Background In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF. Objectives We evaluated associations between maternal employment and breastfeeding (BF) status. We compared formally and non–formally employed mothers in Naivasha, Kenya, where commercial floriculture and hospitality industries employ many women. Methods We conducted a cross-sectional survey among mothers (n = 1186) from September 2018 to October 2019 at 4 postpartum time points: at hospital discharge (n = 296) and at 6 wk (n = 298), 14 wk (n = 295), and 36 wk (to estimate BF at 24 wk; n = 297) postpartum. Mothers reported their BF status and reasons for EBF cessation. We used multivariable logistic regression models to test the association between formal maternal employment and 3 outcomes: early BF initiation (within 1 h of birth), EBF at each time point, and continued BF at 9 mo. Models were informed by a directed acyclic graph: a causal diagram used to characterize the relationship among variables that influence the independent (employment) and dependent (BF status) variables. Results EBF did not differ by employment status at hospital discharge or at 6 wk postpartum. However, formally employed mothers were less likely than those not formally employed to report EBF at 14 wk (59.0% compared with 95.4%, respectively; AOR: 0.19; 95% CI: 0.10, 0.34) and at 24 wk (19.0% compared with 49.6%, respectively; AOR: 0.25; 95% CI: 0.14, 0.44). The prevalence of continued BF at 36 wk did not differ by group (98.1% for formally employed compared with 98.5% for non–formally employed women; AOR: 0.80; 95% CI: 0.10, 6.08). The primary reasons reported for early EBF cessation were returning to work (46.5%), introducing other foods based on the child's age (33.5%), or perceived milk insufficiency (13.7%). Conclusions As more women engage in formal employment in low- and middle-income countries, additional supports to help prolong the period of EBF may be beneficial for formally employed mothers and their children.
Exclusive breastfeeding (EBF) for the first 6 months of life improves survival, growth and development. In Kenya, recent legislation and policies advocate for maternity leave and workplace support for breastfeeding and breast milk expression. We conducted a qualitative study to describe factors influencing EBF for 6 months among mothers employed in commercial agriculture and tourism. We interviewed employed mothers (n = 42), alternate caregivers and employed mothers' husbands (n = 20), healthcare providers (n = 21), daycare directors (n = 22) and commercial flower farm and hotel managers (n = 16) in Naivasha, Kenya. Despite recognizing the recommended duration for EBF, employed mothers describe the early cessation of EBF in preparation for their return to work. Managers reported supporting mothers through flexible work hours and duties. Yet, few workplaces have lactation spaces, and most considered adjusting schedules more feasible than breastfeeding during work. Managers and healthcare providers believed milk expression could prolong EBF but thought mothers lack experience with pumping. The most frequently suggested interventions for improving EBF duration were to expand schedule flexibility (100% of groups), provide on-site daycare (80% of groups) and workplace lactation rooms (60% of groups), improve milk expression education and increase maternity leave length (60% of groups). Returning to work corresponds with numerous challenges including lack of proximate or on-site childcare and low support for and experience with milk expression. These factors currently make EBF for 6 months unattainable for most mothers in these industries. Interventions and supports to improve breastfeeding upon return to work are recommended to strengthen employed mothers' opportunity for EBF.
Objectives We conducted a non-randomized evaluation of a nutrition education program delivered by Soins de Santé Primaire in rural Senegal to identify the impact of participation on household dietary diversity scores (HDDS). We also sought to understand participant's perceptions of program strengths and weaknesses. Women participated in a single education session that emphasized hygiene, selecting from a variety of food groups, risk awareness of diet-related non-communicable diseases, and a recipe demonstration of a locally-sourced, balanced meal. We hypothesized that program participation would be associated with increased HDDS. Methods We surveyed 20 female program participants sampled from two communities and compared their responses with 20 women sampled from two non-intervention communities (n = 40). Surveys collected 24-hour dietary recall to calculate a dietary diversity score using the 12-point HDDS scale. The mean difference in HDDS was evaluated between post-program and comparison groups using linear regression. Models controlled for household size, employment, education, marital status, and the Food Insecurity Experience Scale. We conducted key informant interviews with post-program participants (n = 19) to understand message recall, reported behavior change, and feedback for future sessions. Results Women in intervention households reported higher HDDS than comparison households [Mean (SE) = 9.0 (0.39) vs. 7.65 (0.24), P = .003]. In the adjusted model, program participation was positively associated with HDDS (β = 1.16, P = .041). Household food insecurity was associated with lower HDDS (β = −0.52, P = .024). Program participants recalled the importance of reducing bouillon cube usage and eating from each food group. Participants reported changes in food preparation and hygiene routines, such as adding more beans or vegetables and changing dirty dishwater often. The key improvement suggestion was to increase session frequency and expand education on hygiene and sanitation. Conclusions Low intensity nutrition education programs that include meal demonstrations may be a low-cost, effective method for improving dietary diversity among a population with moderate food insecurity in rural Senegal. Funding Sources World Renew, Services Luthériens pour le Developpement au Sénégal, and the Wheaton Human Needs and Global Resources Program.
Objectives Kenya has legislation and policies on maternity leave and workplace support for breastfeeding (BF), and breastmilk expression. The extent to which this framework influences the BF practices of low-wage mothers is unknown. The purpose of this study was to understand the influences of EBF for 6 mo among mothers employed in the commercial agriculture and tourism industries. Methods We conducted in-depth interviews with employed mothers (n = 25), husbands of employed mothers (n = 10), managers of commercial flower farms and hotels (n = 8), daycare directors (n = 22), and health care providers (n = 20) in Naivasha, Kenya. Results Despite a widespread recognition of the recommended 6 months duration for EBF, employed mothers describe early cessation of EBF in preparation for their return to work, following a mandated 3-mo maternity leave. Husbands of employed women support EBF and would like to see the duration of EBF extended, but note similar challenges. Managers support lactating mothers through flexible work schedules and duties, yet few farms or hotels have designated lactation areas, and most recognize that mothers prefer to arrive later or leave early rather than visit children to feed during the workday. Daycare directors describe lack of refrigeration for expressed milk, and low interest from mothers in leaving expressed milk to feed their children during the workday. Employers with on-site housing and/or daycare report a more favorable environment to support EBF. Health care providers perceive low-wage, maternal employment as a challenge to 6 months of EBF, yet see childcare and a strengthened continuum of education from antenatal care to immunization services and community outreach as opportunities to improve EBF promotion. Conclusions Beliefs about optimal BF practices do not align with practice. Mothers employed in low-wage work receive some benefits from their employers to support child care responsibilities, but distance from daycare, a low efficacy for expressing and storing milk, and lack of support for milk expression currently make EBF unattainable for most mothers in these industries. Interventions to improve the desirability and feasibility of milk expression are needed to strengthen the opportunity for EBF for employed mothers. Funding Sources Fogarty International Center, National Institutes of Health.
The traditional dietary habits of differing ethnic groups vary greatly; concomitantly nutritional intakes are also likely to vary. Knowledge of differences in nutritional intakes between ethnic groups is important for understanding associated health risks. There is limited data on dietary intakes and patterns of South Asian populations. The aim of this study was to compare nutritional intakes of two ethnic groups; Caucasian (Cauc) and South Asian (SA).Healthy Cauc and SA women, aged 20-64yrs, were recruited from the county of Surrey onto the D2-D3 study (1)(2)(3) and a sub-set of these women were used in these analyses: n47 Cauc and n47 SA women. Anthropometrics and four-day food diaries were collected at baseline, as part of the D2-D3 study. Under-reporting of dietary intakes were determined by calculating energy intake (EI) to basal metabolic rate (BMR) ratio, and ratios below 1·35 were classified as under-reported (4) . Dietary and statistical analyses were carried out using DietPlan6(2013) and SPSS21(2013) respectively.The Cauc women had significantly smaller waist circumferences than the SA women (Cauc:79·44 ± 11·33 cm vs. SA:87·62 ± 12·62 cm; p < 0·001), however BMI was not significantly different (Cauc: 24·60 ± 3·75 kg/m 2 vs. SA: 25·18 ± 3·85 kg/m 2 ). As shown in Table 1, there were significantly lower daily intakes of micro-nutrients in the SA women compared to the Cauc women.Under-reporting of dietary intakes was present in 46·8% of Cauc women and 57·4% of SA women, however there was no significant difference between ethnic groups (EI:BMR ratios: Cauc:1·40 ± 0·34; SA: 1·29 ± 0·38).These data suggest that although macro-nutrient intakes of these ethnic groups are similar, the foods from which these are sourced are likely to be different, thus contributing to the differences shown in micro-nutrient intakes. These differences in diets between the ethnic groups could be a contributing factor in the differing health and disease rates between ethnicities. The levels of under-reporting across both ethnic groups were high but nonetheless lower than those reported in our National surveys. Further analysis of the data is currently underway to investigate differences in intake when adjusted for total energy intake given
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.