Hollow Breanna Louise, Bulsara Max K, Pant Prakash Dev, Wallace Hilary Jane
School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.
Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia.
PLOS Glob Public Health. 2023 Apr 17;3(4):e0001824. doi: 10.1371/journal.pgph.0001824. eCollection 2023.
Infant and Young Child Feeding (IYCF) breastfeeding guidelines of the World Health Organization (WHO) have been promoted in Nepal since the early 1990s. This study investigated whether antenatal and perinatal service delivery in Nepal are associated with early initiation of breastfeeding and age-appropriate feeding practice (exclusive breastfeeding to six months; introduction of complementary foods at six months with continued breastfeeding to two years). Data from the 2016 Nepal Demographic and Health Survey (NDHS) were analysed using multivariable logistic regression. The unit of analysis was an interviewed woman and her last-born child aged 0-23 months. We examined number of antenatal visits, place and type of delivery, infant-mother skin-to-skin contact post-delivery, and breastfeeding observation and counselling by a healthcare provider within two days post-delivery. Of 1938 mother-infant dyads, 1073 (55.4%) commenced breastfeeding within one hour of delivery and 1665 (85.9%) were engaged in age-appropriate feeding. Breastfeeding within one hour of delivery was associated with infants delivered vaginally (aOR: 4.76, 95% CI: 2.96-7.65), infant-mother skin-to-skin contact post-delivery (aOR:2.10, 95% CI: 1.63-2.72) and observation of breastfeeding by a healthcare provider within two days post-delivery (aOR: 1.58, 95% CI: 1.20-2.08). Age-appropriate feeding was lowest amongst mothers with infants aged 4-5 months (40.8%) compared to those with infants aged 0-1 month (aOR: 0.158, 95% CI: 0.083-0.302). Antenatal and perinatal service delivery were not significantly associated with age-appropriate feeding. Further promotion of infant-mother skin-to-skin contact post-delivery (including after caesarean delivery) and observation of early breastfeeding may increase the rate of breastfeeding within one hour of delivery. Promotion of exclusive breastfeeding in antenatal and perinatal services and additional postnatal support should be considered to increase exclusive breastfeeding of infants to six months. These improvements may be achieved through enhanced implementation of the Baby Friendly Hospitals Initiative and effective training and sufficient practice for skilled birth attendants.
自20世纪90年代初以来，世界卫生组织（WHO）的婴幼儿喂养（IYCF）母乳喂养指南就在尼泊尔得到了推广。本研究调查了尼泊尔的产前和围产期服务提供情况是否与早期开始母乳喂养及适宜年龄喂养做法（纯母乳喂养至六个月；六个月时引入辅食并持续母乳喂养至两岁）相关。使用多变量逻辑回归分析了2016年尼泊尔人口与健康调查（NDHS）的数据。分析单位是接受访谈的妇女及其最后一个年龄在0至23个月的孩子。我们考察了产前检查次数、分娩地点和类型、产后母婴皮肤接触情况，以及医疗服务提供者在产后两天内对母乳喂养的观察和咨询情况。在1938对母婴中，1073对（55.4%）在分娩后一小时内开始母乳喂养，1665对（85.9%）采用了适宜年龄喂养方式。分娩后一小时内进行母乳喂养与经阴道分娩的婴儿有关（调整后比值比：4.76，95%置信区间：2.96 - 7.65）、产后母婴皮肤接触有关（调整后比值比：2.10，95%置信区间：1.63 - 2.72）以及医疗服务提供者在产后两天内对母乳喂养的观察有关（调整后比值比：1.58，95%置信区间：1.20 - 2.08）。与0至1个月婴儿的母亲相比，4至5个月婴儿的母亲中适宜年龄喂养的比例最低（40.8%）（调整后比值比：0.158，95%置信区间：0.083 - 0.302）。产前和围产期服务提供情况与适宜年龄喂养无显著关联。进一步推广产后母婴皮肤接触（包括剖宫产术后）以及早期母乳喂养观察可能会提高分娩后一小时内的母乳喂养率。应考虑在产前和围产期服务中推广纯母乳喂养以及提供额外的产后支持，以提高婴儿纯母乳喂养至六个月的比例。这些改进可通过加强实施爱婴医院倡议以及对熟练助产人员进行有效培训和提供充足实践来实现。
