Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

Zhao Li; Priya Mannava; John Charles Scott Murray; Howard Lawrence Sobel; Annie Jatobatu; Anthony Calibo; Baldan Tsevelmaa; Bounnack Saysanasongkham; Divinal Ogaoga; Edward Joseph Waramin; Elizabeth Mary Mason; Hiromi Obara; Hoang Thi Tran; Hoang Anh Tuan; Jacqueline Kitong; Jessica Mara Yaipupu; Kannitha Cheang; Maria Asuncion Silvestre; Outhevanh Kounnavongsa; Pamela Putney; Pham Thi Quynh Nga; Rathavy Tung; Sano Phal; Shogo Kubota; Sidonn Krang; Simon Burggraaf; Sommana Rattana; Tao Xu; Tuohong Zhang; Ulziikhutag Enkhmaa; Vanya Delgermaa; Y Meng Chhour; Western Pacific Region Early Essential Newborn Care Working Group

doi:10.1136/bmjgh-2020-002581

Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

BMJ Glob Health. 2020 Aug;5(8):e002581. doi: 10.1136/bmjgh-2020-002581.

Authors

Zhao Li¹, Priya Mannava¹, John Charles Scott Murray¹, Howard Lawrence Sobel², Annie Jatobatu³, Anthony Calibo⁴, Baldan Tsevelmaa⁵, Bounnack Saysanasongkham⁶, Divinal Ogaoga³, Edward Joseph Waramin⁷, Elizabeth Mary Mason⁸, Hiromi Obara⁹, Hoang Thi Tran¹⁰, Hoang Anh Tuan¹¹, Jacqueline Kitong¹², Jessica Mara Yaipupu¹³, Kannitha Cheang¹⁴, Maria Asuncion Silvestre¹⁵, Outhevanh Kounnavongsa¹⁶, Pamela Putney¹⁷, Pham Thi Quynh Nga¹⁸, Rathavy Tung¹⁹, Sano Phal¹⁴, Shogo Kubota¹⁶, Sidonn Krang²⁰, Simon Burggraaf²¹, Sommana Rattana⁶, Tao Xu²², Tuohong Zhang²³, Ulziikhutag Enkhmaa⁵, Vanya Delgermaa²⁴, Y Meng Chhour²⁵; Western Pacific Region Early Essential Newborn Care Working Group

Collaborators

Western Pacific Region Early Essential Newborn Care Working Group:
Zhao Li, Priya Mannava, John Christopher Murray, Howard Lawrence Sobel, Annie Jatobatu, Anthony Calibo, Baldan Tsevelmaa, Bounnack Saysanasongkham, Divinal Ogaoga, Edward Waramin, Elizabeth Mason, Hiromi Obara, Hoang Tran, Hoang Anh Tuan, Jacqueline Kitong, Jessica Yaipupu, Kannitha Cheang, Maria Asuncion Silvestre, Outhevanh Kounnavongsa, Pamela Putney, PhamThi Quynh Nga, Rathavy Tung, Sano Phal, Shogo Kubota, Sidonn Krang, Simon Burggraaf, Sommana Rattana, Tao Xu, Tuohong Zhang, Ulziikhutag Enkhmaa, Vanya Delgermaa, Y Meng Chhour

Affiliations

¹ Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
² Maternal, Child Health and Quality and Safety, World Health Organization Regional Office for the Western Pacific, Manila, Philippines sobelh@who.int.
³ Maternal and Child Health Division, Ministry of Health of Solomon Islands, Honiara, Solomon Islands.
⁴ Disease Prevention and Control Bureau, Department of Health, Manila, Philippines.
⁵ Department of Medical Service, Mongolia Ministry of Health, Ulaanbaatar, Mongolia.
⁶ Department of Health Care and Rehabilitation, Ministry of Health, Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic.
⁷ Department of Population and Family Health Services, Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea.
⁸ Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
⁹ Division of Global Health Policy and Research, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
¹⁰ Neonatal Department, Da Nang Hospital for Women and Children, Da Nang, Viet Nam.
¹¹ Department of Maternal and Child Health, Government of Viet Nam Ministry of Health, Hanoi, Viet Nam.
¹² Department of Maternal Child Health and Nutrition, World Health Organization Country Office for Philippines, Manila, Philippines.
¹³ Department of Maternal and Child Health, Office of the WHO Representative in Papua New Guinea, Port Moresby, Papua New Guinea.
¹⁴ Department of Maternal and Child Health, WHO Representative Office Cambodia, Phnom Penh, Cambodia.
¹⁵ Kalusugan ng Mag-Ina (KMI; translation - Health of Mother and Child), Quezon City, Philippines.
¹⁶ Department of Maternal and Child Health, Office of the WHO Representative in Laos PDR, Vientiane, Lao People's Democratic Republic.
¹⁷ International Consultant, Martha's Vineyard, Massachusetts, USA.
¹⁸ Department of Maternal and Child Health, Office of the WHO Representative in Viet Nam, Hanoi, Viet Nam.
¹⁹ National Maternal and Child Health Center, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia.
²⁰ Department of Communicable Diseases Control, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia.
²¹ Department of Maternal and Child Health, Office of the WHO Representative in Solomon Islands, Honiara, Solomon Islands.
²² National Center for Women and Children's Health, Child Health Care Department, Chinese Center for Disease Control and Prevention, Beijing, China.
²³ Department of Health Systems, Office of the WHO Representative in China, Beijing, China.
²⁴ Department of Maternal and Child Health, Office of the WHO Representative in Mongolia, Ulaanbaatar, Mongolia.
²⁵ Under-Secretary of State for Health, Royal Government of Cambodia Ministry of Health, Phnom Penh, Cambodia.

Abstract

Objective: To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes.

Design: Cross-sectional observational study.

Setting: 150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific.

Participants: 1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017.

Main outcome measures: Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation.

Results: Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose-response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30-59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60-89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF.

Conclusion: EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.

Keywords: child health; cross-sectional survey; maternal health; paediatrics; public health.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Asia / epidemiology
Breast Feeding*
Cross-Sectional Studies
Female
Humans
Infant, Newborn
Mothers*

Grants and funding

001/WHO_/World Health Organization/International