Factors that influence breastfeeding initiation and duration in urban, suburban and rural areas of Zhejiang Province, Peoples Republic of China

Introduction: Breast milk is the best way to feed all infants. It results in better nutrition for the infant and to reduced rates of chronic disease later in childhood and adulthood. Breastfed babies have lower rates of infectious diseases and will not be exposed to contaminated infant formula, such as the recent experience with melamine in China. The WHO Expert Consultation on Infant Feeding recommended exclusive breastfeeding for six months, with the introduction of complementary foods and continued breastfeeding thereafter. It was also recommended by the WHO that breastfeeding continue beyond six months for up to two years and beyond. Breastmilk can provide the majority of nutrients for the first 12 months of life. Complementary foods were given in the second half year gradually.However with the rapid economic development, the traditional home based obstetric system in China has changed. Following the change in women’s living styles, traditional infant feeding perceptions and practices have changed. Women now have high rates of returning to work after delivering a baby, especially in the urban areas, and more infants are being given infant formula and other substitutes for breastfeeding. Zhejiang Province is the one of fastest developing economic regions located in the mid Eastern coast of China. The breastfeeding rate has dropped rapidly since the 1970’s. This has significant implications for the child health in this region. A longitudinal study of breastfeeding was needed to provide the data necessary to implement a comprehensive health promotion program. Efforts are needed to promote breastfeeding, which should be one of the highest health promotion priorities.The aim of this study was to document the prevalence and duration of breastfeeding and exclusive breastfeeding in city, suburban and rural areas in Zhejiang Province; analyze the factors determining the initiation and the duration of breastfeeding; document mothers’ knowledge about the benefits of breastfeeding; identify the prevalence of problems associated with breastfeeding and constraints to exclusive breastfeeding up to six months of life; document the prevalence of prelacteal feeds and finally to describe differences in breastfeeding between city, suburb and rural area.Method: In order to achieve these objectives a longitudinal cohort study was undertaken of infant feeding practices in three locations in Zhejiang Province which represent city and suburban and rural areas. Mothers who delivered babies during 2004 and 2005 were randomly selected from the obstetric wards while in hospital and invited to voluntarily participate in the study. The mothers were interviewed in hospital and after discharge, were contacted by telephone three more times at 1, 3 and 6 months. The few mothers who could not be reached by telephone were interviewed during the scheduled routine immunisation clinics at their local MCH clinic. On each of these follow up occasions they were interviewed using a structured questionnaire to obtain details of infant feeding practices. A total of 1520 mothers were recruited in 4 hospitals located in city, suburb and rural areas. Almost all mothers (98%) agreed to participate. All data analyses were carried out using the Statistical Package for Social Science (SPSS), release 14.0 (SPSS Inc., Chicago, IL, USA). Descriptive techniques and survival analysis were used to document breastfeeding rates and duration. Cox regression analysis was undertaken to explore factors affecting breastfeeding.Results: Of the total 1520 mothers were recruited into the study, 628 were from the city, 347 from the suburb and 535 from the rural area. Breastfeeding initiation rates were high in all three locations. Initially more than 95% of the mothers began breastfeeding, but only 50.3% babies averagely in three locations were being exclusively breastfed at discharge. The number of infants being exclusively breastfed prior to discharge was relatively low. Exclusive breastfeeding before discharge was positively related to delivery method, the first feed given to the baby, mother’s place of residence, mother’s age, mothers’ education level and family income.‘Any breastfeeding’ rates at discharge and at 1, 3 and 6 months were 96.9%, 96.0%, 89.7% and 76.7% respectively. ‘Exclusive breastfeeding’ rates at discharge, and at 1, 3, 6 months were 50.3%, 55.1%, 45.8% and 3.9% respectively. The average duration of ‘exclusive breastfeeding’ was 44.7 days (95% CI, 41.6-47.9).Overall about half of mothers gave the babies prelacteal feeds before commencing breastfeeding. This situation was more common in city, compared with the suburban and rural mothers. The prelacteal feeding rates were 62.0%, 36.6% and 39.0% in city, suburb and rural area respectively.The breastfeeding rates differed by location between the city, suburb and rural areas. ‘Any breastfeeding’ rates in the city, suburb and rural area at discharge were 96.5 %, 96.8 % and 97.4 % respectively, the ‘exclusive breastfeeding’ rates in city, suburb and rural area at discharge were 38.0%, 63.4 % and 61.0 % respectively. The rates of exclusive breastfeeding at six months were only 0.2%, 0.5 % and 7.2 % respectively, well below the Chinese and WHO targets.The risk factors related to cessation of ‘any breastfeeding’ were ‘mother’s age’, ‘the time the decision to breastfeed was made’, ‘whether the infant was admitted to special care nursery’, ‘mother’s return to work within 6 months’, ‘the early feeding of water and /or other complementary foods, and location of mother’s usual residence. Factors negatively associated with ‘exclusive breastfeeding’ duration were early return to work and to place of residence, with the mothers living in the rural area exclusively breastfeeding for longer.Delivery method was an important influence on breastfeeding. In this study the highest caesarean section rate was in the city (76%), with a similar rate in the suburbs (74%) and the lowest in the rural area (53%). Mothers who had a caesarean section were less likely to be exclusively breastfeeding on discharge (35.8% in city, 59.6% in the suburbs) compared to vaginal delivery where the rates were 45% and 74.4% respectively. The adjusted odds ratio for exclusive breastfeeding in caesarean section deliveries in the city and suburban mothers was 0.64 (95% CI 0.46, 0.88).Conclusion: The study has descried the initiation and duration of breastfeeding (to six months) of babies in the different areas of Zhejiang Province. Separate information is provided on the prevalence of ‘any breastfeeding’ and ‘exclusive breastfeeding'. The factors that are associated with the initiation and duration of breastfeeding in Zhejiang Province are documented. Health promotion programs are needed to change some traditional inappropriate breastfeeding perceptions and to promote ‘exclusive breastfeeding’ in the first six months of life in Zhejiang. Education should be given and regulations should be introduced restricting hospital staff from recommending prelacteal and supplementary feeds unless warranted for medical reasons. The research also shows that there would be a benefit to breastfeeding if delivery and lactation leave were extended to six months and if the incidence of caesarean section could be reduced to levels more consistent with WHO expected levels

Breastfeeding in China: a review

This review aims to describe changes in breastfeeding and summarise the breastfeeding rates, duration and reasons of discontinuing 'any breastfeeding' or 'exclusive breastfeeding' in P.R. China. Breastfeeding rates in China fell during the 1970s when the use of breast milk substitutes became widespread, and reached the lowest point in the 1980s. As a result many efforts were introduced to promote breastfeeding. The breastfeeding rate in China started to increase in the 1990s, and since the mid-1990s 'any breastfeeding' rates in the majority of cities and provinces, including minority areas, have been above 80% at four months. But most cities and provinces did not reach the national target of 'exclusive breastfeeding' of 80%. The 'exclusive breastfeeding' rates in minority areas were relatively lower than comparable inland provinces. The mean duration of 'any breastfeeding' in the majority of cities or provinces was between seven and nine months. The common reasons for ceasing breastfeeding, or introducing water or other infant food before four months, were perceived breast milk insufficiency, mother going to work, maternal and child illness and breast problems. Incorrect traditional perceptions have a strong adverse influence on 'exclusive breastfeeding' in less developed areas or rural areas. China is a huge country, geographically and in population size, and there is considerable ethnic diversity. Therefore breastfeeding rates in different parts of China can vary considerably

Initiation of breastfeeding and prevalence of exclusive breastfeeding at hospital discharge in urban, suburban and rural areas of Zhejiang China

<p>Abstract</p> <p>Background</p> <p>Rates of exclusive breastfeeding in China are relatively low and below national targets. The aim of this study was to document the factors that influence exclusive breastfeeding initiation in Zhejiang, PR China.</p> <p>Methods</p> <p>A cohort study of infant feeding practices was undertaken in Zhejiang Province, an eastern coastal region of China. A total of 1520 mothers who delivered in four hospitals located in city, suburb and rural areas during late 2004 to 2005 were enrolled in the study. Multivariate logistic regression analysis was used to explore factors related to exclusive breastfeeding initiation.</p> <p>Results</p> <p>On discharge from hospital, 50.3% of the mothers were exclusively breastfeeding their infants out of 96.9% of the mothers who had earlier initiated breastfeeding. Exclusive breastfeeding was positively related to vaginal birth, baby's first feed being breast milk, mother living in the suburbs or rural areas, younger age of mother, lower maternal education level and family income.</p> <p>Conclusion</p> <p>The exclusive breastfeeding rate in Zhejiang is only 50.3% on discharge and does not reach Chinese or international targets. A number of behaviours have been identified in the study that could be potentially incorporated into health promotion activities.</p

A cohort study of infant feeding practices in city, suburban and rural areas in Zhejiang Province, PR China

<p>Abstract</p> <p>Background</p> <p>Breastfeeding is the basis for appropriate nutrition for infants and is strongly supported by the Ministry of Health in China. However, there are differences in infant feeding practices in different areas of the country. The aim of this study was to compare the infant feeding practices and the prevalence of determinants of initiation and continuing to breastfeed until six months of age in city, suburb and rural areas in Zhejiang Province, PRC.</p> <p>Methods</p> <p>A longitudinal cohort study of infant feeding practices was undertaken in city, suburban and rural areas in 2004/2005. Mothers were recruited and interviewed before discharge from hospitals. A total of 1520 mothers were recruited into the study. Follow-up interviews were administered at 1, 3 and 6 months after birth to obtain details of infant feeding practices.</p> <p>Results</p> <p>'Any breastfeeding' rates were high before discharge at all three locations, 96.5% in city, 96.8% in suburb and 97.4% in the rural area. The 'exclusive breastfeeding' rates in the city, suburban and rural areas before discharge were 38.0%, 63.4% and 61.0% respectively. By sixth months the 'any breastfeeding' rates had declined to 62.8%, 76.9% and 83.6% and the 'exclusive breastfeeding' rates had fallen to 0.2%, 0.5% and 7.2% in city, suburb and rural areas respectively. There were differences in feeding practices between the three locations, including the use of prelacteal feeds and the introduction of supplementary feeds.</p> <p>Conclusion</p> <p>Mothers who lived in the city were least likely to be 'exclusive breastfeeding' at discharge. At six months the city infants also had lower rates of 'any breastfeeding' and 'exclusive breastfeeding'.</p

Soy and Isoflavone Intake Associated With Reduced Risk of Ovarian Cancer in Southern Chinese Women

Isoflavones, mainly found in soy, have been shown to inhibit ovarian cancer cell proliferation. We hypothesized that soy consumption and isoflavone intake are related to the risk of ovarian cancer. A case–control study was conducted in southern China to ascertain this hypothesis. Five hundred incident patients with histologically confirmed cancer of the ovary and 500 controls (mean age 59 years) were recruited from four public hospitals in Guangzhou. Information on habitual consumption of soy foods, including soybean, soy milk, fresh tofu, dried tofu, and soybean sprout, was obtained face-to-face from participants through a validated and reliable semi-quantitative food frequency questionnaire. Isoflavone intakes were then estimated using the USDA nutrient database. The ovarian cancer patients reported lower consumption levels of individual and total soy foods (75.3 ± 53.6 g/day) compared to the controls (110.7 ± 88.8 g/day). Logistic regression analyses showed that regular intake of soy foods could reduce the ovarian cancer risk, the adjusted odds ratio being 0.29 (95% confidence interval 0.20 to 0.42) for women who consumed at least 120 g/day relative to those less than 61 g/day. Similarly, isoflavone intakes were inversely associated with the ovarian cancer risk, with significant dose–response relationships (P < 0.001). We concluded that consumption of soy foods is associated with a reduced risk of ovarian cancer in southern Chinese women

Breastfeeding Practice in Zhejiang Province, PR China, in the Context of Melamine-contaminated Formula Milk

A prospective cohort study of 1,520 mothers from Zhejiang province of China was undertaken to determine the duration of breastfeeding and associated factors during the first six months postpartum. Most (95.3%) mothers had introduced complementary foods by six months, making them at risk from contaminated infant formula. The mean duration of ‘any breastfeeding’ was greater than 180 days but only 48 days for ‘exclusive breastfeeding’. Factors relating to cessation of any breastfeeding were maternal age, timing of the breastfeeding decision, admission of the infant to a special-care nursery, return of the mother to work, the early introduction of water and/or other complementary foods, and their location of residence. The introduction of infant formula before three months was positively associated with the late decision to breastfeed, births in city, and infants being given a prelacteal feed. To combat the melamine disaster, strategies to improve the duration of breastfeeding must be developed taking these factors into account

MicroRNA-29a Inhibits Growth, Migration and Invasion of Melanoma A375 Cells in Vitro by Directly Targeting BMI1

Background/Aims: Melanoma is one of the most aggressive malignant tumors, with increasing incidence, poor prognosis, and lack of any effective targeted therapies. Abnormal expression of miR-29a has been found in several types of cancers, including melanoma. In this study, experiments were performed to investigate the role of miR-29a in melanoma, and the molecular mechanism by which miR-29a represses melanoma. Methods: miR-29 and Bmi1 expression was examined by quantitative real-time polymerase chain reaction (qRT-PCR). The cell viability, apoptosis, migration and invasion were respectively determined by Cell Counting Kit-8 assay, Propidium iodide (PI) fluorescein isothiocynate (FITC)-Annexin V staining assay, wound healing assay and transwell assay. Luciferase reporter assay was performed to determine a target gene of miR-29a. Western blot was used to analyze protein expression of apoptosis-related proteins, Bmi1, Wnt/β-catenin and Nuclear factor-κB (NF-κB) pathway target genes. Results: miR-29a was down-regulated in all tested melanoma cell lines. Up-regulation of miR-29a effectively inhibited cell viability, migration, and invasion, but promoted apoptosis in A375 cells. Bmi1 was a direct target gene of miR-29a. Transfection with miR-29a mimic decreased cell migration and invasion and Bmi1 expression in Malme-3M cells, SK-MEL-2, SK-MEL-5, and M14 cell lines. Moreover, miR-29a might suppress growth, migration and invasion of A375 cells by negatively regulating Bmi1. In addition, our results demonstrated that transfection with miR-29a mimic effectively blocked Wnt/β-catenin and NF-κB pathways via down-regulating Bmi1. Conclusion: miR-29a could be functioned as a potential tumor suppressor through direct regulation of Bmi1 in melanoma cells

Breastfeeding rates and growth charts—the Zhejiang infant feeding trial

A randomised control trial was undertaken in Hangzhou, China, to study the influence of the growth chart used on breastfeeding rates. Mothers with infants who were being fully breastfed at 6 weeks after birth (n = 1602) were invited to participate in the trial; 1415 agreed to participate and 1295 completed the study. Two growth charts were used, one that was heavier for the first six months of life (Chart A, n = 686) and a lighter growth chart (Chart B, n = 609). Mothers were interviewed and infants measured at 6 weeks and 3, 4, 5 and 6 months after delivery. At 6 months the full breastfeeding rates were 18.1% in the group using the heavier growth chart compared to 22.8% in the lighter growth chart group. After adjusting for potential confounders this difference remained significant (aOR 1.41, 95% confidence intervals 1.02, 1.93). These results suggest that breastfeeding rates may be influenced by the type of growth chart used. Mothers who perceive that their infants are not growing adequately (i.e., using the heavier charts) may introduce other foods to their infants earlier than mothers using the lighter chart. While a larger trial is required to confirm the results, in the interim it is suggested that if heavier growth charts are used, a lower percentile line could be used to assess adequacy of growth

Breastfeeding Practice in Zhejiang Province, PR China, in the Context of Melamine-Contaminated Formula Milk

A prospective cohort study of 1,520 mothers from Zhejiang province of China was undertaken to determine the duration of breastfeeding and associated factors during the first six months postpartum. Most (95.3%) mothers had introduced complementary foods by six months, making them at risk from contaminated infant formula. The mean duration of \u2018any breastfeeding\u2019 was greater than 180 days but only 48 days for \u2018exclusive breastfeeding\u2019. Factors relating to cessation of any breastfeeding were maternal age, timing of the breastfeeding decision, admission of the infant to a special-care nursery, return of the mother to work, the early introduction of water and/or other complementary foods, and their location of residence. The introduction of infant formula before three months was positively associated with the late decision to breastfeed, births in city, and infants being given a prelacteal feed. To combat the melamine disaster, strategies to improve the duration of breastfeeding must be developed taking these factors into account