Marie Tarrant

In recent years there has been a steady influx of immigrants into Hong Kong from Mainland China, where breastfeeding patterns differ. Studies in other regions have found substantial differences in breastfeeding rates between native-born and immigrant mothers. The purpose of this study was to examine factors associated with breastfeeding initiation in Hong Kong born and Mainland China born mothers living in Hong Kong. We used a multi-center cross-sectional study design and recruited 2761 new mothers from the postnatal wards of all eight public hospitals in Hong Kong that offer obstetric services. We assessed breastfeeding status as well as various socio-demographic, maternal and birth characteristics. Chi-square tests and multivariable logistic regression were used to identify the predictors of breastfeeding initiation in Hong Kong born and Mainland China born participants. 80.3 % of Hong Kong and 81.1 % of Mainland Chinese born women initiated breastfeeding. In the fully adjusted models, multiparity (Odds Ratio [OR] 0.53, 95 % CI 0.43–0.66) and maternal smoking (OR 0.29, 95 % CI 0.18–0.45) were strongly associated with failure to initiate breastfeeding in both Hong Kong and Mainland China born participants. In Hong Kong born mothers, participants with lower maternal education and those who had a cesarean section were significantly less likely to breastfeed. For Mainland China born mothers, paternal smoking (OR 0.70, 95 % CI 0.49–0.99) and having a pregnancy-related health problem (OR 0.60, 95 % CI 0.38–0.94) were both additional risk factors for not breastfeeding. This study has identified predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers. Given the current high breastfeeding initiation rates among both groups, antenatal breastfeeding education and promotion programmes need to specifically intervene with sub-groups of pregnant women at risk for not breastfeeding so that their efforts are more strategic and cost-effective.

Background: The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers’ exposure to Baby-Friendly steps. Objectives: To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers’ exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. Methods: We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother–infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants’ exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. Results: After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). Conclusion: After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.

Objective: To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration.Design: Prospective cohort study.Setting: In-patient postnatal units of four public hospitals in Hong Kong.Subjects: Two cohorts of breast-feeding mother–infant pairs (n2560). Cohort 1 (n1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.Results: The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd3·11) in cohort 1 and 1·17 (sd1·94) in cohort 2 (PP<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose–response pattern.Conclusions: After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.

Objective: To evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding.Design: Multicentre, three‐arm, cluster randomised controlled trial.Population: A cohort of 722 primiparous breastfeeding mothers with uncomplicated, full‐term pregnancies.Methods: The three study interventions were: (1) standard postnatal maternity care; (2) standard care plus three in‐hospital professional breastfeeding support sessions, of 30–45 minutes in duration; or (2) standard care plus weekly post‐discharge breastfeeding telephone support, of 20–30 minutes in duration, for 4 weeks. The interventions were delivered by four trained research nurses, who were either highly experienced registered midwives or certified lactation consultants.Main outcome measures: Prevalence of any and exclusive breastfeeding at 1, 2, and 3 months postpartum.Results: Rates of any and exclusive breastfeeding were higher among participants in the two intervention groups at all follow‐up points, when compared with those who received standard care. Participants receiving telephone support were significantly more likely to continue any breastfeeding at 1 month (76.2 versus 67.3%; odds ratio, OR 1.63, 95% confidence interval, 95% CI 1.10–2.41) and at 2 months (58.6 versus 48.9%; OR 1.48, 95% CI 1.04–2.10), and to be exclusively breastfeeding at 1 month (28.4 versus 16.9%; OR 1.89, 95% CI 1.24–2.90). Participants in the in‐hospital support group were also more likely to be breastfeeding at all time points, but the effect was not statistically significant.Conclusions: Professional breastfeeding telephone support provided early in the postnatal period, and continued for the first month postpartum, improves breastfeeding duration among first‐time mothers. It is also possible that it was the continuing nature of the support that increased the effectiveness of the intervention, rather than the delivery of the support by telephone specifically.

Pregnant women are the highest priority group for annual influenza vaccination. Studies have shown unacceptably low uptake of both seasonal and pandemic A/H1N1 influenza vaccination among pregnant women. This paper will describe the study protocol and methodology of a randomised controlled trial designed to assess the effectiveness of a brief educational intervention in improving the uptake of seasonal influenza vaccine among pregnant women in Hong Kong.

Multiple-choice questions are frequently used in high-stakes nursing assessments. Many nurse educators, however, lack the necessary knowledge and training to develop these tests. The authors discuss test development guidelines to help nurse educators produce valid and reliable multiple-choice assessments.

During the 2009–2010 A/H1N1 influenza pandemic, pregnant women infected with the virus experienced excess morbidity and mortality when compared with other groups. Once a vaccine was available, pregnant women were a priority group for vaccination. Only a few studies have reported on the uptake of 2009 A/H1N1 influenza vaccine among pregnant women during the pandemic and none were from Asia. The purpose of this study was to examine factors associated with 2009 A/H1N1 influenza vaccine uptake among pregnant women in Hong Kong. Using a multi-center, cross-sectional design, we recruited 549 postpartum women from four post-natal wards in Hong Kong over a 4-month period during the second wave of the A/H1N1 influenza pandemic in the winter and spring of 2010. Only 6.2% (n = 34) of participants had received the 2009 A/H1N1 influenza vaccine and 4.9% (n = 27) had received the seasonal influenza vaccine. The most common reasons for not receiving the 2009 A/H1N1 vaccine were fear of causing harm to themselves or their fetus. A high knowledge level (OR = 19.06; 95% CI 5.55, 65.48), more positive attitudes (OR = 3.52; 95% CI 1.37, 9.07), and having a family member who had the 2009 A/H1N1 influenza vaccine (OR = 7.69; 95% CI 2.92, 20.19) were independently and positively associated with vaccination. Study results show an unacceptably low uptake of the pandemic A/H1N1 influenza vaccine among pregnant women in Hong Kong. Interventions to increase influenza vaccine knowledge and uptake among this group should be a priority for future pandemic planning and seasonal vaccination campaigns.