclusive breast feeding and in the positive trends in the duration of exclusive breast feeding in many low income countries. At the same time means to ensure the adequacy of iron and zinc intake and to reduce HIV transmission in exclusively breast fed infants need to be sought. (excerpt)
Indian Pediatrics. 2001 May; 38(5):565-567.This article presents conclusions and recommendations of the WHO Expert Consultation based on the results of a systematic review of scientific evidence on the optimal duration of exclusive breastfeeding.
Early breastfeeding cessation as an option for reducing postnatal transmission of HIV in Africa: issues, risks, and challenges.
Washington, D.C., Academy for Educational Development [AED], 2001 Aug. 40 p.This document examines the recent WHO recommendations for modifying breastfeeding to reduce postnatal transmission of HIV in Africa. Specifically, it reviews the three-stage strategy for "modified breastfeeding" for HIV- positive mothers that involves exclusive breastfeeding followed by an early transition to exclusive replacement feeding. Organized into six chapters, this document also describes a step-by-step process for making the transition from exclusive breastfeeding to exclusive replacement feeding. However, many of the behaviors discussed in this review represent a major change in traditional infant care practices in Africa, and their feasibility and impact on child survival have yet to be determined. It is recommended, therefore, that these guidelines be subjected to additional research and testing before being implemented.