Breastfeeding practices in Nepal: A Systematic Review - Health Advancement and Promotion Nursing Assignment Help

Internal Code: 1AJAFA Title: Breastfeeding practices in Nepal: A systematic review Introduction: Evidence on your topic

• Breastfeeding is one of the most natural and best forms of preventative medicine.
• Globally, only 38% of infants are exclusively breastfed in 4 months, and about 1.5 million deaths can be attributed to sub-optimal breastfeeding practices
• Exclusive breastfeeding in the first six months of life if universally practised could save an estimated 13% of all under 5 deaths, and that in India alone means the lives of 200,000 children saved each year.
• A global review of child undernutrition in 2012 revealed Nepal had the fourth highest prevalence of child underweight globally
• A recent meta-analysis of individual peer counselling for the promotion of exclusive breastfeeding found that the odds of exclusive breastfeeding in mothers receiving the counselling was “substantially increased in the neonatal period (15 studies; odds ratio [OR] 3·45, 95% Confidence Interval (CI):2·20–5·42, p<0·0001; random effects) and at 6 months of age (nine studies; OR 1·93, 95% CI:1·18–3·15, p<0·0001).
• Breastfed children are 6 times more likely to survive the first few months of life compared to non-breastfed children.
• Optimal Breastfeeding can prevent 13% of under-five mortality (U5M) in developing countries (including Nepal).
• Breastfeeding reduces under –five mortality from ARI & diarrhoea – common causes of under –five mortality in Nepal.
• Evidence from the 2016 Nepal Demographic and Health Survey (NDHS) revealed that 66% of infants <6 months were exclusively breastfed. 6% of these young infants consume plain water, 6% consume non-milk liquids, 10% consume other milk, and 12% consume complementary foods.

What motivated this review? Although there are many research studies on breastfeeding in Nepal, there are hardly any systematic reviews and hence, the necessity of this review would contribute to the better understanding of breastfeeding practices in Nepal and would also enable policy makers to target subpopulation for future interventions. Methods: Search strategy

• Data sources: Five electronic databases (PubMed, Scopus, CINAHL, Google scholar, and Web of Science) were searched for English language publications on childhood feeding practices in India for the period (2000 – date). Additional searches were also conducted using Google website for.....
• Search terms/keywords: The main search term was “breastfeeding” or “Nepal” or “feeding practices” and subsequent searches included infant and young child, breastfeeding practices, complementary feeding practices, optimal, suboptimal etc.

Inclusion/exclusion criteria

• Articles which mentioned feeding practices or breastfeeding practices or exclusive breastfeeding or early initiation of breastfeeding or bottle feeding or complementary feeding practices or India were considered
• Articles which mentioned feeding practices in exceptionally difficult circumstances (such as breastfeeding in HIV positive mothers) were excluded
• Feeding practices were defined by the infant and young child feeding indicators specified by WHO/UNICEF (WHO, 2008)
• Study characteristics (such as design) were also considered
• Only studies published in English
• Only studies adopts the WHO definition of breastfeeding (see link : http://apps.who.int/iris/bitstream/10665/43895/1/9789241596664_eng.pdf).

Figure 1 below shows the PRISMA diagram of how the reviewed studies were selected. Flow Chart Results: Summary evidence from the reviewed 29 studies

• Inappropriate breastfeeding and complementary feeding are important predictors of poor growth and morbidity in young children and these feeding practices are very poor in Nepal
• Determinants associated with feeding behaviours in Nepal included socio-economic factors (maternal education, household wealth), health service factors (ANC, place of delivery) and individual factors (maternal & child age).
• Cultural practices were also identified - Cultural belief.
• Community- and facility-based initiatives that considered the specific socio-economic context of peer counselling of mothers have been shown to successfully improve feeding practices of mothers in Nepal.
• Using change agents was also very important in improving feeding practices of mothers Conclusion:

Conclusion from the evidence

• Breastfeeding practices have declined over time
• Complementary feeding behaviours have remained unchanged
• Weak implementation of Infant and Young Child Feeding (IYCF) policies
• Community- and facility-based initiatives have been successful elsewhere in improving IYCF practices among mothers

Study objectives from the evidence

• To improve the feeding practices of mothers for under 2 years in Nepal

- To educate community-based stakeholders on the benefits of optimal feeding practices - To train health care professionals on how to educate mothers and the family on how to engage in optimal feeding practices - To liaise with government and non-governmental agencies on how best to fully implement current policies and guidelines for IYCF practices Further research:

• Intervention studies to support breastfeeding are needed to provide evidence about the most effective interventions to increase breastfeeding practices including exclusive breastfeeding in rural Nepal.

Does physical activity reduce risk of cardio vascular disease among males compared to physical inactivity? Problem/population: cardio vascular disease among males Synonym: cardiac arrest, congestive heart failure, myocardial infraction, angina pectoris. Intervention: physical activity Synonym: exercise, Comparison: physical inactivity Outcome: reduce risk of cardio vascular diseases.