In Honduras a decreasing prevalence of exclusive breast feeding with over 50% of infants given supplemental liquids during the first 30 days was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk... more
In Honduras a decreasing prevalence of exclusive breast feeding with over 50% of infants given supplemental liquids during the first 30 days was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding amenorrhea and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians provide updated information to at least 50 nurses through a workshop train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status health system affiliation reproductive history breastfeeding and infant feeding practices contraceptive use and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation interviews were conducted and 4 mother support groups were observed. BAs were given record-keeping forms and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
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Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the... more
Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the 10 Steps to Successful Breastfeeding, are helping to educate society about the benefits of breastfeeding and to create supports for mothers and their children, but advocacy and education are still needed
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Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum... more
Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4-6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4-6 mo (SF-M). After the intervention phase (4-6 mo; n= 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 mo only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. These results indicate that delaying the introduction of complementary foods until 6 mo does not adversely affect appetite or food acceptance among breast-fed infants.
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The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1–2 months... more
The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1–2 months and the duration of any breastfeeding to 12 months. The second phase of the project sought to extend the program nationwide. One of the original pilot hospitals in San Pedro Sula was well along in breastfeeding promotion but felt there were still problems in breastfeeding education and the integration with family planning services. Following retraining of staff and the opening of a Breastfeeding Clinic and a Temporary Methods Family Planning Clinic, there have been improvements in both areas.
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SummaryA significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a... more
SummaryA significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.
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To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United... more
To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United States. Randomized intervention trial from 4 to 6 months and longitudinal study of infants from birth to 12 months. Low-income communities in San Pedro Sula, Honduras. Primiparous, breast-feeding mothers and their infants (n = 141) recruited from public maternity hospitals. Infants were randomly assigned to exclusive breast-feeding to 6 months, or exclusive breast-feeding with addition of hygienically prepared, nutritionally adequate complementary foods at 4 months, with or without maintenance of baseline breast-feeding frequency. After 6 months, mothers continued to breast-feed and also fed their infants home-prepared foods after receiving instruction in appropriate feeding practices. Infant weight was measured monthly during the first year of life and infant length monthly from 4 to 12 months. Growth parameters were compared between the Honduran and US cohorts using multiple-regression and repeated-measures analysis of variance. Stepwise multiple regression was used to identify determinants of infant growth. There were no differences in growth patterns by intervention group. Mean birth weight of the Honduran infants was significantly less than that of a cohort of breast-fed infants in an affluent US population (n = 46) (2889 +/- 482 vs 3611 +/- 509 g), but the Honduran infants exhibited rapid catch up in weight in the first few months of life, and the cohorts were similar in weight by 3 months. Mean weight and length gain were similar to those of the US cohort from 4 to 9 months but were lower from 9 to 12 months. Mean length for age was significantly less than that of the US cohort from 4 to 12 months; this was attributable to the difference in maternal height (12 cm shorter in Honduras on average). Within the Honduran cohort, growth velocity of low birth weight infants (< 2500 g; n = 28) was similar to that of their normal birth weight peers; thus, the former subgroup remained smaller than the latter throughout the first year of life. In poor populations, when breast-feeding is exclusive for the first 4 to 6 months, continues from 6 to 12 months, and is accompanied by generally adequate complementary foods, faltering in weight does not occur before 9 months among infants born with birth weights of more than 2500 g.
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Research Interests: Endocrinology, Genetics, Cardiology, Hematology, Nephrology, and 15 moreNeurology, Epidemiology, Immunology, Nutrition, Medicine, Allergy, Humans, Female, Male, Infant, Breast feeding, Fetus, Body Height, Infant food, and Limiting
An operations research project organized by the Instituto Hondureno de Seguridad Social (IHSS) of the Ministry of Health of Honduras seeks to demonstrate the impact of postpartum services that promote both breastfeeding and family... more
An operations research project organized by the Instituto Hondureno de Seguridad Social (IHSS) of the Ministry of Health of Honduras seeks to demonstrate the impact of postpartum services that promote both breastfeeding and family planning. The control group consisted of 360 women who gave birth in the IHSS hospital in January-February 1987 and were exposed to the existing system of postpartum care that included some promotion of breastfeeding for reasons of child health but no information on family planning services available from the hospital. The experimental group consists of an equal number of women who gave birth at the IHSS facility in September-October 1987 but are being given extensive practical advice on breastfeeding techniques and contraceptive methods. Preliminary findings are now available on the 360 controls and on 32 women from the experimental group. Among controls the percentage of mothers exclusively breastfeeding fell dramatically from 44% at 1 month postpartum t...
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PROALMA (Proyecto en Apoyo a la Lactancia Materna) is a project to support breastfeeding intended to be organized in Honduras in 1983-1985 under the auspices of USAID with the cooperation of the Honduran Ministries of Health Welfare and... more
PROALMA (Proyecto en Apoyo a la Lactancia Materna) is a project to support breastfeeding intended to be organized in Honduras in 1983-1985 under the auspices of USAID with the cooperation of the Honduran Ministries of Health Welfare and Social Security. Even before the project officially began certain birthing rooming-in and initial feeding routines in selected urban hospitals resulted in declines in infant morbidity due to septicemia and diarrhea. The primary goals for the 1st year of PROALMA were education of hospital personnel in theory and practice of breastfeeding support an changes in hospital practices through courses and a national seminar. The seminar encouraged regional hospitals to institute rooming-in and stimulated the Ministry of Health to commit to a national policy of breastfeeding support. In the 2nd year implementation of changes in birthing practices and solution of problems in breastfeeding encountered by mothers were emphasized. Breast pumps were obtained and br...
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Infant formula is just food but the living fluid called breastmilk is food and medicine uniquely engineered for human consumption. Breastfed babies are healthier have fewer hospitalizations and have lower mortality rates than formula fed... more
Infant formula is just food but the living fluid called breastmilk is food and medicine uniquely engineered for human consumption. Breastfed babies are healthier have fewer hospitalizations and have lower mortality rates than formula fed infants. This paper authored by representatives from La Leche League the Mothercare Project and Wellstart International who live and work in several countries provides a history of La Leche League International followed by case studies from Dominican Republic Egypt Honduras and Pakistan that highlight different critical program aspects such as training IEC materials development and supervision. The success of La Leche League derives in part from its focus on motivational and behavior change strategies that are more broadly applicable beyond breastfeeding and weaning. La Leche League provides a model that offers NGOs concrete guidelines for working at the community level. The paper discusses the spread (to over 60 countries) and sustainability of the...
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This report presents the strategies proposed by the Cooperative Assistance Relief Everywhere to increase male participation in reproductive health activities in Honduras. A 16-month operations research project was conducted to test the... more
This report presents the strategies proposed by the Cooperative Assistance Relief Everywhere to increase male participation in reproductive health activities in Honduras. A 16-month operations research project was conducted to test the different strategies and surveys recorded the response of the target audience. Overall evidence suggests that a high level of communication about family planning existed prior to the intervention and did not improve much as a result of the project. High levels of assistance are provided to women contraceptors by men both before and after the intervention. Hence it is concluded that in rural Honduras the most of men are aware of their partners contraceptive use status and provide women with both material and moral support in obtaining a method and that there is little need to improve this aspect of reproductive health communication. The elements from this operations research project selected include training for both extension agents and village promot...
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through the support of the Office of Health, Infectious Disease, and Nutrition, Bureau for Global Health, and the Office of Food for Peace, Bureau for Democracy, Conflict and Humanitarian Affairs, United States Agency for International... more
through the support of the Office of Health, Infectious Disease, and Nutrition, Bureau for Global Health, and the Office of Food for Peace, Bureau for Democracy, Conflict and Humanitarian Affairs, United States Agency for International Development (USAID), under terms of Cooperative Agreement No. HRN-A-00-98-00046-00, through the FANTA Project, operated by FHI 360. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.
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The 1991/92 Epidemiology and Family Health Survey (ENESF) from Honduras was examined for associations between prelacteal feeds and breast-feeding outcomes. The ENESF is a self-weighted nationally representative survey that included 2380... more
The 1991/92 Epidemiology and Family Health Survey (ENESF) from Honduras was examined for associations between prelacteal feeds and breast-feeding outcomes. The ENESF is a self-weighted nationally representative survey that included 2380 women with children under the age of two. Multivariate logistic regression was used to examine the association between prelacteal feeds and breast-feeding practices among 0- to 6-mo-old infants (n = 714), and to identify factors associated with milk-based prelacteal feeds. Providing milk-based prelacteal feeds was negatively associated with both exclusive (odds ratio = 0.18) and any breast-feeding (0.21). Prelacteal water was negatively associated with exclusive breast-feeding (0.19). Both water- and milk-based prelacteal feeds were associated with a delayed milk arrival and a delay in the time at which the child was offered the breast for the first time. Our findings suggest that prelacteal feeds have an adverse effect on breast-feeding outcomes.
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Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the... more
Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the 10 Steps to Successful Breastfeeding, are helping to educate society about the benefits of breastfeeding and to create supports for mothers and their children, but advocacy and education are still needed
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Lactational amenorrhea (LA) is associated with postpartum infertility and is known to be related to breast-feeding frequency and duration, but the exact role of complementary feeding of the infant has not been clearly defined. Data on LA... more
Lactational amenorrhea (LA) is associated with postpartum infertility and is known to be related to breast-feeding frequency and duration, but the exact role of complementary feeding of the infant has not been clearly defined. Data on LA were collected during and after a 2-mo intervention trial in which low-income Honduran women who had breast-fed fully for 4 mo were randomly assigned to one of three groups: continued full breast-feeding until 6 mo (FBF, n = 50), introduction of complementary foods at 4 mo with ad libitum breast-feeding from 4 to 6 mo (SF, n = 47), or introduction of complementary foods at 4 mo with maintenance of baseline breast-feeding frequency from 4 to 6 mo (SF-M, n = 44). Women were followed up until the infant was 12 mo of age, or later if menses had not occurred by then. All but six of the women continued to breast-feed for > or = 12 mo. With the exclusion of those whose menses returned before 18 wk postpartum (which could not have been due to the interve...
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As part of a study on the optimal timing of complementary feeding in Honduras, we assessed breast milk volume and composition at 4, 5, and 6 mo in 141 low-income women who were randomly assigned to exclusively breast-feed for the first 6... more
As part of a study on the optimal timing of complementary feeding in Honduras, we assessed breast milk volume and composition at 4, 5, and 6 mo in 141 low-income women who were randomly assigned to exclusively breast-feed for the first 6 mo or to complement breast milk with prepared solid foods beginning at 4 mo. Milk volume averaged 797 +/- 139 g/d at 4 mo. Maternal body mass index was positively associated with infant birth weight and milk energy density. In multivariate analyses in which group assignment was controlled for, milk volume was positively associated with birth weight but negatively associated with milk energy density. Infant breast milk energy intake was positively associated with birth weight and milk energy density. Maternal anthropometric status was not a significant predictor of milk volume or infant energy intake when birth weight and milk energy density were included in the models. These results indicate that infant characteristics, such as birth weight and the ...
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To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United... more
To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United States. Randomized intervention trial from 4 to 6 months and longitudinal study of infants from birth to 12 months. Low-income communities in San Pedro Sula, Honduras. Primiparous, breast-feeding mothers and their infants (n = 141) recruited from public maternity hospitals. Infants were randomly assigned to exclusive breast-feeding to 6 months, or exclusive breast-feeding with addition of hygienically prepared, nutritionally adequate complementary foods at 4 months, with or without maintenance of baseline breast-feeding frequency. After 6 months, mothers continued to breast-feed and also fed their infants home-prepared foods after receiving instruction in appropriate feeding practices. Infant weight was measured monthly during the first year of life...
Research Interests: Pediatrics, Comparative Study, Growth, Humans, Age, and 15 moreHonduras, Female, Male, Complementation, Regression Analysis, Infant, Longitudinal Studies, Sex Factors, Breast feeding, Age Factors, Body Weight, Energy Intake, Psychology and Cognitive Sciences, Infant food, and Medical and Health Sciences
Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum... more
Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4-6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4-6 mo (SF-M). After the intervention phase (4-6 mo; n= 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, numb...
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The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1-2 months... more
The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1-2 months and the duration of any breastfeeding to 12 months. The second phase of the project sought to extend the program nationwide. One of the original pilot hospitals in San Pedro Sula was well along in breastfeeding promotion but felt there were still problems in breastfeeding education and the integration with family planning services. Following retraining of staff and the opening of a Breastfeeding Clinic and a Temporary Methods Family Planning Clinic, there have been improvements in both areas.
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A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease... more
A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.