1.
Paid Family Leave Effects on Breastfeeding: A Quasi-Experimental Study of US Policies.
Hamad, R, Modrek, S, White, JS
American journal of public health. 2019;(1):164-166
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Abstract
Objectives. To test whether paid family leave policies in California and New Jersey improved breastfeeding practices, overall and among key subgroups.Methods. We conducted difference-in-differences analyses, comparing pre-post policy changes in California and New Jersey with changes in states where no paid family leave policies were implemented. We examined a large, diverse sample of children born during 2001 to 2013 (n = 306 266), drawn from the 2003 to 2015 National Immunization Survey waves. Outcomes included ever breastfed, breastfed exclusively at 3 and 6 months, and still breastfed at 6 and 12 months, as well as duration of any breastfeeding and exclusive breastfeeding. We examined heterogeneity in policy response by maternal characteristics.Results. Paid family leave policies resulted in a modestly greater likelihood of exclusively breastfeeding at 6 months. Subgroup analyses were mixed, although several breastfeeding outcomes were consistently improved among married, White, higher-income, and older mothers.Conclusions. Exclusive breastfeeding improved after implementation of paid family leave policies in the overall sample, and additional benefits were noted for more advantaged mothers. This contributes critical evidence to an ongoing policy discussion, suggesting that subsequent paid family leave policies should be designed to target more vulnerable mothers.
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The impact of environmental pollution on the quality of mother's milk.
Pajewska-Szmyt, M, Sinkiewicz-Darol, E, Gadzała-Kopciuch, R
Environmental science and pollution research international. 2019;(8):7405-7427
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Abstract
Breastfeeding is a gold standard of neonate nutrition because human milk contains a lot of essential compounds crucial for proper development of a child. However, milk is also a biofluid which can contain environmental pollution, which can have effects on immune system and consequently on the various body organs. Polychlorinated biphenyls are organic pollutants which have been detected in human milk. They have lipophilic properties, so they can penetrate to fatty milk and ultimately to neonate digestive track. Another problem of interest is the presence in milk of heavy metals-arsenic, lead, cadmium, and mercury-as these compounds can lead to disorders in production of cytokines, which are important immunomodulators. The toxicants cause stimulation or suppression of this compounds. This can lead to health problems in children as allergy, disorders in the endocrine system, end even neurodevelopment delay and disorder. Consequently, correlations between pollutants and bioactive components in milk should be investigated. This article provides an overview of environmental pollutants found in human milk as well as of the consequences of cytokine disorder correlated with presence of heavy metals. Graphical abstract.
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Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial.
Kimani-Murage, EW, Griffiths, PL, Wekesah, FM, Wanjohi, M, Muhia, N, Muriuki, P, Egondi, T, Kyobutungi, C, Ezeh, AC, McGarvey, ST, et al
Globalization and health. 2017;(1):90
Abstract
BACKGROUND Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. METHODS We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant's first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis. RESULTS A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718). CONCLUSIONS EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions. TRIAL REGISTRATION ISRCTN ISRCTN83692672 . Registered 11 November 2012. Retrospectively registered.