The impact of the Healthcom mass media campaign on timely initiation of breastfeeding in Jordan.

Initiation of breastfeeding within several hours after a child's birth increases the likelihood of exclusive breastfeeding and longer duration of breastfeeding. However, common beliefs among mothers and health-care providers and routine hospital practices can constrain timely breastfeeding initiation. This article examines the impact of a mass media breastfeeding campaign in Jordan within the context of other activities occurring during and after the child's birth. The campaign had a positive impact on all mothers' knowledge, and on timely initiation of breastfeeding for home and public hospital deliveries, but not for those in private hospitals. The findings indicate that a communication campaign can bring about change in breastfeeding initiation behavior, but that providing mothers with information should be but one part of an integrated program to ensure that hospital and midwife policies and practices support timely initiation.

PIP: The study aim was to examine the role of mass communication in increasing timely initiation of breast feeding after a birth in Jordan through 1) a 2-day seminar on lactation management for health professionals, and 2) 2 intensive television and radio campaigns aired between May 15 and July 15, 1989 and from mid-March through April 1990. Surveys were conducted before the media campaign in August and September 1988 and after in July and August 1990. 930 interviews were carried out in 1988 among mothers under 35 years of age with a child under 2 years of age; and 777 women with children under 20 months of age in 1990. Sample were weighted because of differences. The results showed that breast feeding significantly from 90.5% to 97.2%. Among breast feeding mothers, timely initiation increased significantly from 40% to 54%; timely initiation increased significantly only in public hospitals and home births. Knowledge about initiation of breast feeding within 6 hours of the birth increased from 51% to 75%. Only 5% of mothers were unexposed. There was a low, significant correlation between campaigns exposure in 1990 and knowledge. Logistic regression analysis, controlling for demographic predictors of breast-feeding initiation, showed that changes in initiation were related to media exposure in general and exposure to the campaigns. Women with high media exposure were significantly more likely to initiate breast feeding within 6 hours of the birth, if the birth was after the media campaign. Significant predictors of breast-feeding initiation were rooming in, delivery without use of anesthesia, withholding of supplementary feedings during the first 3 days, health personnel's advice to the mother about breast-feeding initiation, and a day or early evening birth. Surprisingly, a strong positive predictor of timely initiation was a mother's having received formula to take home. Those less likely to initiate breast feeding within the first 6 hours were urban mothers and those with a first child; although both urban and rural mothers showed increased timely initiation, there were larger increases outside the city and among experienced mothers. Delayed initiation was influenced more by policies and routine practices than individual impacts. Independent predictors of timely initiation, that were interrelated, were parity, residence, and where the child was born, which when controlled for, showed that rural, experienced mothers showed a significantly greater change in timing behavior. Caution is urged in applying these findings to other countries, or applying these findings to supplementation or duration of breast feeding. A careful media campaign must also be supported with appropriate hospital policies and routines.

Severe mental retardation in Jordanian children. A retrospective study.

The etiology of severe mental retardation has not previously been studied in Jordan. In a group of 203 mainly severely mentally retarded children born 1975-1985, we found the etiology to be related to two main factors: (1) sequele from high perinatal morbidity or meningitis in infancy leading to a combination of severe mental retardation and cerebral palsy; (2) a high degree of intermarriage and a high frequency of retarded siblings indicating that genetic causes of MR are common. The results underscore the importance of further development of antenatal and perinatal care, especially for poor people and the need of genetic counselling.

The duration for which exclusive breast-feeding is adequate. A study in Jordan.

The object of this study was to determine the length of time for which exclusive breast-feeding supported adequate growth in a cohort of infants from families in and around Amman, Jordan. The infants were described as "faltering" if their incremental growth over 4 weeks fell below -2 standard deviations of the increments reported by Fomon in the USA. The infants were examined every 2 weeks until they faltered, or, without faltering, were started on supplementary foods. In general, up to the time of faltering, growth was satisfactory by international standards. The median time of faltering was 6 months. The results support the view that, at least in this relatively well-nourished community, exclusive breast-feeding is satisfactory for 4-6 months. However, further examination is needed of the risk factors that lead to early faltering in some breast-fed children.

Distribution of adult lactase phenotypes in Bedouins and in urban and agricultural populations of Jordan.

Lactose tolerance tests with breath hydrogen determination identified 39 lactose malabsorbers among 162 Jordanian Bedouins (24%), and 111 lactose malabsorbers among 148 subjects from the urban/agricultural zone of western Jordan and Palestine (75%). This highly significant difference supports the hypothesis that milk dependence in nomadic desert populations resulted in selective pressures in favour of the lactase persistence gene. Within the urban/agricultural zone which extends from the desert border in Jordan to the Mediterranean shore, a significant increase in the frequency of lactose malabsorbers (and hypolactasia gene frequencies) from east to west was observed. The suggested genetic cline is problably due to migration from the desert populations to the agricultural zone.