Birthing practices of traditional birth attendants in South Asia in the context of training programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes

Does Timely Introduction of Complementary Foods Lead to Improved Nutritional Status? Analysis of Data from Maharashtra, India

Two independent cross-sectional studies on early infant feeding behaviors and practices conducted in Bangladesh (1996) and India (1997-98) were unable to find a statistically significant relationship between the time of introduction of complementary foods and the nutritional status of the children. The results of the India data, presented here, indicate that a primary intervening determinant of the infant's nutritional status is mother's time spent with the child. The weight for age and height for age Z scores increased significantly as mothers' time spent with the child increased. Importantly, increased maternal contact also was associated with later introduction of complementary foods and with longer duration of breastfeeding. Analysis of dietary data also showed some relationship between quality of the food and weight for height z score of the children. The study concludes that while the timing of complementary feeding in and of itself may not lead to improved nutritional status, timely introduction of foods of appropriate quantity and quality in a hygienic environment, along with increased maternal interaction time would likely have desired positive effects on the growth of young children.India, health

Duração do aleitamento materno, regime alimentar e fatores associados segundo condições de vida em Salvador, Bahia, Brasil Breastfeeding duration, infant feeding regimes, and factors related to living conditions in the city of Salvador, Bahia, Brazil

Este trabalho tem como objetivo conhecer a duração do aleitamento materno, regime alimentar e fatores associados segundo condições de vida em Salvador, Bahia, Brasil. Este estudo de prevalência envolve 811 crianças menores de 24 meses. Para analisar os dados utilizou-se análise de sobrevivência, qui-quadrado de Pearson e regressão logística. A duração mediana do aleitamento exclusivo, predominante e total foi de 30,6, 73 e 131,5 dias, respectivamente. Identificou-se que 83,3% das crianças tiveram interrupção precoce do aleitamento exclusivo ou predominante. As crianças de famílias com condições de vida consideradas baixas tinham 2,3 vezes mais chances (IC95%: 1,09-5,01) de consumirem alimentos complementares precocemente; essa chance se elevou para 2,5 (IC95%: 1,20-5,34) entre aquelas de famílias com condições de vida muito baixas. A interrupção precoce do aleitamento exclusivo ou predominante associou-se com a maternidade em idade precoce e as precárias condições de vida das crianças e suas famílias. Programas direcionados à promoção da prática adequada do aleitamento materno e adoção da alimentação saudável na infância devem considerar a relevância dos fatores sociais envolvidos no oferecimento precoce de alimentos complementares à criança.<br>This cross-sectional study aimed to identify breastfeeding duration, infant feeding regimes, and factors related to living conditions among 811 children under 24 months of age in Salvador, Bahia, Brazil. Data were statistically analyzed by survival analysis, Pearson's chi-square test, and multivariate logistic regression. Median duration of exclusive, predominant, and total breastfeeding was 30.6, 73.0, and 131.5 days, respectively. Exclusive or predominant breastfeeding was discontinued in 83.6% of the subjects. Children with poor living conditions were 2.3 times more likely (95%CI: 1.09-5.01) to receive early supplementary food, whereas the figure for the very poor increased to 2.5 (95%CI: 1.20-5.34). Early exclusive or predominant breastfeeding discontinuation was associated with early pregnancy and poor living conditions of the children and their families. Programs directed towards proper breastfeeding and healthy feeding practices in childhood should consider the social factors associated with early introduction of supplementary foods in this population