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21 pages, 1032 KB  
Article
Pregnant Women and Vaccine Safety in Uganda: Knowledge, Barriers, and Opportunities for Engagement
by Victoria Prudence Nambasa, Robinah Komuhendo, Allan Serwanga, Dan Kajungu, Birgit C. P. Koch, Beate Kampmann, Kirsty Le Doare and Agnes Ssali
Vaccines 2025, 13(12), 1210; https://doi.org/10.3390/vaccines13121210 - 30 Nov 2025
Abstract
Background/Objectives: New vaccines designed to combat infections such as Group B Streptococcus and respiratory syncytial virus will soon be accessible in Africa. While outbreak response vaccines are given to pregnant women, safety data for maternal vaccines in low- and middle-income countries (LMICs) [...] Read more.
Background/Objectives: New vaccines designed to combat infections such as Group B Streptococcus and respiratory syncytial virus will soon be accessible in Africa. While outbreak response vaccines are given to pregnant women, safety data for maternal vaccines in low- and middle-income countries (LMICs) are limited. This study explored Ugandan pregnant women’s knowledge, attitudes, and engagement in adverse event reporting and vaccine decision-making. Methods: This nested qualitative study was part of a national gap analysis of pharmacovigilance systems for maternal vaccines. Five Focus Group Discussions (FGDs), each involving eight participants, were held with pregnant and or breastfeeding women at four healthcare facilities and one research center. The data collected from these discussions were analyzed thematically using a manifest content analysis, conducted in Atlas.ti software version 9 for qualitative data analysis. Results: Women valued maternal vaccines, particularly tetanus, but reported confusion about schedules and hesitancy when informed of potential side effects. Many adverse events were normalized, therefore not reported, and most participants were unaware of national reporting mechanisms beyond informing healthcare providers. Barriers included inadequate information, dismissive or rushed provider interactions and reliance on family, peers, and informal care networks to manage side effects. Women expressed a strong desire to be informed and actively involved in decisions about pregnancy vaccines, including the introduction of new vaccines. Conclusions: Strengthening maternal vaccine safety monitoring requires clearer, balanced communication; simplified and well-publicized reporting tools; supportive provider–patient interactions; and integration of community and informal networks. Pregnant women should be engaged as active partners in pharmacovigilance and maternal vaccine introduction to build trust, improve adverse event reporting, and support vaccine uptake. Full article
(This article belongs to the Special Issue Advance Public Health Through Vaccination)
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10 pages, 225 KB  
Article
Pregnancy and Childbirth in Neurodivergent Women: Shift Towards Personalized Maternity Care
by Anna M. Avdeeva, Mariia A. Parfenenko, Elena V. Bryzgalina, Kamilla T. Muminova and Zulfiya S. Khodzhaeva
J. Pers. Med. 2025, 15(11), 557; https://doi.org/10.3390/jpm15110557 - 17 Nov 2025
Viewed by 323
Abstract
Introduction: Neurodevelopmental disorders (NDs), including autism spectrum disorder and related conditions, are increasingly recognized among women of reproductive age, yet their unique needs during pregnancy and childbirth remain poorly studied. Communication differences, sensory sensitivities, and co-occurring psychiatric conditions may complicate maternity care, leading [...] Read more.
Introduction: Neurodevelopmental disorders (NDs), including autism spectrum disorder and related conditions, are increasingly recognized among women of reproductive age, yet their unique needs during pregnancy and childbirth remain poorly studied. Communication differences, sensory sensitivities, and co-occurring psychiatric conditions may complicate maternity care, leading to higher risks of adverse outcomes and ethical challenges in clinical practice. This study aimed to examine pregnancy complications, delivery outcomes, and postpartum characteristics in women with NDs, compared with a control group, and to identify specific barriers in perinatal care. Methods: A retrospective observational study was conducted at the National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, including 18 pregnant women with confirmed NDs and 21 matched controls with uncomplicated pregnancies. Data were extracted from medical records and included demographic parameters, pregnancy course, complications, labor management, neonatal outcomes, and documented communication or ethical issues. Comparative analyses were performed using chi-square or Fisher’s exact tests for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables. Results: Pregnant women with NDs had significantly higher rates of pelvic girdle pain (66.7% vs. 23.8%, p = 0.01), vaginal bleeding (44.4% vs. 14.3%, p = 0.04), anxiety (61.1% vs. 19.0%, p = 0.007), and depression (50.0% vs. 14.3%, p = 0.02) compared with controls. Persistent daily nausea was also more common (50.0% vs. 14.3%, p = 0.03). Attendance of prenatal physician visits was lower in the ND group (66.7% vs. 95.2%, p = 0.02). Cesarean delivery occurred in 83.3% of ND women versus 23.8% of controls (p < 0.001), with psychiatric recommendations often cited as the indication. Breastfeeding was declined in 94.4% of ND cases versus 4.8% of controls. Labor duration was prolonged, and neonatal anthropometrics were lower in the ND group. Communication difficulties were documented in 83.3% of ND participants, and postpartum depressive symptoms were identified in 77.8%. Conclusions: Pregnant women with NDs face a multidimensional vulnerability in maternity care, including higher frequencies of pain, bleeding, nausea, anxiety, and depression, prolonged labor, markedly increased cesarean rates, reduced breastfeeding initiation, and smaller neonatal anthropometrics. Frequent communication barriers, guardian decision-making, and postpartum separation further complicate care. These findings underscore the necessity of neurodiversity-informed, individualized perinatal strategies, integrating sensory accommodations, trauma-informed communication, and proactive mental health support to improve both clinical outcomes and patient experiences. Full article
(This article belongs to the Section Personalized Medical Care)
14 pages, 1146 KB  
Article
The Effect of mHealth on Exclusive Breastfeeding and Its Associated Factors Among Women in South Ethiopia: A Cluster Randomized Controlled Trial
by Girma Gilano, Andre Dekker and Rianne Fijten
Nutrients 2025, 17(21), 3477; https://doi.org/10.3390/nu17213477 - 5 Nov 2025
Viewed by 581
Abstract
Introduction: Exclusive breastfeeding (EBF) is vital for optimal infant health, reducing the risk of infections and enhancing cognitive development. Despite WHO’s recommendation of EBF for the first six months of life, global adherence remains suboptimal, particularly in low-resource settings. This study evaluates the [...] Read more.
Introduction: Exclusive breastfeeding (EBF) is vital for optimal infant health, reducing the risk of infections and enhancing cognitive development. Despite WHO’s recommendation of EBF for the first six months of life, global adherence remains suboptimal, particularly in low-resource settings. This study evaluates the impact of mobile health (mHealth) interventions on exclusive breastfeeding (EBF) among mothers in South Ethiopia. Methods: A cluster randomized controlled trial was conducted in the Gamo Gofa zones, South Ethiopia, involving 20 health facilities (10 intervention and 10 control). The study included 680 pregnant mothers recruited using simple random sampling from antenatal care (ANC) registers and family folders. Mothers in the intervention group received mHealth support, including breastfeeding information and reminders, while the control group received standard care. Participants were followed from the second trimester to six months postpartum. Multilevel survival analysis was applied to assess EBF duration, and multilevel logistic regression was used to evaluate complementary feeding within the first month. Results: The intervention group had a significantly higher probability of maintaining EBF at six months than the control group (AHR = 0.40, 95% CI: 0.26–0.62, p < 0.001). The secondary outcome also shows higher odds of early breastfeeding initiation in the intervention group (AOR = 4.71, 95% CI: 3.10–7.16, p < 0.001). ANC frequency was associated with a lower hazard of stopping EBF (AHR = 0.87, 95% CI: 0.79–0.97, p <0.05). The presence of diarrhea was associated with a high hazard of EBF (AHR = 1.47, 95% CI: 1.07–2.02, p < 0.05). College and above partner education was associated with high hazards of EBF (AHR = 2.41, 95% CI: 1.01–5.78, p < 0.05). The random effects variance (Var = 0.10, 95% CI: 0.01–0.07) indicated significantly lowered cluster-level variability. Conclusion and Recommendations: The mHealth intervention significantly improved EBF adherence and early breastfeeding initiation among mothers in South Ethiopia. Early breastfeeding, ANC frequency, and family size were protective factors, while high partner education and diarrhea disease increased the risk of early cessation of EBF. These findings highlight the potential of mHealth in addressing key barriers to EBF. Scaling up similar interventions, focusing on high-risk groups, could enhance adherence to WHO’s breastfeeding recommendations and improve maternal and child health outcomes in resource-limited settings. Full article
(This article belongs to the Section Pediatric Nutrition)
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12 pages, 391 KB  
Article
Digital Insights into Workplace Breastfeeding in Indonesia: A Google Trends Analysis of Barriers and Opportunities
by Ray Wagiu Basrowi, Tonny Sundjaya, Dessy Pratiwi, Nurfadilah M. Rajab, Rachel Amanda, Heru Komarudin and Gassani Amalia
Nutrients 2025, 17(21), 3433; https://doi.org/10.3390/nu17213433 - 31 Oct 2025
Viewed by 527
Abstract
Background/Objectives: Exclusive breastfeeding rates in Indonesia remain low, particularly among working mothers, despite government policies and the substantial contribution of women to the national economy. Inadequate workplace support, with only 21.5% of working mothers having access to proper lactation facilities, is a [...] Read more.
Background/Objectives: Exclusive breastfeeding rates in Indonesia remain low, particularly among working mothers, despite government policies and the substantial contribution of women to the national economy. Inadequate workplace support, with only 21.5% of working mothers having access to proper lactation facilities, is a key barrier. This study aimed to analyze Google Trends search data to understand the barriers and opportunities regarding workplace breastfeeding support in Indonesia, providing a data-driven foundation for advocacy campaigns and policy development. Methods: We conducted a retrospective analysis of Google Trends data from July 2020 to July 2025. Temporal and geographic search patterns for selected keywords, along with related queries and topics, were analyzed using a normalized relative search volume index (0–100). Results: “Lactation room” was the dominant, foundational search term with sporadic, event-driven peaks. Search interest in “exclusive breastfeeding” was consistently high (“evergreen”), while “World Breastfeeding Week” showed predictable seasonal peaks. Geographically, the need for basic infrastructure was nationally distributed, but searches for practical solutions, deeper topics, and event momentum were concentrated in urban economic centers. A nationwide knowledge gap on rights was identified. Analysis of “Rising Queries” and “Topics” revealed a shift in user focus from general information toward specific needs regarding rights, policy, and community support. Conclusions: The geographic and temporal alignment of user-identified needs with campaign momentum validates a targeted, multi-layered advocacy strategy. A three-pillar approach combining data-driven communication, workplace policy change, and multi-sectoral collaboration is recommended to improve breastfeeding support for working mothers in Indonesia. Full article
(This article belongs to the Section Pediatric Nutrition)
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22 pages, 1224 KB  
Article
Beyond Biology: Uncovering Structural and Sociocultural Predictors of Breast Cancer Incidence Worldwide
by Janet Diaz-Martinez, Gustavo A. Hernández-Fuentes, Josuel Delgado-Enciso, Mario A. Alcalá-Pérez, Isaac Jiménez-Calvo, Carmen A. Sánchez-Ramírez, Fabian Rojas-Larios, Alejandrina Rodriguez-Hernandez, Mario Ramírez-Flores, José Guzmán-Esquivel, Karmina Sánchez-Meza, Ana C. Espíritu-Mojarro, Osval A. Montesinos-López and Iván Delgado-Enciso
Curr. Oncol. 2025, 32(10), 553; https://doi.org/10.3390/curroncol32100553 - 2 Oct 2025
Viewed by 938
Abstract
Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from [...] Read more.
Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from 183 countries (2017–2023), encompassing 33 variables and 7 subvariables related to demographics, nutrition, environment, health, and healthcare access, drawn from open-access international databases. Spearman correlation analysis identified strong positive associations between breast cancer incidence and discontinued breastfeeding, high LDL cholesterol, out-of-pocket healthcare expenditure, and educational attainment. Conversely, poor sanitation, lack of handwashing facilities, unsafe water, and certain nutritional deficiencies exhibited robust negative correlations, likely reflecting under detection and reporting limitations in lower-resource settings rather than true protective effects. These findings were further explored using multiple linear regression, which explained approximately 73% of the variance in global breast cancer incidence. The final model highlighted discontinued breastfeeding, prevalence of cocaine use, unsafe sanitation, high out-of-pocket healthcare expenditure, limited handwashing access, and high processed meat consumption as the most influential independent predictors. Receiver operating characteristic (ROC) analysis confirmed strong predictive value for discontinued breastfeeding and out-of-pocket expenditure, with sanitation and hygiene variables showing paradoxical inverse associations. Our results emphasize that breast cancer risk is shaped not only by individual behaviors and genetics, but also by larger-scale structural, socioeconomic, and environmental factors. These patterns suggest that targeted interventions addressing both lifestyle behaviors and systemic inequities—such as promoting breastfeeding, reducing financial barriers to healthcare, and strengthening public health infrastructure—could meaningfully reduce the global burden of breast cancer. In conclusion, this study underscores the importance of multisectoral, equity-focused prevention strategies. It also highlights the value of country-level ecological analyses in uncovering upstream determinants of cancer incidence and calls for further research to disentangle individual and contextual effects in cancer epidemiology. Full article
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16 pages, 489 KB  
Article
Characteristics, Preventive Factors, and Barriers to Breastfeeding and Mixed Feeding in the First Month of Life in Barcelona: The Multicenter Observational Study GREEN MOTHER
by Azahara Reyes-Lacalle, Rosa Maria Cabedo-Ferreiro, Judit Cos-Busquets, Liudmila Liutsko, Margalida Colldeforns-Vidal, Rosa García-Sierra, Mª Mercedes Vicente-Hernández, Miriam Gómez-Masvidal, Laura Montero-Pons, Encarnación López-Gimeno, Pere Torán-Monserrat, Gemma Falguera-Puig, Gemma Cazorla-Ortiz and The GREEN MOTHER Group
Nutrients 2025, 17(19), 3109; https://doi.org/10.3390/nu17193109 - 30 Sep 2025
Viewed by 1298
Abstract
Background/Objectives: Breastfeeding is the best source of food for newborns. Leading health organizations recommend exclusive breastfeeding for the first 6 months of life, followed by the gradual introduction of complementary foods. Evidence shows that breastfeeding offers numerous benefits for newborns, mothers, society as [...] Read more.
Background/Objectives: Breastfeeding is the best source of food for newborns. Leading health organizations recommend exclusive breastfeeding for the first 6 months of life, followed by the gradual introduction of complementary foods. Evidence shows that breastfeeding offers numerous benefits for newborns, mothers, society as a whole, and the environment. Current breastfeeding rates fall below the established recommendations. This study aims to describe breastfeeding rates at hospital discharge and one month postpartum, analyze fluctuations in feeding types during this period, and identify any characteristics, preventive factors, and barriers to breastfeeding and mixed feeding. Methods: This is a multicenter observational study in the North Metropolitan area of Barcelona, with 411 participants surveyed by midwives. Results: In total, 79% of women were exclusively breastfeeding, 14% practiced mixed breastfeeding, and 7% used formula feeding at hospital discharge. At one month postpartum, these rates fluctuated to 64%, 23%, and 13%, respectively. Factors such as older age, having a university education, having 16 weeks of parental leave, and having a foreign-born status were positively associated with exclusive breastfeeding, while mental illness was associated with a lower prevalence. The use of breastfeeding accessories was not significantly associated with fluctuations in feeding type, but it was associated with maintaining mixed feeding. Conclusions: It is essential to implement individual and community interventions, educate healthcare professionals on factors that hinder breastfeeding, and promote workplace policies that support breastfeeding. Full article
(This article belongs to the Special Issue Own or Donated Human Milk: Its Role in Today's Society)
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24 pages, 935 KB  
Review
Keystone Species Restoration: Therapeutic Effects of Bifidobacterium infantis and Lactobacillus reuteri on Metabolic Regulation and Gut–Brain Axis Signaling—A Qualitative Systematic Review (QualSR)
by Michael Enwere, Edward Irobi, Adamu Onu, Emmanuel Davies, Gbadebo Ogungbade, Omowunmi Omoniwa, Charles Omale, Mercy Neufeld, Victoria Chime, Ada Ezeogu, Dung-Gwom Pam Stephen, Terkaa Atim and Laurens Holmes
Gastrointest. Disord. 2025, 7(4), 62; https://doi.org/10.3390/gidisord7040062 - 28 Sep 2025
Viewed by 2021
Abstract
Background: The human gut microbiome—a diverse ecosystem of trillions of microorganisms—plays an essential role in metabolic, immune, and neurological regulation. However, modern lifestyle factors such as antibiotic overuse, cesarean delivery, reduced breastfeeding, processed and high-sodium diets, alcohol intake, smoking, and exposure to [...] Read more.
Background: The human gut microbiome—a diverse ecosystem of trillions of microorganisms—plays an essential role in metabolic, immune, and neurological regulation. However, modern lifestyle factors such as antibiotic overuse, cesarean delivery, reduced breastfeeding, processed and high-sodium diets, alcohol intake, smoking, and exposure to environmental toxins (e.g., glyphosate) significantly reduce microbial diversity. Loss of keystone species like Bifidobacterium infantis (B. infantis) and Lactobacillus reuteri (L. reuteri) contributes to gut dysbiosis, which has been implicated in chronic metabolic, autoimmune, cardiovascular, and neurodegenerative conditions. Materials and Methods: This Qualitative Systematic Review (QualSR) synthesized data from over 547 studies involving human participants and standardized microbiome analysis techniques, including 16S rRNA sequencing and metagenomics. Studies were reviewed for microbial composition, immune and metabolic biomarkers, and clinical outcomes related to microbiome restoration strategies. Results: Multiple cohort studies have consistently reported a 40–60% reduction in microbial diversity among Western populations compared to traditional societies, particularly affecting short-chain fatty acid (SCFA)-producing bacteria. Supplementation with B. infantis is associated with a significant reduction in systemic inflammation—including a 50% decrease in C-reactive protein (CRP) and reduced tumor necrosis factor-alpha (TNF-α) levels—alongside increases in regulatory T cells and anti-inflammatory cytokines interleukin-10 (IL-10) and transforming growth factor-beta 1 (TGF-β1). L. reuteri demonstrates immunomodulatory and neurobehavioral benefits in preclinical models, while both probiotics enhance epithelial barrier integrity in a strain- and context-specific manner. In murine colitis, B. infantis increases ZO-1 expression by ~35%, and L. reuteri improves occludin and claudin-1 localization, suggesting that keystone restoration strengthens barrier function through tight-junction modulation. Conclusions: Together, these findings support keystone species restoration with B. infantis and L. reuteri as a promising adjunctive strategy to reduce systemic inflammation, reinforce gut barrier integrity, and modulate gut–brain axis (GBA) signaling, indicating translational potential in metabolic and neuroimmune disorders. Future research should emphasize personalized microbiome profiling, long-term outcomes, and transgenerational effects of early-life microbial disruption. Full article
(This article belongs to the Special Issue Feature Papers in Gastrointestinal Disorders in 2025–2026)
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16 pages, 306 KB  
Article
Factors Influencing Exclusive Breastfeeding During the Postpartum Period: A Mixed-Methods Study
by Greyce Minarini, Eliane Lima, Karla Figueiredo, Ana Paula Carmona, Mariana Bueno, Nátaly Monroy and Cândida Primo
Nutrients 2025, 17(18), 2992; https://doi.org/10.3390/nu17182992 - 18 Sep 2025
Cited by 2 | Viewed by 1045
Abstract
Background/Objectives: Breastfeeding is essential to maternal and child health, and multiple factors influence its success. This study examined the factors associated with breastfeeding type among infants aged 0 to 12 weeks. Methods: A mixed-methods study, employing a convergent design, was conducted in the [...] Read more.
Background/Objectives: Breastfeeding is essential to maternal and child health, and multiple factors influence its success. This study examined the factors associated with breastfeeding type among infants aged 0 to 12 weeks. Methods: A mixed-methods study, employing a convergent design, was conducted in the rooming in unit of a hospital in Espírito Santo, Brazil. A total of 296 mothers of neonates ≥ 34 weeks participated in both the quantitative and qualitative phases. The qualitative phase involved semi-structured interviews conducted in the hospital setting. In the quantitative phase, data were collected via telephone in three waves (on days 14, 40, and 90 postpartum), critical moments for establishing and maintaining breastfeeding, analyzing sociodemographic factors (age, education, marital status, number of pregnancies), clinical factors (gestational age, mode of delivery, milk production) and support factors (social and hospital). Descriptive statistical analysis and binomial and multinomial logistic regression models were used, conducted in R 4.3.3 software. The qualitative and quantitative findings were integrated through simultaneous incorporation and presented in a joint display. Results: The analysis showed that although most mothers had high adherence to prenatal care, breastfeeding counseling was insufficient. In addition to the type of delivery and immediate skin-to-skin contact, other factors were also found to be relevant to maintaining exclusive breastfeeding. Higher maternal education and a greater number of pregnancies were associated with better breastfeeding practices, albeit with variations in statistical significance. Support received during hospitalization, especially from the healthcare team, also emerged as a central element in the qualitative reports, reinforcing its role as a protective factor for continued breastfeeding. Early formula use within the first 48 h was identified as a barrier to initiating and maintaining breastfeeding. Conclusions: The duration and maintenance of exclusive breastfeeding varied over time, depending on factors such as the number of prenatal appointments, education level, number of pregnancies, mode of delivery, immediate skin-to-skin contact, and, most importantly, the use of formula in the first 48 h. The early introduction of formula in maternity wards represented a significant obstacle to breastfeeding, reinforcing the importance of integrated public policies and multidisciplinary initiatives that promote breastfeeding from birth. Full article
(This article belongs to the Special Issue Women's Nutrition, Metabolism and Reproductive Health)
17 pages, 262 KB  
Article
Drivers of and Barriers to Behavioural Change to Support Public Health and Social Wellbeing in Mbire District, Zimbabwe
by Davison Munodawafa, Pepukai Manjeru and Lioyd Goronga
Int. J. Environ. Res. Public Health 2025, 22(9), 1419; https://doi.org/10.3390/ijerph22091419 - 11 Sep 2025
Viewed by 523
Abstract
Foundational behaviours across health, education, sanitation, and energy use remain suboptimal in Mbire District, Zimbabwe. This qualitative formative study examined drivers of and barriers to five priority behaviours: birth notification and registration (BNR), exclusive breastfeeding (EBF), early childhood development education (ECDE), open-defecation-free (ODF) [...] Read more.
Foundational behaviours across health, education, sanitation, and energy use remain suboptimal in Mbire District, Zimbabwe. This qualitative formative study examined drivers of and barriers to five priority behaviours: birth notification and registration (BNR), exclusive breastfeeding (EBF), early childhood development education (ECDE), open-defecation-free (ODF) practices, and efficient use of energy (EUE). Between 15 January and 30 March 2023, we conducted 15 focus group discussions (n = 180 participants) and 20 key informant interviews (n = 20 participants). Data were thematically analysed in QDA Miner 6 (Cohen’s κ = 0.82). Drivers of positive behaviours included leadership support, peer networks, and radio/village meetings, while barriers included bureaucratic requirements, cultural norms, and financial constraints. We recommend a multi-sectoral Social and Behavioural Change (SBC) approach integrating community events, subsidies, and culturally sensitive communication. These findings provide actionable evidence to inform district-level programming and contribute to achieving Zimbabwe’s national development targets and relevant Sustainable Development Goals. Full article
(This article belongs to the Special Issue Health Inequalities in Primary Care)
13 pages, 220 KB  
Article
Barriers and Facilitators to the Elimination of Mother-to-Child Transmission Services Among Pregnant and Breastfeeding Women in Gauteng Province, South Africa
by Ndivhuwo Mukomafhedzi, Takalani Tshitangano and Shonisani Tshivhase
Nurs. Rep. 2025, 15(9), 318; https://doi.org/10.3390/nursrep15090318 - 2 Sep 2025
Viewed by 608
Abstract
Introduction: Eliminating mother-to-child transmission (EMTCT) of HIV is a global health priority to ensure that no child is born with HIV. When EMTCT services are underutilized, mothers and babies face greater risks, including the vertical transmission of HIV and higher rates of [...] Read more.
Introduction: Eliminating mother-to-child transmission (EMTCT) of HIV is a global health priority to ensure that no child is born with HIV. When EMTCT services are underutilized, mothers and babies face greater risks, including the vertical transmission of HIV and higher rates of maternal and neonatal mortality. Despite ongoing efforts, many women worldwide still struggle to access and use these vital services. Objective: This study sought to explore barriers and facilitators to the elimination of mother-to-child transmission services among pregnant and breastfeeding women (PBFW) in Gauteng province, South Africa. Methods: A qualitative, explorative, and descriptive research design was used. Convenience and purposive sampling were used to select participants. The study population consisted of PBFW aged 18 years or above who were utilizing EMTCT services. Data was collected through in-depth face-to-face individual interviews with participants. A semi-structured interview guide was used to collect data until data saturation was reached after interviewing 25 participants. Data were analyzed using thematic analysis (Tesch’s open coding method). Trustworthiness and ethical principles were ensured. Results: Four main themes emerged from the data analyzed, namely, barriers associated with EMTCT service utilization, facility-based strategies to improve EMTCT service uptake, community support for enhancing EMTCT engagement, and the role of partner support in service utilization, each with linked sub-themes. This study found that health education about EMTCT, along with community awareness and involvement, encourages the target group to utilize these services. Conclusions: Increasing women’s use of EMTCT services is an important step toward eliminating MTCT and increasing the health and well-being of mothers and their children. Addressing numerous barriers to receiving these services, as well as implementing targeted measures, can help ensure that all women gain access to the care and support that they require to safeguard their families from HIV. Full article
23 pages, 811 KB  
Article
Overcoming Barriers to Exclusive Breastfeeding in Lao PDR: Social Transfer Intervention Randomised Controlled Trial
by Najmeh Karimian-Marnani, Elizabeth Tilley and Jordyn T. Wallenborn
Nutrients 2025, 17(15), 2396; https://doi.org/10.3390/nu17152396 - 22 Jul 2025
Viewed by 722
Abstract
Background/Objectives: Despite the numerous health benefits of exclusive breastfeeding (EBF) for the infant and the mother, EBF rates in Lao People’s Democratic Republic, Lao PDR, remain at 40%. We investigate how barriers to EBF were overcome by a social transfer intervention. Methods [...] Read more.
Background/Objectives: Despite the numerous health benefits of exclusive breastfeeding (EBF) for the infant and the mother, EBF rates in Lao People’s Democratic Republic, Lao PDR, remain at 40%. We investigate how barriers to EBF were overcome by a social transfer intervention. Methods: Data from the Social Transfers for Exclusive Breastfeeding ongoing randomised controlled trial (RCT) (n = 298) in Vientiane, Lao PDR, was used. Mothers in the RCT were randomised equally into a control group, an unconditional transfer group and a conditional transfer group and followed up to six months (n = 280). We used logistic and Cox proportional hazards regression models to investigate the association of predictor variables with EBF at six months and the risk of EBF cessation in each of the three groups. Results: Greater breastfeeding self-efficacy increased the odds of EBF at six months in both intervention groups (unconditional transfer OR 1.39 [95% CI 1.09, 1.87, p = 0.02] and conditional transfer OR 1.26 [1.01, 1.61, p = 0.05]) and reduced the risk of EBF cessation (unconditional transfer HR 0.87 [0.77, 0.98, p = 0.02]). Maternal secondary and tertiary education in the intervention groups showed higher odds of EBF at six months and lower EBF cessation risk. Participants in the intervention group that intended to exclusively breastfeed in pregnancy showed a reduced EBF cessation risk in both intervention groups. Conclusions: Social transfers helped overcome the exclusive breastfeeding barrier of a higher education level and working status and improved EBF outcomes for mothers who intended to exclusively breastfeed and wanted the pregnancy. Breastfeeding self-efficacy positively influences EBF outcome, regardless of whether the mother received a social transfer or not. Full article
(This article belongs to the Section Nutrition and Public Health)
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20 pages, 868 KB  
Article
Association of Pre- and Gestational Conditions and Barriers to Breastfeeding with Exclusive Breastfeeding Practices
by Reyna Sámano, Gabriela Chico-Barba, Hugo Martínez-Rojano, María Eugenia Mendoza-Flores, María Hernández-Trejo, Carmen Hernández-Chávez, Andrea Luna-Hidalgo, Estefania Aguirre-Minutti, Ricardo Gamboa, María Eugenia Flores-Quijano, Otilia Perichart-Perera and Andrea López-Ocampo
Nutrients 2025, 17(14), 2309; https://doi.org/10.3390/nu17142309 - 13 Jul 2025
Viewed by 1474
Abstract
Background: Breastfeeding is essential for preventing non-communicable diseases. However, mothers with chronic illnesses tend to breastfeed less, increasing the likelihood of abandoning breastfeeding, especially if they experience gestational complications. Objective: To analyze the association between factors such as prepregnancy maternal characteristics, gestational complications, [...] Read more.
Background: Breastfeeding is essential for preventing non-communicable diseases. However, mothers with chronic illnesses tend to breastfeed less, increasing the likelihood of abandoning breastfeeding, especially if they experience gestational complications. Objective: To analyze the association between factors such as prepregnancy maternal characteristics, gestational complications, food security, barriers, and facilitators with the practice of exclusive breastfeeding. Methods: Cross-sectional study with 566 women who had prenatal care and gave birth at the National Institute of Perinatology (Mexico City) between 2021 and 2024. Surveys were administered on breastfeeding practices, food insecurity, barriers, and facilitators of exclusive breastfeeding in mothers. In addition, sociodemographic information, medical history (prepregnancy conditions and complications), gestational weight gain, and neonatal outcomes were recorded. Results: Of the 566 women, only 43.6% practiced exclusive breastfeeding, with a median duration of 4 months. Exclusive breastfeeding was more frequent in young, stay-at-home mothers with lower educational attainment and in those with food insecurity, who also tended to delay the introduction of complementary foods until after six months. Prepregnancy risk conditions (OR 1.56, 95% CI 1.06–2.30) and multiparity (OR 1.64, 95% CI 1.08–2.49) increased the risk of non-exclusive breastfeeding. Conversely, food insecurity (OR 0.40, 95% CI 0.20–0.78) and counseling from healthcare personnel (OR 0.09, 95% CI 0.01–0.51) showed a protective effect. The analysis also showed that paid employment (OR 4.68, 95% CI 1.65–13.21), the perception of low milk production (OR 6.45, 95% CI 2.95–14.10), maternal illness/medication (OR 3.91, 95% CI 1.36–11.28), and fatigue (OR 4.67, 95% CI 1.36–11.28) increased the probability of non-exclusive breastfeeding. Conclusions: In Mexico, the promotion of exclusive breastfeeding faces challenges, especially in mothers who begin pregnancy with significant chronic conditions such as diabetes, hypertension, obesity, advanced maternal age, and hypothyroidism, among others. Healthcare personnel should provide personalized advice to each woman from the prenatal stage on strategies to achieve and maintain exclusive breastfeeding. Full article
(This article belongs to the Section Nutrition in Women)
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19 pages, 923 KB  
Article
Developing a Framework for Culturally Sensitive Breastfeeding Interventions: A Community Needs Assessment of Breastfeeding Experiences and Practices in a Black Immigrant Community
by Temitope Awelewa, Alexandra Murra and William T. Story
Nutrients 2025, 17(13), 2094; https://doi.org/10.3390/nu17132094 - 24 Jun 2025
Viewed by 942
Abstract
Background/Objectives: Despite high breastfeeding initiation rates nationwide, disparities in breastfeeding continuation among Black mothers remain a public health issue. The BreastFeed Iowa Black Immigrant Project aimed to improve breastfeeding rates among low-income Black immigrant mother-infant dyads in Johnson County, Iowa by exploring factors [...] Read more.
Background/Objectives: Despite high breastfeeding initiation rates nationwide, disparities in breastfeeding continuation among Black mothers remain a public health issue. The BreastFeed Iowa Black Immigrant Project aimed to improve breastfeeding rates among low-income Black immigrant mother-infant dyads in Johnson County, Iowa by exploring factors influencing breastfeeding retention and developing a framework for culturally sensitive breastfeeding interventions. Methods: Using a descriptive cross-sectional study design, we employed a convergent, parallel mixed-methods approach to explore factors that influence breastfeeding duration among Black immigrant mothers with children 0–2 years old. Nine focus group discussions (FGDs) were conducted on Zoom among 40 participants with a semi-structured guide on breastfeeding beliefs, experiences, and feeding practices. Additionally, a 22-item survey was administered to 33 participants. Results: Based on the survey, one out of five participants indicated that they were unable to breastfeed for as long as they had planned. The top five reasons why mothers stopped breastfeeding included having received formula from the Supplemental Nutrition Program for Women, Infants and Children; being sick and having to take medicine; the baby was hungry too often; the baby was sick and could not breastfeed; and not producing enough milk. The top five themes that emerged from FGDs as barriers to breastfeeding included lack of lactation support, knowledge gaps on breastfeeding benefits, perception of inadequate milk supply, lack of comfort with breast milk expression, and work-related barriers. Conclusions: The community needs assessment identified the elements needed to develop a culturally sensitive framework with targeted interventions to address breastfeeding barriers in the Black immigrant community. Full article
(This article belongs to the Section Pediatric Nutrition)
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15 pages, 844 KB  
Systematic Review
A Systematic Review of Multifactorial Barriers Related to Breastfeeding
by Amparo Moret-Tatay, Marcelino Pérez-Bermejo, Adalberto Asins-Cubells, Carmen Moret-Tatay and María Teresa Murillo-Llorente
Healthcare 2025, 13(11), 1225; https://doi.org/10.3390/healthcare13111225 - 23 May 2025
Cited by 4 | Viewed by 2006
Abstract
Background/Objectives: Breastfeeding is widely recognized as the best way to feed infants and has numerous health benefits for both mothers and infants. However, despite its well-documented benefits, breastfeeding rates remain lower than recommended in many parts of the world. This systematic review [...] Read more.
Background/Objectives: Breastfeeding is widely recognized as the best way to feed infants and has numerous health benefits for both mothers and infants. However, despite its well-documented benefits, breastfeeding rates remain lower than recommended in many parts of the world. This systematic review examines factors that create barriers for mothers trying to breastfeed, covering studies published between 2003 and 2025. Methods: A total of 18 studies were included in this systematic review, selected from the following databases: PsycINFO, MEDLINE, Academic Search Complete, Communication and Mass Media Complete, ERIC, SocINDEX, and CINAHL. Studies were selected based on predefined inclusion criteria, focusing on peer-reviewed articles that examined factors influencing breastfeeding practices. Data extraction and quality assessment were performed independently by two reviewers using standardized tools. The review analyzed personal, cultural, economic, and health-related barriers. Results: The analysis revealed multiple barriers to breastfeeding, categorized into personal, sociocultural, economic, and healthcare-related factors. Common challenges included a lack of counseling, latching difficulties, insufficient workplace support, and cultural misconceptions. The heterogeneity of study designs posed challenges in synthesizing the findings. Conclusions: More targeted policies and programs are needed to address these barriers and help mothers succeed in breastfeeding. Improving breastfeeding outcomes worldwide will require better healthcare, social support, and an understanding of cultural influences. Full article
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27 pages, 330 KB  
Article
A Nutritional and Anthropometric Analysis of the Double Burden of Malnutrition in Children Under Two in Madagascar
by Rosita Rotella, María Morales-Suarez-Varela, Agustín Llopis-Gonzalez and Jose M. Soriano
Children 2025, 12(5), 640; https://doi.org/10.3390/children12050640 - 15 May 2025
Viewed by 1635
Abstract
Background: Almost half of all deaths worldwide in children under five are related to malnutrition. Malnutrition encompasses a wide array of nutritional conditions and emerging evidence indicates a growing overlap of these different forms of malnutrition. Nutrimetry, which combines assessments of height-for-age [...] Read more.
Background: Almost half of all deaths worldwide in children under five are related to malnutrition. Malnutrition encompasses a wide array of nutritional conditions and emerging evidence indicates a growing overlap of these different forms of malnutrition. Nutrimetry, which combines assessments of height-for-age (HAZ) with BMI-for-age (BMIZ) to offer a more integrated assessment of nutritional status, can be particularly useful in low-resource settings to correctly reflect the complex interplay of stunting and overweight. Objective: The objective of this study is to explore the impact of malnutrition on children in Madagascar and demonstrate how integrating HAZ assessments with BMIZ can reveal the double burden of malnutrition—encompassing both undernutrition and overnutrition—within the same population. Methods: This cross-sectional observational study employing Nutrimetry was carried out in rural communities in the Itasy region of Madagascar. A systematic random sampling method was used to choose the 500 women to invite to participate from the approximately 5000 who formed the pool of potential participants. A total of 437 were able to be invited and all invited women agreed to participate, resulting in 437 mother–child (0–24 months) pairs being included in the study. Results: Chronic undernutrition or thinness (31.6%), overweight and obesity (21.3%), and stunting (57.6%) were prevalent among the children included in the study. Among children with chronic undernutrition, 55.06% were identified as stunted. Among children with overweight or obese, 61.03% were identified as stunted. This highlights a significant overlap between inadequate weight and stunting. A socioeconomic analysis revealed significant barriers, including limited financial resources and poor dietary diversity, exacerbating malnutrition. Maternal nutritional status and breastfeeding practices also emerged as critical determinants of child nutritional outcomes. Conclusions: The study underscores the importance of prioritizing height assessments as a preliminary step in nutritional evaluations to prevent undetected acute malnutrition. Full article
(This article belongs to the Special Issue Childhood Malnutrition: 2nd Edition)
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