For group 1 nutrients, earlier studies among thiamine-deficient women in Gambia and India (125, 126) demonstrated strong human milk response to maternal thiamine supplementation. Infants have the capacity to self-regulate breast-milk intake as a function of milk energy density, therefore it is difficult to predict nutrient deficiency risk solely based on human milk composition. Fewtrell M, Wilson D, Booth I, Lucas A. The United Kingdom's Enquiring about Tolerance (EAT) trial focused on EBF infants randomly assigned to introduction of 6 potentially allergenic foods at age 3 mo (compared with age 6 mo): cooked egg, peanut, cow milk, sesame, white fish, and wheat (58). The knowledge index was created through the sums of binary input variables, where the highest and lowest values were selected for each underlying pointer. In the exceptional circumstances where formula supplementation may be called for, it should be done with careful oversight from a qualified provider, keeping in mind that early breastfeeding problems and corresponding introduction of infant formula are major risk factors for the early termination of both exclusive breastfeeding and any breastfeeding (74, 91, 156160). However, it is likely that this proportion is low because the lactation process is mainly driven by a highly protected infant demand-maternal supply process (77, 78). DASCOH Foundation was got approval from Community Based Health Care (CBHC) under the Ministry of Health and Family Welfare Government of Bangladesh. Recent studies suggest that breastfeeding may protect against development of food allergies and that this relation may be influenced by maternal diet. Yes An observational analysis of the Promoting Breastfeeding Interventional Trial in Belarus, a country with an adequate sanitation infrastructure, reported that EBF-6 infants had comparable growth and lower risk of gastrointestinal infections when compared to EBF-3 infants, consistent with evidence from low and LMIC settings (12). However, it is not the only contributor, as infants can self-regulate energy and nutrient intakes by adjusting the volume of milk they consume. A community clinic (CC) based study has been conducted by using semi-structured questionnaire. From the total sample population, approximately 61.2% and 79.5% were 20 years of age and Muslim. However, in each instance there are interventions that can be tailored to the needs of specific infants rather than changing the EBF-6 recommendation for the population of infants at large. Data Availability: All relevant data are within the manuscript and Supporting Information files. e0232027. Some evidence shows that for some of the nutrients that can be increased in breast milk through maternal supplementation (i.e., group 1 nutrients), very high supplementation would be needed to achieve modest nutrient increases in the infant's status for the corresponding nutrient (see supplementation section below). The prevalence of knowledge and practices on EBF were 34.5% and 27.9% among mothers having at least one child aged 612 months. The amount of iron provided from stores at birth plus intake from breast milk can provide sufficient iron for 6 mo if the exclusively breastfed infant is born at term, normal birth weight, the mother had adequate prenatal iron status, and the infant underwent delayed cord clamping. Study results was consistent with previous other study in Ethiopia [46, 47]. Therefore, successful implementation of the EBF-6 recommendation relies on having a qualified work force and appropriate social protection policies in place to protect, support, and promote breastfeeding since gestation (154). In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. Jonsdottir OH, Thorsdottir I, Hibberd PL, Fewtrell MS, Wells JC, Palsson GI, Lucas A, Gunnlaugsson G, Kleinman RE. In the Gambia study, both maternal and infant thiamine status improved in <2 wk after supplementation. This study had some limitations such as it was a community clinic based study so, it did not permit us to create any complete progressive associations for identifying knowledge and practices on EBF and several socio-economic and demographic factors and health performance linked with this features. Yes Duration of adequate body iron after birth by birth weight and timing of umbilical-cord clamping. Wojcik KY, Rechtman DJ, Lee ML, Montoya A, Medo ET. Regarding macronutrient composition, evidence suggests uniformity in mean human milk protein, fat, carbohydrate (lactose), and energy concentration across populations, regardless of maternal nutritional status (101, 102). We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account. Greenhawt M, Fleischer DM, Chan ES, Venter C, Stukus D, Gupta R, Spergel JM. Findings on the relation between maternal diet and HMO composition are inconsistent (66), however, and further research is warranted to better understand these relations. Among urban Bangladeshi women, the effects of maternal supplementation on human milk content were detected within 24 h for thiamin, riboflavin, vitamin A, and vitamin B-6, although the fraction transferred to breast milk ranged from 0.1% to 6.17% (129). Thirteen reviews and an expert report from the National Academies of Sciences, Engineering and Medicine (52, 53) found a lack of evidence to support the previous recommendations to delay introduction of potentially allergenic foods (specifically peanuts, eggs, fish, and gluten-containing foods) beyond age 12 mo to reduce the risk of allergies. Sinha B, Chowdhury R, Sankar MJ, Martines J, Taneja S, Mazumder S, Rollins N, Bahl R, Bhandari N. Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey KG. viii) Do you know what is happen if EBF were not done? We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. In this review, nutrient capability of EBF is maximum usually assessed for infant development [17]. 
The delayed cord clamping recommendation was issued by WHO based on strong evidence, and was subsequently incorporated into the WHO's Essential Newborn Care Course in 2012 (36) and to an official WHO Guideline in 2014 (37). In the second stage, purposive sampling technique was used to select sample size. Furthermore, it was found that these characteristics were statistically significant (p<0.05). Achieving these developmental milestones strongly correlates with the maturation of the gastrointestinal tract, kidneys, and immune system required to benefit from introducing complementary foods (147, 148). here. Oxford University Press is a department of the University of Oxford. Because food allergies can lead to serious health problems, including anaphylactic reactions and premature death, there is an interest in better understanding of whether, and how, they are related to diverse infant-feeding practices (52, 53). https://doi.org/10.1371/journal.pone.0232027.t004. Another outcome variable in this study was practices about EBF, which was measured through two different questions, namely: i) Do you feed any complement food for your last baby during EBF? The risk for iron deficiency in the first 6 mo of life can be successfully mitigated by delayed umbilical-cord clamping (22, 33, 34) (Figure 1). As shown in this Perspective, the risk of development of iron-deficiency anemia can be greatly reduced, even among those at highest risk (premature and low-birth-weight newborns) through delayed cord clamping, which is a simple and strongly effective intervention that can be readily implemented through proper training of healthcare providers (33, 152). Before measuring the level of knowledge and practices using consistent or reliability of respondents answer. The persistent reports of insufficient milk supply by mothers as a reason for supplementing breast milk with infant formula can be explained by the lack of adequate lactation management and social support rather than for primary biological reasons that cannot be properly addressed through sound lactation management. . The suckling infant ingests these nutrients, which are absorbed by the infant's gastrointestinal tract into the bloodstream, and then enter the infant's body tissues. Secondly, there are 64 districts and 491 sub-districts (upazilas) in Bangladesh, in this study, considered only one district and one upazila of considering district. The WHO committee issuing the EBF-6 recommendation in 2001 acknowledged the dearth of evidence they had available to assess how EBF impacts maternal nutrition. This study was assumption that educated mothers have and practices. From a child-development perspective, this individual-level variability in readiness to start consuming solid foods should be expected, given that in all developmental domains that have been studiedincluding crawling, walking, and languagechildren achieve the same developmental milestones at quite different ages, even when living in relatively similar environments (143145). iii) Do you know when supplementary feeding is needed? Low breastfeeding rates were found in Canada, and especially in industrialized countries [15]. 
This process involves numerous protein transporters and steps highly synchronized with each other. Knowledge index = (Actual value- Minimum value) / (Maximum value-Minimum value). Roles Jorgensen JM, Arnold C, Ashorn P, Ashorn U, Chaima D, Cheung YB, Davis JC, Fan YM, Goonatilleke E, Kortekangas E et al. It is important to reiterate that whereas some of the micronutrients in milk are affected by maternal diet (most of the vitamins, plus iodine and selenium), others are not (most of the minerals, including iron and zinc). . The child-development literature confirms that there is variability in the age at which infants achieve the necessary developmental milestones to be introduced to complementary foods, and that, on average, this happens at around 6 mo. Gupta RS, Warren CM, Smith BM, Blumenstock JA, Jiang J, Davis MM, Nadeau KC. Self-reported insufficient milk (SRIM) is the most commonly mentioned reason provided by women the world over for introducing breast-milk substitutes into the infant's diet or for stopping breastfeeding altogether (6870). The Canadian Asthma Primary Prevention Birth Cohort study examined the relation between maternal peanut consumption while breastfeeding, timing of peanut introduction to the child diet, and peanut sensitization at age 7 y. Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh. Miliku K, Robertson B, Sharma AK, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Lefebvre DL, Sears MR, Bode L et al. Breastfeeding is highly protective against infant morbidity and mortality in settings where infectious diseases and undernutrition are common, and therefore is strongly recommended even though the amounts of some micronutrients in mothers milk may be suboptimal (155). (82) found an association among stress indicators including longer labor duration, maternal exhaustion, increased stress hormones, and DOL. Supported by the Bill & Melinda Gates Foundation. Several studies have been performed to assess the knowledge, perception and practices on breastfeeding among females and shown global trends in EBF [13, 28], knowledge, attitude and techniques of breastfeeding under five children mothers in Nigerian [29,30], knowledge and practices of EBF in Nigerian populations [28]. Malnutrition will be decreased if EBF was widely established in Bangladesh. Opinions expressed in Perspective articles are those of the author and are not attributable to the funder(s) or the sponsor(s) or the publisher, Editor, or Editorial Board of Advances in Nutrition. EAT found that the exposed infants were less likely to develop food allergies compared with their counterparts who continued EBF for about 6 mo (59). Once lactation has been established, mothers produce a mean of 750g/d breast milk, although there is wide variation among women (from 440g/d to 1220g/d) (103), in part driven by infant demand. This Perspective also reaffirms that women with mild to moderate malnutrition, who comprise the majority of undernourished women in LMICs, can produce enough milk volume provided infant demand is not restricted because milk synthesis is dependent more on infant suckling than on maternal nutritional status itself. The dependent variable in this study is the level of knowledge about EBF, which was measured through nine different questions, namely: i) What do you mean by EBF? 
The WHO EBF-6 recommendation could not take human milk nutritional quality fully into account because of a lack of data on breast-milk composition in different settings. It also recognized the lack of evidence on human milk meeting all infant nutrient requirements (2). For this study researchers were received written consent from all of the subjects. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. No, Is the Subject Area "Rural areas" applicable to this article? However, this study measures the knowledge and practices through a lot of indicators which were reflected by several previous studies [26,5255]. Transport of calcium, electrolytes, and water-soluble vitamins occurs through transcellular pathways involving complex protein transport systems working in concert with each other (108). Special concern has been paid to the association between school going girls perception and knowledge about breastfeeding [31], knowledge, and practice of babys moms towards EBF and its related issues in Ethiopia [3234]. Female education should be increased substantially and hence more job opportunities could be created in various dimensional job sectors for them. It was found that 9,999 BDT income respondents have practice as compared to their counterparts. Ethics committee of Non-governmental Affairs Bureau (NGOAB) of Bangladesh has approved this project. Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Reeves T et al. This trial used the term high risk for infants with severe eczema or who tested positive for an egg allergy. Service holders mothers were (AOR = 9.992, 95% CI: 4.48522.260, p<0.05) times more likely to have practices than that of house wife. Hypothetical model proposing how lack of access to lactation support can lead to SRIM. Valid concerns have been expressed regarding how this recommendation may not be optimal for certain subgroups of infants, e.g., those born with low iron stores, at high risk of developing food allergies, or not being able to consume an adequate volume of milk. In both studies infants were provided with safe and nutritious complementary foods (5, 6). Diagnosis and Surgical Management of Neonatal Hydrocephalus. Dewey KG, Cohen RJ, Rivera LL, Brown KH. In 2001, the WHO recommended exclusive breastfeeding (EBF) for the first 6 mo of life (EBF-6), replacing its previous recommendation of EBF for 4-6 mo (1, 2). An extra assumption that most of the low monthly income mother watched BTV and follow those indications as compared with the rich housewife mothers they watch different type of Indian serial through dish channel [49]. According to WHO and UNICEF, EBF should start within less than one hour of delivery and must have to continue up to 6 months of infants age as it is the only source diets or fluids for babies at that age and have to sustain with balancing feeding on at the minimum 24 months of infants age [6]. Children mothers age 21 years (adjusted odds ratio, (AOR) = 13.840; 95% confidence interval CI: 7.39425.904), mothers were more likely to have a good knowledge on EBF compared to their counterparts and it was statistically significant (p<0.05). Effect on breast-milk volume and quality, Studies on human lactation. Breast milk does not provide infants with adequate vitamin D intake, even in populations typically known to be well nourished, and especially when infants are not exposed to sufficient sunlight (124). ii) Do you know when EBF should be started? This updated review included 23 studies, 3 of which were not included in the first review, 11 from LMICs, and 12 from high-income countries (3). Children especially new born babies are at large danger of malnutrition from first six months of life when breast milk alone is necessary to meet all nutritious supplies and balancing feeding needs to be in progress [8, 9]. This study suggested for more longitudinal research to realize this complex relationship and understand the fundamental tools. Peters RL, Koplin JJ, Gurrin LC, Dharmage SC, Wake M, Ponsonby AL, Tang MLK, Lowe AJ, Matheson M, Dwyer T et al. This study found poor knowledge and practices on EBF among mothers. The synthesis of human milk proteins, fat, and lactose involves different lactocyte organelles before secretion into the alveolar lumen (106). This area is situated at the nearest of Rajshahi is identified as divisional and education city [37]. Because RCTs are the gold standard for making causal inferences, the scarcity of RCTs underlying the WHO EBF-6 recommendation is seen by some as a weakness. In this study, data were collected from September to December2015 (i) socio-demographic characteristics and (ii) knowledge about EBF using a semi-structured questionnaire. This has led some to argue that the risk of iron deficiency through EBF-6 implementation outweighs this recommendation's other benefits, and that iron-rich complementary foods should be introduced to infants as early as age 4 mo (8, 11, 28, 29). Copyright American Society for Nutrition 2019. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. However, the numerous maternal and child health benefits associated with breastfeeding (1319) make experimental research designs impractical and unlikely to receive ethical approval in many settings. Hence, a change to the EBF-6 recommendation for the population at large to prevent food allergies is unwarranted. Because vitamin D synthesis is stimulated by sunlight on the skin and not obtained in significant amounts from the diet, breastfed and formula-fed infants without sufficient exposure and synthesis may require supplementary vitamin D. Studies in Finland and the United States show that very high maternal vitamin D supplementation is needed (2000 IU/d) to provide a significant amount of breast-milk vitamin D for the infant (123, 124). Place of delivery was divided into two group hospital and home and occupation also classified into two categorized such as housewife and service holder. Effect of dietary vitamin supplementation on vitamin contents of breast milk, Breast milk vitamin B-12 concentrations in Guatemalan women are correlated with maternal but not infant vitamin B-12 status at 12 months postpartum, Milk folate secretion is not impaired during iron deficiency in humans, Vitamin concentrations in human milk vary with time within feed, circadian rhythm, and single-dose supplementation, Lipid-based nutrient supplements providing approximately the recommended daily intake of vitamin A do not increase breast milk retinol concentrations among Ghanaian Women, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition, Prevention of rickets and vitamin D deficiency in infants, children, and adolescents, Maternal anthropometric status and lactation performance in a low-income Honduran population: evidence for the role of infants, Effect of frequent breast-feeding on early milk production and infant weight gain, Infant self-regulation of breast milk intake, Maternal versus infant factors related to breast milk intake and residual milk volume: the DARLING study, Nutrient intake and growth performance of older infants fed human milk, Human milk composition: nutrients and bioactive factors, Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach, Healthy Eating Research-Robert Wood Johnson Foundation, American Academy of Pediatrics. . Socio-economic and demographic differences regarding knowledge and practices of EBF were assessed by 2 test through significance for all analyses was set at p<0.05. A study conducted in the United Kingdom (136) that allowed for mothers to randomly select the breast from which to feed the baby first, found that intake from the second breast was only about 60% of the amount consumed from the first breast. Therefore, for the population at large, maternal concerns about milk supply do not justify revision of the EBF-6 recommendation. Mild to moderate maternal undernutrition can lead to suboptimal amounts of some key micronutrients in human milk (98). Concentrations of vitamin D in human milk correlate with maternal vitamin D intake and sunlight exposure. First, study have found very poor knowledge and practices 34.50%, 27.9% on EBF was noted among study participants. Bangladesh has a key amounts of malnourishment in South East Asia with nearly partial for children aged 59 months being underweight and 64%, 36%, 35.90% EBF reported [23,24,26,27]. The difficulty of judging knowledge lies in its multidimensional aspects. Pitt TJ, Becker AB, Chan-Yeung M, Chan ES, Watson WTA, Chooniedass R, Azad MB. This finding is consistent across studies even when different human milk sampling and analysis methods are used to determine macronutrient content; and also, when socioeconomic, nutritional status, and demographic characteristicsincluding infant age at which milk samples were obtainedvary within the populations assessed. The aim of this study was to determine the level of knowledge and practices on EBF and its relationship between different socioeconomic and demographic factors among mothers having at least one child of aged 612 months in the rural area of Rajshahi District, Bangladesh. These 2 studies showed that human milk responds to maternal riboflavin supplementation, and that riboflavin status rapidly improved in both mothers and infants after maternal supplementation was started. Department of Electrical and Electronic Engineering, Northern University, Dhaka, Bangladesh, Affiliation Moreover, service holder (AOR = 9.992; 95% CI: 4.48522.260) mothers were more likely to have good practices on EBF than their counterparts and it was statistically significant (p<0.05). . Data from both trials indicated that EBF-6 infants crawled sooner and in the first trial they also walked earlier compared with EBF-4 infants (9). Studies have shown that lactation support during the first days and weeks after birth is central to successful establishment of lactation and to minimizing the risk of subsequent lactation difficulties (77, 78).
The delayed cord clamping recommendation was issued by WHO based on strong evidence, and was subsequently incorporated into the WHO's Essential Newborn Care Course in 2012 (36) and to an official WHO Guideline in 2014 (37). In the second stage, purposive sampling technique was used to select sample size. Furthermore, it was found that these characteristics were statistically significant (p<0.05). Achieving these developmental milestones strongly correlates with the maturation of the gastrointestinal tract, kidneys, and immune system required to benefit from introducing complementary foods (147, 148). here. Oxford University Press is a department of the University of Oxford. Because food allergies can lead to serious health problems, including anaphylactic reactions and premature death, there is an interest in better understanding of whether, and how, they are related to diverse infant-feeding practices (52, 53). https://doi.org/10.1371/journal.pone.0232027.t004. Another outcome variable in this study was practices about EBF, which was measured through two different questions, namely: i) Do you feed any complement food for your last baby during EBF? The risk for iron deficiency in the first 6 mo of life can be successfully mitigated by delayed umbilical-cord clamping (22, 33, 34) (Figure 1). As shown in this Perspective, the risk of development of iron-deficiency anemia can be greatly reduced, even among those at highest risk (premature and low-birth-weight newborns) through delayed cord clamping, which is a simple and strongly effective intervention that can be readily implemented through proper training of healthcare providers (33, 152). Before measuring the level of knowledge and practices using consistent or reliability of respondents answer. The persistent reports of insufficient milk supply by mothers as a reason for supplementing breast milk with infant formula can be explained by the lack of adequate lactation management and social support rather than for primary biological reasons that cannot be properly addressed through sound lactation management. . The suckling infant ingests these nutrients, which are absorbed by the infant's gastrointestinal tract into the bloodstream, and then enter the infant's body tissues. Secondly, there are 64 districts and 491 sub-districts (upazilas) in Bangladesh, in this study, considered only one district and one upazila of considering district. The WHO committee issuing the EBF-6 recommendation in 2001 acknowledged the dearth of evidence they had available to assess how EBF impacts maternal nutrition. This study was assumption that educated mothers have and practices. From a child-development perspective, this individual-level variability in readiness to start consuming solid foods should be expected, given that in all developmental domains that have been studiedincluding crawling, walking, and languagechildren achieve the same developmental milestones at quite different ages, even when living in relatively similar environments (143145). iii) Do you know when supplementary feeding is needed? Low breastfeeding rates were found in Canada, and especially in industrialized countries [15]. This process involves numerous protein transporters and steps highly synchronized with each other. Knowledge index = (Actual value- Minimum value) / (Maximum value-Minimum value). Roles Jorgensen JM, Arnold C, Ashorn P, Ashorn U, Chaima D, Cheung YB, Davis JC, Fan YM, Goonatilleke E, Kortekangas E et al. It is important to reiterate that whereas some of the micronutrients in milk are affected by maternal diet (most of the vitamins, plus iodine and selenium), others are not (most of the minerals, including iron and zinc). . The child-development literature confirms that there is variability in the age at which infants achieve the necessary developmental milestones to be introduced to complementary foods, and that, on average, this happens at around 6 mo. Gupta RS, Warren CM, Smith BM, Blumenstock JA, Jiang J, Davis MM, Nadeau KC. Self-reported insufficient milk (SRIM) is the most commonly mentioned reason provided by women the world over for introducing breast-milk substitutes into the infant's diet or for stopping breastfeeding altogether (6870). The Canadian Asthma Primary Prevention Birth Cohort study examined the relation between maternal peanut consumption while breastfeeding, timing of peanut introduction to the child diet, and peanut sensitization at age 7 y. Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh. Miliku K, Robertson B, Sharma AK, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Lefebvre DL, Sears MR, Bode L et al. Breastfeeding is highly protective against infant morbidity and mortality in settings where infectious diseases and undernutrition are common, and therefore is strongly recommended even though the amounts of some micronutrients in mothers milk may be suboptimal (155). (82) found an association among stress indicators including longer labor duration, maternal exhaustion, increased stress hormones, and DOL. Supported by the Bill & Melinda Gates Foundation. Several studies have been performed to assess the knowledge, perception and practices on breastfeeding among females and shown global trends in EBF [13, 28], knowledge, attitude and techniques of breastfeeding under five children mothers in Nigerian [29,30], knowledge and practices of EBF in Nigerian populations [28]. Malnutrition will be decreased if EBF was widely established in Bangladesh. Opinions expressed in Perspective articles are those of the author and are not attributable to the funder(s) or the sponsor(s) or the publisher, Editor, or Editorial Board of Advances in Nutrition. EAT found that the exposed infants were less likely to develop food allergies compared with their counterparts who continued EBF for about 6 mo (59). Once lactation has been established, mothers produce a mean of 750g/d breast milk, although there is wide variation among women (from 440g/d to 1220g/d) (103), in part driven by infant demand. This Perspective also reaffirms that women with mild to moderate malnutrition, who comprise the majority of undernourished women in LMICs, can produce enough milk volume provided infant demand is not restricted because milk synthesis is dependent more on infant suckling than on maternal nutritional status itself. The dependent variable in this study is the level of knowledge about EBF, which was measured through nine different questions, namely: i) What do you mean by EBF? The WHO EBF-6 recommendation could not take human milk nutritional quality fully into account because of a lack of data on breast-milk composition in different settings. It also recognized the lack of evidence on human milk meeting all infant nutrient requirements (2). For this study researchers were received written consent from all of the subjects. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. No, Is the Subject Area "Rural areas" applicable to this article? However, this study measures the knowledge and practices through a lot of indicators which were reflected by several previous studies [26,5255]. Transport of calcium, electrolytes, and water-soluble vitamins occurs through transcellular pathways involving complex protein transport systems working in concert with each other (108). Special concern has been paid to the association between school going girls perception and knowledge about breastfeeding [31], knowledge, and practice of babys moms towards EBF and its related issues in Ethiopia [3234]. Female education should be increased substantially and hence more job opportunities could be created in various dimensional job sectors for them. It was found that 9,999 BDT income respondents have practice as compared to their counterparts. Ethics committee of Non-governmental Affairs Bureau (NGOAB) of Bangladesh has approved this project. Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Reeves T et al. This trial used the term high risk for infants with severe eczema or who tested positive for an egg allergy. Service holders mothers were (AOR = 9.992, 95% CI: 4.48522.260, p<0.05) times more likely to have practices than that of house wife. Hypothetical model proposing how lack of access to lactation support can lead to SRIM. Valid concerns have been expressed regarding how this recommendation may not be optimal for certain subgroups of infants, e.g., those born with low iron stores, at high risk of developing food allergies, or not being able to consume an adequate volume of milk. In both studies infants were provided with safe and nutritious complementary foods (5, 6). Diagnosis and Surgical Management of Neonatal Hydrocephalus. Dewey KG, Cohen RJ, Rivera LL, Brown KH. In 2001, the WHO recommended exclusive breastfeeding (EBF) for the first 6 mo of life (EBF-6), replacing its previous recommendation of EBF for 4-6 mo (1, 2). An extra assumption that most of the low monthly income mother watched BTV and follow those indications as compared with the rich housewife mothers they watch different type of Indian serial through dish channel [49]. According to WHO and UNICEF, EBF should start within less than one hour of delivery and must have to continue up to 6 months of infants age as it is the only source diets or fluids for babies at that age and have to sustain with balancing feeding on at the minimum 24 months of infants age [6]. Children mothers age 21 years (adjusted odds ratio, (AOR) = 13.840; 95% confidence interval CI: 7.39425.904), mothers were more likely to have a good knowledge on EBF compared to their counterparts and it was statistically significant (p<0.05). Effect on breast-milk volume and quality, Studies on human lactation. Breast milk does not provide infants with adequate vitamin D intake, even in populations typically known to be well nourished, and especially when infants are not exposed to sufficient sunlight (124). ii) Do you know when EBF should be started? This updated review included 23 studies, 3 of which were not included in the first review, 11 from LMICs, and 12 from high-income countries (3). Children especially new born babies are at large danger of malnutrition from first six months of life when breast milk alone is necessary to meet all nutritious supplies and balancing feeding needs to be in progress [8, 9]. This study suggested for more longitudinal research to realize this complex relationship and understand the fundamental tools. Peters RL, Koplin JJ, Gurrin LC, Dharmage SC, Wake M, Ponsonby AL, Tang MLK, Lowe AJ, Matheson M, Dwyer T et al. This study found poor knowledge and practices on EBF among mothers. The synthesis of human milk proteins, fat, and lactose involves different lactocyte organelles before secretion into the alveolar lumen (106). This area is situated at the nearest of Rajshahi is identified as divisional and education city [37]. Because RCTs are the gold standard for making causal inferences, the scarcity of RCTs underlying the WHO EBF-6 recommendation is seen by some as a weakness. In this study, data were collected from September to December2015 (i) socio-demographic characteristics and (ii) knowledge about EBF using a semi-structured questionnaire. This has led some to argue that the risk of iron deficiency through EBF-6 implementation outweighs this recommendation's other benefits, and that iron-rich complementary foods should be introduced to infants as early as age 4 mo (8, 11, 28, 29). Copyright American Society for Nutrition 2019. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. However, the numerous maternal and child health benefits associated with breastfeeding (1319) make experimental research designs impractical and unlikely to receive ethical approval in many settings. Hence, a change to the EBF-6 recommendation for the population at large to prevent food allergies is unwarranted. Because vitamin D synthesis is stimulated by sunlight on the skin and not obtained in significant amounts from the diet, breastfed and formula-fed infants without sufficient exposure and synthesis may require supplementary vitamin D. Studies in Finland and the United States show that very high maternal vitamin D supplementation is needed (2000 IU/d) to provide a significant amount of breast-milk vitamin D for the infant (123, 124). Place of delivery was divided into two group hospital and home and occupation also classified into two categorized such as housewife and service holder. Effect of dietary vitamin supplementation on vitamin contents of breast milk, Breast milk vitamin B-12 concentrations in Guatemalan women are correlated with maternal but not infant vitamin B-12 status at 12 months postpartum, Milk folate secretion is not impaired during iron deficiency in humans, Vitamin concentrations in human milk vary with time within feed, circadian rhythm, and single-dose supplementation, Lipid-based nutrient supplements providing approximately the recommended daily intake of vitamin A do not increase breast milk retinol concentrations among Ghanaian Women, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition, Prevention of rickets and vitamin D deficiency in infants, children, and adolescents, Maternal anthropometric status and lactation performance in a low-income Honduran population: evidence for the role of infants, Effect of frequent breast-feeding on early milk production and infant weight gain, Infant self-regulation of breast milk intake, Maternal versus infant factors related to breast milk intake and residual milk volume: the DARLING study, Nutrient intake and growth performance of older infants fed human milk, Human milk composition: nutrients and bioactive factors, Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach, Healthy Eating Research-Robert Wood Johnson Foundation, American Academy of Pediatrics. . Socio-economic and demographic differences regarding knowledge and practices of EBF were assessed by 2 test through significance for all analyses was set at p<0.05. A study conducted in the United Kingdom (136) that allowed for mothers to randomly select the breast from which to feed the baby first, found that intake from the second breast was only about 60% of the amount consumed from the first breast. Therefore, for the population at large, maternal concerns about milk supply do not justify revision of the EBF-6 recommendation. Mild to moderate maternal undernutrition can lead to suboptimal amounts of some key micronutrients in human milk (98). Concentrations of vitamin D in human milk correlate with maternal vitamin D intake and sunlight exposure. First, study have found very poor knowledge and practices 34.50%, 27.9% on EBF was noted among study participants. Bangladesh has a key amounts of malnourishment in South East Asia with nearly partial for children aged 59 months being underweight and 64%, 36%, 35.90% EBF reported [23,24,26,27]. The difficulty of judging knowledge lies in its multidimensional aspects. Pitt TJ, Becker AB, Chan-Yeung M, Chan ES, Watson WTA, Chooniedass R, Azad MB. This finding is consistent across studies even when different human milk sampling and analysis methods are used to determine macronutrient content; and also, when socioeconomic, nutritional status, and demographic characteristicsincluding infant age at which milk samples were obtainedvary within the populations assessed. The aim of this study was to determine the level of knowledge and practices on EBF and its relationship between different socioeconomic and demographic factors among mothers having at least one child of aged 612 months in the rural area of Rajshahi District, Bangladesh. These 2 studies showed that human milk responds to maternal riboflavin supplementation, and that riboflavin status rapidly improved in both mothers and infants after maternal supplementation was started. Department of Electrical and Electronic Engineering, Northern University, Dhaka, Bangladesh, Affiliation Moreover, service holder (AOR = 9.992; 95% CI: 4.48522.260) mothers were more likely to have good practices on EBF than their counterparts and it was statistically significant (p<0.05). . Data from both trials indicated that EBF-6 infants crawled sooner and in the first trial they also walked earlier compared with EBF-4 infants (9). Studies have shown that lactation support during the first days and weeks after birth is central to successful establishment of lactation and to minimizing the risk of subsequent lactation difficulties (77, 78).