Association of Postpartum Maternal Morbidities with Children’s Mental, Psychomotor and Language Development in Rural Bangladesh.

Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children’s development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children’s developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children’s milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children’s development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children’s language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children’s development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children’s development.

Orientación sobre la lactancia materna en un hospital para enfermedades diarréicas / Breast-feeding counseling in a diarrhoeal disease hospital

Se adiestró a consejeras en materia de lactancia materna para que dieran asesoramiento a las madres de lactantes parcialmente amamantados y hospitalizados por diarrea, con el fin de lograr que las madres iniciaran la lactancia materna exclusiva durante su permanencia en el hospital. Se asignó de forma aleatoria a lactantes (n = 250) de 12 meses de edad o menos a un grupo de intervención y a un grupo testigo. Las madres del grupo de intervención fueron asesoradas individualmente por las consejeras, mientras que las madres del grupo testigo recibieron solo la educación sanitaria impartida en grupo rutinariamente. Durante el seguimiento que hicieron las consejeras en el hogar una semana más tarde, solo las madres del grupo de intervención fueron asesoradas. A las 2 semanas de su egreso, todas las madres fueron evaluadas en términos de sus prácticas de amamantamiento en el hogar. En cuanto a los 125 pares de madres e hijos que había en cada grupo, 60% de las madres del grupo de intervención alimentaban a sus hijos al pecho exclusivamente en el momento del egreso, en comparación con solo 6% de las madres del grupo testigo (P < 0,001); 2 semanas más tarde, estos porcentajes subieron a 75 y 8 en el grupo de intervención y en el grupo testigo, respectivamente (P < 0,001). Sin embargo, 49% de las madres del grupo testigo volvieron a alimentar a sus hijos con biberón, en comparación con 12% de las madres del grupo de intervención (P < 0,001). Por consiguiente, la orientación individual tuvo un efecto favorable en las madres, ya que hizo que iniciaran la lactancia materna exclusiva durante la hospitalización y que la siguieran practicando en el hogar. Los centros de salud maternoinfantil deben incluir la orientación sobre lactancia materna como parte integral de sus programas para mejorar las prácticas de alimentación de los lactantes.

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother­infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programmes to improve infant feeding practices.