Project description:BackgroundExclusive breastfeeding (EBF) can prevent death and disease among young children. The proportion of EBF is low in Niger. This study aimed to identify the prevalence and correlates of exclusive breastfeeding.MethodsWe conducted a community-based cross-sectional study in urban and rural areas of Niger among mothers of infants under 7 months old. We used a structured questionnaire to investigate breastfeeding practices, sociodemographic factors, and health service use. We used multivariate analysis to explore the correlates of EBF since birth.ResultsThe study involved 234 urban and 283 rural mothers. Colostrum was almost universally given to newborns (98.7% [231/234] urban and 97.9% [277/283] rural) and many mothers started breastfeeding within an hour of giving birth (69.2% [162/234] and 90.5% [256/283]). The proportion of EBF since birth in urban and rural areas was 15.8% (37/234) and 54.4% (154/283), respectively. Among mothers who had ceased EBF, proportion of prelacteal feeding was 85.3% (168/197) in urban areas and 62.0% (80/129) in rural areas, while 93.4% (183/196) and 72.7% (88/121) had stopped EBF within 1 week after birth respectively. The median duration of EBF was 1 week in urban and 2 months in rural areas. In urban areas, EBF was more likely in mothers with infants 3 months old or younger (Adjusted Odds Ratio [AOR] 2.78; 95% Confidence Interval 95% [CI] 1.07, 7.21) and problems with delivery including Caesarean section (AOR 3.60; 95% CI 1.17, 11.01). In rural areas, lower socioeconomic status (AOR 1.89; 95% CI 1.12, 3.18), early initiation of breastfeeding (AOR 4.04; 95% CI 1.50, 10.83) and delivery assisted by a traditional birth attendant (AOR 3.49; 95% CI 1.37, 8.89) were correlated with exclusive breastfeeding.ConclusionsExclusive breastfeeding was uncommon. Most mothers ceased EBF within 1 week after birth. Adequate information about EBF by health professionals around delivery seems to encourage its use. To encourage EBF in Niger, it is important to educate health professionals, including traditional birth attendants, and enable them to discuss the practice with mothers through individual counselling or group education.

Project description:IntroductionGutka, a popular smokeless tobacco (SLT) product combining chewing tobacco, areca nut, and spices, was banned by states in India beginning in 2012. Gutka can be recreated by the user mixing twin packets of tobacco and spice mixtures. We examine the availability of premixed gutka, the sale of twin packets (chewing tobacco and spice mixture sold together but in separate packets) and whether SLT was sold without legally mandated health warning labels (HWLs), without the printed maximum retail price (MRP), and above the MRP.Aims and methodsIn October/November of 2017, unique SLT packets were purchased using a systematic protocol in 25 localities with populations under 50 000 across five Indian states. Purchase information (location, twin packets, price paid) and packaging information (SLT type, printed MRP, type of HWL) were used to assess legality.ResultsOf the 240 purchases of unique SLT packets, three were premade gutka. Twin packets were half of the sample, sold in every state, and illegally sold in Maharashtra where they were banned. Over half (62%) of single packets and 27% of twin packets did not feature a legal HWL. While only 5% of packets did not have a printed MRP, 29% of single packets, and 38% of twin packets were sold illegally for more than the MRP.ConclusionsSLT without the proper HWL or sold above the MRP were common. Twin packets were widely available. India should consider a country-wide restriction to ban single serving tobacco packets that would decrease affordability.ImplicationsThis study is the earliest and that first outside of Mumbai that we are aware of to present evidence of tobacco products being sold above the MRP in India. While finding little evidence of premade gutka being sold, we found twin packets (chewing tobacco and spice mixture packets sold together) are widely available even in Maharashtra, which has a policy in place to ban twin packets. This study also finds evidence of SLT products sold without the correct HWL and without a MRP listed which shows that implementation and enforcement of regulations are as important as passing regulations.

Project description:BACKGROUND:World Health Organization (WHO) suggests that exclusive breastfeeding (EBF) is the best nutrition for the neonate. Still, it remains a big challenge to establish EBF not only in Bangladesh but also in any developing countries. OBJECTIVE:The aim of this study was to determine the level of knowledge and practices on EBF and its relationship between different socioeconomic and demographic factors among mothers having at least one child of aged 6-12 months in the rural area of Rajshahi District, Bangladesh. METHODOLOGY:A community clinic (CC) based study has been conducted by using semi-structured questionnaire. A total of 513 mothers having at least one child aged 6-12 months from 32 different CC in the rural area of Rajshahi District, Bangladesh during September to December 2015. A composite index, chi-square test, and logistic regression model were utilized in this study. RESULTS:The prevalence of knowledge and practices on EBF were 34.5% and 27.9% among mothers having at least one child aged 6-12 months. From the analyses, mothers age of ?21 years were (adjusted odds ratio (AOR) = 13.840, 95% CI: 7.394-25.904; p<0.001) times more likely to have knowledge on EBF and (AOR = 0.084, 95% CI: 0.050-0.143; p<0.05) times less likely to have practices of EBF compared to mother's age ?20 years. Service holders mothers were (AOR = 9.992, 95% CI: 4.485-22.260, p<0.05) times more likely to have practices than that of house wife. Home delivery mothers was (AOR = 0.208, 95% CI: 0.111-0.389; p<0.05) times less likely to have practices of EBF than that of the hospital delivery mothers. Those mothers monthly family income ?10,000 Bangladeshi taka (BDT) currency was (AOR = 0.092, 95% CI: 0.050-0.168, p<0.05) times less likely to have practices of EBF compared to their counterparts. CONCLUSIONS:This study was found poor knowledge and practices on EBF. This study suggested that education and EBF related intervention could play an important role to increase good knowledge and practices on EBF among mothers. Malnutrition will be decreased if EBF was widely established in Bangladesh.

Project description:BACKGROUND:The 2013 WHO guidelines for nutritional rehabilitation of hospitalized and non-hospitalized malnourished infants under six months (u6m) recommend the re-establishment of exclusive breastfeeding. However, in most low-income settings these recommendations are not consistently applied. A recently concluded pilot study on the effects of implementing these guidelines among hospitalized malnourished infants u6m of age in Kilifi, Kenya introduced breastfeeding peer supporters (BFPS) to the inpatient setting to support guideline implementation. Here we report a sub-study investigating mothers' experiences and perceptions of the process of re-establishing exclusive breastfeeding during their infant's admission to hospital. METHODS:Interviews were conducted with mothers just prior to their infant's discharge to explore their experiences and perceptions of the breastfeeding support process. A trained social science researcher conducted the interviews in Kiswahili language using a structured interview guide with open questions. Interviews were tape recorded, transcribed and translated into English for analysis. Data were managed and organized using NVIVO version 10 and analyzed using a framework approach. RESULTS:Twenty mothers were interviewed. While some mothers found re-establishing breastfeeding challenging, they all reported improved knowledge on the relationships between maternal nutrition, stress management, hygiene practices and breastmilk production. They also reported gaining skills in breast care, breastfeeding techniques, hand expression and handling of expressed breastmilk. The breastfeeding peer supporters were said to have provided technical, social and emotional support which facilitated the process of re-establishing exclusive breastfeeding. The mothers identified the key characteristics of an effective and trustworthy BFPS as well as gaps in support. CONCLUSION:BFPS are able share knowledge and skills in a way that is understood and appreciated by the mothers of inpatient malnourished infants u6m of age, enhancing the reestablishment of exclusive breastfeeding. Central to the success of BFPS is their ability to develop close and supportive relationships with the mothers based on shared social and cultural backgrounds. Future studies should focus on evaluating the long-term impact of inpatient breastfeeding support strategies on the quality of breastfeeding and growth, as well as on understanding where, when and how BFPS might be incorporated into routine hospital settings.

Project description:Atmospheric particulate matter (PM) is a recognized risk factor for the global burden of disease in human populations. We are presenting here the application of toxicogenomics in the evaluation of the toxic effects of organic content of atmospheric particle matter (PM), from urban and rural environments (city of Barcelona and village of La Pobla, NE Spain), using the developing zebrafish embryo. The main goal is to identify the metabolic pathways involved in the adverse effects observed in zebrafish embryos exposed to PM organic content from urban and rural environments, also allowing the selection of genes of interest that are differentially expressed. The relevance of particle size to the PM toxicity is also addressed. Indeed, the zebrafish embryos were exposed to PM of aerodynamic diameter larger than 7.2 μm and smaller than 0.5 μm (PM10 and PM0.5, respectively). PM0.5 concentrated biological and toxic activities linked to organic substances. Transcriptomic analyses showed strong induction of the AhR signalling pathway (a.k.a. dioxin-like activity) for embryos exposed to both rural and urban extracts, correlating with the concentrations of PAHs. Urban extracts, with strong contribution of traffic emissions, specifically de-regulated oxidative stress-related genes, as well as pancreatic and eye-lens specific genes, two organs known to be affected by air pollution in humans. Exposure to rural extracts, with high contribution of wood burning emissions, affected genes implicated in basic cellular functions, in agreement with their strong embryotoxicity. Extracts from rural and urban samples elicited both common and specific transcriptome responses, suggesting different potentially adverse outcomes depending on PM source and composition. The authors thank the financial support of the Spanish Ministry (project TEA-PARTICLE, grant number CGL2011-29621) and the Portuguese Foundation for Science and Technology for the doctoral grant of Sofia R. Mesquita (SFRH/BD/80710/2011) funded by the Program POPH-QREN through the Portuguese Ministry of Education and Science and the European Social Fund, and support through project PEst-C/MAR/LA0015/2013.

Project description:Atmospheric particulate matter (PM) is a recognized risk factor for the global burden of disease in human populations. We are presenting here the application of toxicogenomics in the evaluation of the toxic effects of organic content of atmospheric particle matter (PM), from urban and rural environments (city of Barcelona and village of La Pobla, NE Spain), using the developing zebrafish embryo. The main goal is to identify the metabolic pathways involved in the adverse effects observed in zebrafish embryos exposed to PM organic content from urban and rural environments, also allowing the selection of genes of interest that are differentially expressed. The relevance of particle size to the PM toxicity is also addressed. Indeed, the zebrafish embryos were exposed to PM of aerodynamic diameter larger than 7.2 Î¼m and smaller than 0.5 Î¼m (PM10 and PM0.5, respectively). PM0.5 concentrated biological and toxic activities linked to organic substances. Transcriptomic analyses showed strong induction of the AhR signalling pathway (a.k.a. dioxin-like activity) for embryos exposed to both rural and urban extracts, correlating with the concentrations of PAHs. Urban extracts, with strong contribution of traffic emissions, specifically de-regulated oxidative stress-related genes, as well as pancreatic and eye-lens specific genes, two organs known to be affected by air pollution in humans. Exposure to rural extracts, with high contribution of wood burning emissions, affected genes implicated in basic cellular functions, in agreement with their strong embryotoxicity. Extracts from rural and urban samples elicited both common and specific transcriptome responses, suggesting different potentially adverse outcomes depending on PM source and composition. The authors thank the financial support of the Spanish Ministry (project TEA-PARTICLE, grant number CGL2011-29621) and the Portuguese Foundation for Science and Technology for the doctoral grant of Sofia R. Mesquita (SFRH/BD/80710/2011) funded by the Program POPH-QREN through the Portuguese Ministry of Education and Science and the European Social Fund, and support through project PEst-C/MAR/LA0015/2013. The PM filter samples used in the present study were PM10 and PM0.5 from the urban site - total of 4 samples from 2 sampling months; and PM0.5 from the rural site - total of 2 samples from 2 sampling months (PM10 samples from the rural site were not tested due to their very low concentration in organic compounds, and insignificant biological activity, previously measured). Sampling occurred during the cold periods of the year 2012/2013. The organic fraction of PM samples was extracted by sonication using a mixture of dichloromethane:methanol. Then, the extracts were filtered, evaporated and re-dissolved in Dimethyl sulfoxide (DMSO). Zebrafish fertilized eggs were exposed to PM organic extracts (0.2% DMSO) from the urban and rural sites from 24 to 120h post-fertilization. Total RNA was isolated from whole embryos (pools of 20 individuals), using Trizol reagent protocol (Invitrogen Life Technologies, Carlsberg, CA). The microarray study was performed using the Agilent Two-colour D. rerio Oligo Microarray v3 platform, following the Agilent Microarray â?? Based Gene Expression Analysis protocol. Three biological replicates were performed for each PM sample and controls. Biological replicates, a technical replicate and a self-to-self, were simultaneously amplified and labelled using Cyanine 3 (Cy3) and Cyanine 5 (Cy5) dye. After cRNA purification (RNeasy Kit, Quiagen GmbH, Hilden, Germany), the cRNA concentration and labelling were quantified in the NanoDrop spectrophotometer, obtaining incorporation rates in the range of 15-20pmol of cyanide dye/Âµl cRNA and yield values > 0.825ug, as recommended. cRNA was fragmented and hybridized in 4x44K arrays, for 17h at 65oC. After the hybridization the array slides were washed, and immediately scanned using Microarray Scanner Agilent G2505C system. Data was extracted using Agilent Feature Extraction Software v10.5.1.1, and the quality of microarray data was evaluated using the Quality Control report provided by Agilent Software. Based on the microarray data analysis, 22 primers were selected and designed using Primer Express 2.0 software (Applied Biosystems, Foster City, CA). Genes were quantified by real-time PCR to validate the microarray data, and a subset of 13 genes were further selected by their robust behaviour in the validation assays, allowing to differentiate the toxic potential of PM from urban and rural sources.

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Factors associated with a low prevalence of exclusive breastfeeding during hospital stay in urban and semi-rural areas of southern Vietnam.

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Factors associated with a low prevalence of exclusive breastfeeding during hospital stay in urban and semi-rural areas of southern Vietnam.

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