The importance of mother’s care for improving exclusive breastfeeding practices

ABSTRAKLatar Belakang: Secara global, prevalensi ibu yang memberikan ASI (air susu ibu) secara eksklusif untuk bayinya sampai dengan usia 6 bulan masih rendah (38%). Di Indonesia, pemberian ASI sudah dipraktikkan secara luas, namun yang memberikan hingga 6 bulan hanya 15,3% dan belum meningkat, meskipun Panduan Pemberian Makan Bayi dan Anak dari WHO telah tersedia.Tujuan: Studi ini bertujuan untuk menginvestigasi pentingnya pengasuhan oleh ibu (yaitu ibu memiliki peran terbesar dan menghabiskan waktu terbanyak untuk merawat bayinya sehari-hari) untuk meningkatkan praktik ASI Eksklusif pada populasi dengan tingkat ekonomi rendah.Metode: Studi cross-sectional ini dilakukan pada 408 anak usia 6 - 24 bulan dan pengasuhnya di daerah pedesaan Indonesia. Data riwayat ASI, pengasuhan anak, dan status sosio-ekonomi diambil dengan instrumen kuesioner terstruktur oleh pewawancara yang terlatih.Hasil: Lebih dari setengah (61%) Ibu di populasi ini memberikan ASI secara eksklusif pada bayinya sampai dengan usia 6 bulan. Hasil menunjukkan bahwa bayi mempunyai kesempatan yang lebih besar untuk diberikan ASI eksklusif jika diasuh oleh ibu kandungnya (OR = 4.6., 95% CI = 1.75 - 12.2) dan berasal dari keluarga dengan penghasilan rendah (OR = 1.9 95% CI = 1.08 - 3.2), setelah mengendalikan variabel lain.Kesimpulan: Pada populasi berpenghasilan rendah dimana praktik pemberian ASI telah dilakukan, tetapi pengasuhan anak dilakukan oleh seseorang selain ibu kandung, pentingnya pemberian ASI eksklusif harus terus ditekankan. Edukasi untuk meningkatkan motivasi ibu dan anggota keluarga lainnya dalam memberikan ASI, serta membangun lingkungan kerja yang ramah menyusui adalah hal yang penting untuk dilakukan.KATA KUNCI: ASI eksklusif; pengasuh; ibu kandung; tingkat ekonomi; Indonesia Timur ABSTRACTBackground: Globally, the prevalence of women who exclusively breastfeed their infants to 6 months of age remains low (38%). In Indonesia, breastfeeding is widely practiced but the prevalence of exclusive breastfeeding at 6 months is only 15,3% and has not increased over time, despite WHO IYCF guidelines.Objectives: This study aims to examine the importance of mother’s care for improving exclusive breastfeeding practices in low-income populations in Indonesia.Methods: This cross-sectional study was conducted using 408 children aged 6 - 24 months and their caregivers in rural Indonesia. five districts. Data on breastfeeding history, childcare, and socioeconomic status of families were collected using structured questionnaires by trained interviewers.Results: Over half (61%) of mothers in this population exclusively breastfed their infant at 6 months (?) Results showed that infants are more likely to receive exclusive breastfeeding if they were cared by biological mothers (OR = 4.6., 95% CI = 1.75 - 12.2) and reside in low-income households (OR = 1.9 95% CI = 1.08 - 3.2), after adjusting for confounding variables.Conclusion: In low-income populations where breastfeeding is common but the provision of child care is provided by someone besides the biological mother, the importance of exclusive breastfeeding should continue to be emphasizedKEYWORDS: exclusive breastfeeding; caregivers; biological mothers; economic level; Eastern Indonesi

A Field Training Guide for Human Subjects Research Ethics

Maria Merritt and colleagues report on a Field Training Guide for Human Subjects Research Ethics that they have developed to help train field workers in ethics for research

A cluster-randomized, placebo-controlled, maternal vitamin a or beta-carotene supplementation trial in bangladesh: design and methods

<p>Abstract</p> <p>Background</p> <p>We present the design, methods and population characteristics of a large community trial that assessed the efficacy of a weekly supplement containing vitamin A or beta-carotene, at recommended dietary levels, in reducing maternal mortality from early gestation through 12 weeks postpartum. We identify challenges faced and report solutions in implementing an intervention trial under low-resource, rural conditions, including the importance of population choice in promoting generalizability, maintaining rigorous data quality control to reduce inter- and intra- worker variation, and optimizing efficiencies in information and resources flow from and to the field.</p> <p>Methods</p> <p>This trial was a double-masked, cluster-randomized, dual intervention, placebo-controlled trial in a contiguous rural area of ~435 sq km with a population of ~650,000 in Gaibandha and Rangpur Districts of Northwestern Bangladesh. Approximately 120,000 married women of reproductive age underwent 5-weekly home surveillance, of whom ~60,000 were detected as pregnant, enrolled into the trial and gave birth to ~44,000 live-born infants. Upon enrollment, at ~ 9 weeks' gestation, pregnant women received a weekly oral supplement containing vitamin A (7000 ug retinol equivalents (RE)), beta-carotene (42 mg, or ~7000 ug RE) or a placebo through 12 weeks postpartum, according to prior randomized allocation of their cluster of residence. Systems described include enlistment and 5-weekly home surveillance for pregnancy based on menstrual history and urine testing, weekly supervised supplementation, periodic risk factor interviews, maternal and infant vital outcome monitoring, birth defect surveillance and clinical/biochemical substudies.</p> <p>Results</p> <p>The primary outcome was pregnancy-related mortality assessed for 3 months following parturition. Secondary outcomes included fetal loss due to miscarriage or stillbirth, infant mortality under three months of age, maternal obstetric and infectious morbidity, infant infectious morbidity, maternal and infant micronutrient status, fetal and infant growth and prematurity, external birth defects and postnatal infant growth to 3 months of age.</p> <p>Conclusion</p> <p>Aspects of study site selection and its "resonance" with national and rural qualities of Bangladesh, the trial's design, methods and allocation group comparability achieved by randomization, field procedures and innovative approaches to solving challenges in trial conduct are described and discussed. This trial is registered with <url>http://Clinicaltrials.gov</url> as protocol NCT00198822.</p

Development and Management of a Geographic Information System for Health Research in a Developing-country Setting: A Case Study from Bangladesh

In the last decade, geographic information systems (GIS) have become accessible to researchers in developing countries, yet guidance remains sparse for developing a GIS. Drawing on experience in developing a GIS for a large community trial in rural Bangladesh, six stages for constructing, maintaining, and using a GIS for health research purposes were outlined. The system contains 0.25 million landmarks, including 150,000 houses, in an area of 435 sq km with over 650,000 people. Assuming access to reasonably accurate paper boundary maps of the intended working area and the absence of pre-existing digital local-area maps, the six stages are: to (a) digitize and update existing paper maps, (b) join the digitized maps into a large-area map, (c) reference this large-area map to a geographic coordinate system, (d) insert location landmarks of interest, (e) maintain the GIS, and (f) link it to other research databases. These basic steps can produce a household-level, updated, scaleable GIS that can both enhance field efficiency and support epidemiologic analyses of demographic patterns, diseases, and health outcomes

Seasonal Dietary Intakes and Socioeconomic Status among Women in the Terai of Nepal

Despite widespread nutritional deficiencies, investigations of usual diet in rural South Asia remain sparse. The present study characterizes year-round and seasonal dietary patterns of women in the Terai of Nepal by sociodemographic status, using a novel, weekly single-visit and usual food frequency questionnaire that links recall to the agricultural season. The study was conducted across seasons in 2006-2008 among 15,899 women of reproductive age in Sarlahi district. Intakes were tabulated for all foods, overall and by socioeconomic status (SES), and in and out of season, as appropriate. Foods consumed regularly [median (interquartile range) weekly frequency] were rice [13 (7-13)], potatoes [10 (5-13)], legumes [6 (2-9)], and vegetable oil [13 (13-13)]. Animal products were infrequently consumed [1 (0-2) time per week] as were fruits and vegetables, most with a median weekly intake frequency of 0. Higher SES was associated with more frequent consumption of most food-groups, including in-season fruits and vegetables. Diets of women in the Terai of Nepal lack diversity and, likely, nutrient adequacy, which may pose health risks

Validation of Two Portable Instruments to Measure Iron Concentration in Groundwater in Rural Bangladesh

Iron is ubiquitous in natural water sources used around the world for drinking and cooking. The health impact of chronic exposure to iron through water, which in groundwater sources can reach well above the World Health Organization's defined aesthetic limit of 0.3 mg/L, is not currently understood. To quantify the impact of consumption of iron in groundwater on nutritional status, it is important to accurately assess naturally-occurring exposure levels among populations. In this study, the validity of iron quantification in water was evaluated using two portable instruments: the HACH DR/890 portable colorimeter (colorimeter) and HACH Iron test-kit, Model IR-18B (test-kit), by comparing field-based iron estimates for 25 tubewells located in northwestern Bangladesh with gold standard atomic absorption spectrophotometry analysis. Results of the study suggest that the HACH test-kit delivers more accurate point-of-use results across a wide range of iron concentrations under challenging field conditions

Iodine status in pregnancy and household salt iodine content in rural Bangladeshm cn_282 1..12

Abstract Adequate maternal iodine intake is essential during pregnancy for the development of the foetus. To assess the extent of iodine insufficiency and its association with household iodized salt in rural Bangladesh, we measured urinary iodine and household salt iodine content among pregnant women in early (Յ16 weeks, n = 1376) and late (Ն32 weeks, n = 1114) pregnancy. Salt (~20 g) and a spot urine sample (~10 mL) were collected from women participating in a randomized, placebo-controlled trial of vitamin A or beta-carotene supplementation in rural northwestern Bangladesh during home visits in early and late pregnancy. Salt iodine was analyzed by iodometric titration, and urinary iodine by the Ohashi method. Almost all salt samples had some detectable iodine, but over 75% contained &lt;15 ppm. Median (interquartile range) urinary iodine concentrations were 66 (34-133) and 55 (28-110) mg L -1 in early and late pregnancy, respectively; urinary iodine &lt;150 mg L -1 was found in~80% of women at both times in pregnancy. Although the risk of iodine insufficiency declined with increasing iodine content of household salt (P for trend &lt;0.05), median urinary iodine did not reach 150 mg L -1 until iodine in household salt was at least 32 ppm and 51 ppm during early and late pregnancy, respectively. Despite a national policy on universal salt iodization, salt iodine content remains insufficient to maintain adequate maternal iodine status throughout pregnancy in rural northern Bangladesh. Alternative measures like direct iodine supplementation during pregnancy could be considered to assure adequate iodine status during this high-risk period of life

A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study

Background: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. Methods: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urinetest confirmed pregnancy, a subset with gestational age of &lt;15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. Results: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P &lt; 0.05). Lin\u2019s concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. Conclusions: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. Trial registration: ClinicalTrials.gov NCT0086047