Explaining socioeconomic inequalities in exclusive breast feeding in Norway.

BACKGROUND AND OBJECTIVE: In high-income countries, lower socioeconomic position is associated with lower rates of breast feeding, but it is unclear what factors explain this inequality. Our objective was to examine the association between socioeconomic position and exclusive breast feeding, and to explore whether socioeconomic inequality in exclusive breast feeding could be explained by other sociodemographic characteristics, for example, maternal age and parity, smoking habits, birth characteristics, quality of counselling and breastfeeding difficulties. METHODS: We used data from a questionnaire sent to mothers when their infants were five completed months as part of a trial of a breastfeeding intervention in Norway. We used maternal education as an indicator of socioeconomic position. Analyses of 1598 mother-infant pairs were conducted using logistic regression to assess explanatory factors of educational inequalities in breast feeding. RESULTS: Socioeconomic inequalities in exclusive breast feeding were present from the beginning and persisted for five completed months, when 22% of the most educated mothers exclusively breast fed compared with 7% of the least educated mothers: OR 3.39 (95% CI 1.74 to 6.61). After adjustment for all potentially explanatory factors, the OR was reduced to 1.49 (95% CI 0.70 to 3.14). This decrease in educational inequality seemed to be mainly driven by sociodemographic factors, smoking habits and breastfeeding difficulties, in particular perceived milk insufficiency. CONCLUSIONS: Socioeconomic inequalities in exclusive breast feeding at 5 months were largely explained by sociodemographic factors, but also by modifiable factors, such as smoking habits and breastfeeding difficulties, which can be amenable to public health interventions. TRIAL REGISTRATION NUMBER: NCT01025362.

Effectiveness of Baby-friendly community health services on exclusive breastfeeding and maternal satisfaction: a pragmatic trial.

The WHO/UNICEF Baby-friendly Hospital Initiative has been shown to increase breastfeeding rates, but uncertainty remains about effective methods to improve breastfeeding in community health services. The aim of this pragmatic cluster quasi-randomised controlled trial was to assess the effectiveness of implementing the Baby-friendly Initiative (BFI) in community health services. The primary outcome was exclusive breastfeeding until 6 months in healthy babies. Secondary outcomes were other breastfeeding indicators, mothers' satisfaction with the breastfeeding experience, and perceived pressure to breastfeed. A total of 54 Norwegian municipalities were allocated by alternation to the BFI in community health service intervention or routine care. All mothers with infants of five completed months were invited to participate (n = 3948), and 1051 mothers in the intervention arm and 981 in the comparison arm returned the questionnaire. Analyses were by intention to treat. Women in the intervention group were more likely to breastfeed exclusively compared with those who received routine care: 17.9% vs. 14.1% until 6 months [cluster adjusted odds ratio (OR) = 1.33; 95% confidence interval (CI): 1.03, 1.72; P = 0.03], 41.4% vs. 35.8% until 5 months [cluster adjusted OR = 1.39; 95% CI: 1.09, 1.77; P = 0.01], and 72.1% vs. 68.2% for any breastfeeding until 6 months [cluster adjusted OR = 1.24; 95% CI: 0.99, 1.54; P = 0.06]. The intervention had no effect on breastfeeding until 12 months. Maternal breastfeeding experience in the two groups did not differ, neither did perceived breastfeeding pressure from staff in the community health services. In conclusion, the BFI in community health services increased rates of exclusive breastfeeding until 6 months. © 2015 Blackwell Publishing Ltd.

[The WHO Child Growth Standards for children under 5 years]. / Verdens helseorganisasjons nye vekststandard for barn under fem år.

BACKGROUND: In 2006, the World Health Organization (WHO) launched the new global WHO Child Growth Standards for children under five years. The rationale for developing this new growth standard was that a review of the NCHS/WHO-reference, which had been recommended for international use since 1978, showed that the growth of breast-fed infants deviated negatively from this reference. Most children included in the NCHS/WHO-reference from 1978 were fed mainly with infant formula. MATERIAL AND METHOD: A growth reference describes HOW: children without a diagnosed disease grow. The WHO Child Growth Standards document how children SHOULD: grow when they are raised in healthy environments, are breastfed and not exposed to tobacco through their mother. The standard was developed on the basis of a multi-ethnic sample with participants from Norway, USA, Brazil, Oman, Ghana and India. RESULTS AND INTERPRETATION: The WHO Child Growth Standards describe how healthy children grow when key health and environmental needs are met. The new growth standards documents that children with different ethnic backgrounds grow very similarly under equal conditions. The WHO Child Growth Standards are an important tool for prevention and early recognition of overweight, as well as growth faltering and wasting.

Implementation of the WHO Multicentre Growth Reference Study in Norway.

The World Health Organization (WHO) Multicentre Growth Reference Study (MRGS) European site was Oslo, Norway. Oslo has a high breastfeeding rate. Ninety-nine percent of mothers initiate breastfeeding soon after delivery, and 80% continue for at least six months. There is no evidence that socioeconomic conditions constrain growth. As in other sites, the study had two components, longitudinal and cross-sectional. Recruitment for the longitudinal component was conducted in three hospitals that account for most births in Oslo. Approximately 850 subjects were screened in one year by using a systematic allocation scheme to recruit a sample of about 300. Recruitment for the cross-sectional component was based on a systematic interval sampling scheme prepared by the National Registry. More than 4,000 subjects were screened to achieve the required sample size. One of the major challenges of the study was to achieve an acceptable participation rate; great efforts were made to motivate pregnant women via the health care system and the media.

[Treatment of mastitis in general practice]. / Behandling av mastitt i allmennpraksis.

BACKGROUND: This article presents an update on causes and management of mastitis in general practice. MATERIAL AND METHODS: Published articles on the causes and management of mastitis were identified by Medline and Embase searches, and reviewed. In addition, clinical experience from The National Breast-Feeding Centre in Norway is included. RESULTS AND INTERPRETATION: Most studies report an incidence of mastitis of less than 20% though major methodological limitations make estimates difficult. Common symptoms of mastitis is a swollen, red, hot and painful breast, and systemic symptoms as fever occur frequently. Mastitis may be inflammatory or caused by microorganisms, and often secondary to milk stasis. Effective milk removal is a most essential part of the treatment and may make antibiotics superfluous. In most cases bacterial mastitis is caused by Staphylococcus aureus resistant to beta-lactamase sensitive antibiotics. Culture of the milk is necessary to determine the infecting organism and its antibiotic sensitivity. When antibiotics are warranted, dicloxacillin or cloxacillin are suggested as first-line drugs. The transfer of dicloxacillin/cloxacillin to breast milk is minimal. In most cases women with mastitis can continue to breast-feed also from the affected breast during treatment.