|Year : 2019 | Volume
| Issue : 1 | Page : 133-138
Study of mastitis comorbidities among lactating mothers in El-Batanoon village, Menoufia governorate
Hala M Shahin1, Nagwaa N Hegazy1, Heba A Elgohary Taman2
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Public Health and Community of Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||28-Sep-2016|
|Date of Acceptance||20-Dec-2017|
|Date of Web Publication||17-Apr-2019|
Heba A Elgohary Taman
Department of Family Medicine, Faculty of Medicine, Menoufia University, El-Batanoon, El Menoufia
Source of Support: None, Conflict of Interest: None
This study aimed to deter mine the prevalence of mastitis among lactating mothers in El-Batanoon and to assess the risk factors of mastitis.
Mastitis is one of the most common frequent breastfeeding problems among lactating mothers and is frequently associated with comorbid illnesses.
Patients and methods
A case–control study of breastfeeding women, 45 patients (women with mastitis), and 355 control participants was carried out in El-Batanoon family health facilities. All the women attending the vaccination sessions for the children in the family health center on Mondays from 9 a.m. to 2 p.m. for 6 months were assessed. Data were collected using a predesigned structured questionnaire for history of the mothers and the babies, complete physical examination for them and assessment of breastfeeding technique.
The prevalence of mastitis in the groups studied was 14%. The prevalence of mastitis was higher among women who had nipple crack, 39 (86.2%) patients, those who had breast engorgement, 27 (60.5%) patients, and those who had improper position with her baby during breastfeeding, 30 (67.6%) patients. A high prevalence of mastitis affects breastfeeding and decreases the benefits for the mothers and the babies.
According to our results, the current study showed that mastitis is a major problem that affects mothers and their babies, with a prevalence of 11.25% among lactating mothers attending the family health center in rural areas, Menoufia governorate.
Keywords: breastfeeding, breastfeeding problems, mastitis, prenatal awareness, prevalence
|How to cite this article:|
Shahin HM, Hegazy NN, Elgohary Taman HA. Study of mastitis comorbidities among lactating mothers in El-Batanoon village, Menoufia governorate. Menoufia Med J 2019;32:133-8
|How to cite this URL:|
Shahin HM, Hegazy NN, Elgohary Taman HA. Study of mastitis comorbidities among lactating mothers in El-Batanoon village, Menoufia governorate. Menoufia Med J [serial online] 2019 [cited 2019 Aug 25];32:133-8. Available from: http://www.mmj.eg.net/text.asp?2019/32/1/133/256119
| Introduction|| |
Breastfeeding plays an important role in the growth, health, and development of preterm and term infants; also, there are important health benefits for mothers from breastfeeding and lactation . There are many problems that interfere with breastfeeding and its success is a result of the mother's ability to deal with these problems . Family physicians must encourage women to breastfeed, increase their prenatal awareness to improve breastfeeding, and provide advice on the management of breastfeeding problems .
Mastitis is one of the most common problems encountered by breastfeeding mothers, with increased incidence in the first 6 months of the postpartum period . The main etiological causes of mastitis are staphylococci, streptococci, and corynebacteria . The typical clinical symptoms and signs of mastitis include reddish skin, breast tenderness, myalgia, fever, or chills with unilateral edema, erythema, and tenderness of the breast .
Sore nipples and breast engorgement may be an early indicator of a condition that may predispose patients to mastitis. In the early weeks of breastfeeding, sore nipples are often caused by a poor attachment between the infant and the nipple of the breast during breastfeeding . Lactational mastitis is associated with primiparity, and improper nursing technique leads to incomplete emptying of the breast and poor infant suckling .
Some women develop complications of mastitis that result in breast abscess, called lactational breast abscess; this is a collection of infected fluid within the breast tissue and the aim of treatment is to treat the abscess quickly and effectively, and ensure maximum benefit to the mother with minimal interruption of breastfeeding . Mastitis can also be prevented by ensuring effective positioning and attachment and also by avoid missing feeds, unnecessary breast milk supplements, nipple trauma, use of teats and dummies, breast engorgement, and wearing of tight bras . Recent Clinical Practice Guidelines recommend penicillinase-resistant penicillins such as flucloxacillin and dicloxacillin as the drug of first choice, or cephalexin and clindamycin in women who are allergic to penicillin . The aim of this study was to assess the prevalence of mastitis and its risk factors to improve health care for mothers and their babies.
| Patients and Methods|| |
The study was approved by the Research Ethics Committee of Menoufia University and a written informed consent was signed by each study participant.
This was a case–control study. All the eligible lactating women attending the vaccination sessions for children in the family health center on Mondays from 9 a.m. to 2 p.m. for 6 months were assessed. Thus, the calculated sample was 45 patients (women with mastitis) and 355 controls. The sample size was estimated using Epi_ info, version 7 (CDC in Atlanta, Georgia US); this was calculated on the basis of the highest prevalence of mastitis from the literature, which was 33.3% , and the lowest prevalence, which was 9.5% . The following equation was used :
P, the prevalence of breastfeeding problems (33.3%) .
Z, a percentile of the standard normal distribution determined by a 95% confidence level = 1.96.
Δ, the width of the confidence interval = 5%.
The average number of visits to the El-Batanoon Health Care Unit and center was ∼1950 per year 130 per month, 30 per day.
Participants were assessed for mastitis and the possible risk factors through review of history, physical examination, and assessment of the technique of breastfeeding.
Females in the childbearing period, lactating mothers, and mothers who agreed to participate in the study were included in this study.
Women who refused to participate, and mothers who had cancer, chronic illness, or active psychiatric illness were excluded from the study.
A case–control study was carried out in El-Batanoon family health center in El-Batanoon village, Menoufia governorate, Egypt, over a 6-month period (April 1, 2015 to November 30, 2015). All the participants, after their informed consent was obtained, were interviewed for comprehensive mother and child assessments as follows.
Assessment of history of the mothers to assess their sociodemographic data including occupation and socioeconomic level. The maternal status was assessed through assessment of the history of the mothers' parity, lactation, and breast care, both past and present histories, in addition to asking the mother about the birth weight of the baby at delivery, etc.
A comprehensive clinical examination of the mothers was performed to diagnose mastitis and other breastfeeding problems such as nipple cracking and breast engorgement.
A clinical examination of the babies was performed by checking their weights and putting the current weight of the baby on Egyptian weight for age percentile from birth to 36 months. Normal weight is considered to be between the third percentile and the 97th percentile, and a baby is considered underweight below the third percentile and overweight above the 97th percentile. The sex of the babies was recorded and they were examined for nasal problems, jaundice, mouth, or gum inflammation.
The technique of breastfeeding was determined by instructing the mother to lactate her baby and then checking the position of the mother and the baby during breastfeeding and the attachment of the baby mouth to the nipple.
Statistical analysis of the collected data was carried out; the data were tabulated and analyzed using the statistical package for the social science, version 20 for Windows (SPSS Inc., Chicago, Illinois, USA). Qualitative data were expressed as number and percentage and analyzed using the χ2 test; Fisher's exact test and the Z test were used to compare two proportions. For all analyses, a P value less than 0.05 was considered statistically significant.
| Results|| |
The frequency of mastitis was 11.25% among the studied group [Figure 1]. The highest prevalence for mastitis was associated with the working mothers resembling 67% of the cases(P = 0.0001). regarding the socioeconomic level, mothers with middle socioeconomic level had a high risk for mastitis resembling 91% of the cases [Table 1].
The table listing maternal risk factors of mastitis shows that the prevalence of mastitis was higher among mothers who did not feed their babies from both breasts (55.6%) patients, the frequency of lactation was less than 5 hours (55.6%), who are primigravida (66.6%) patients, did not have prenatal awareness (89.5%), did not do nipple care during the last trimester of pregnancy (100%), had diabetes mellitus (13.8%), had nipple crack (86.2%) patients, had a bad position during breastfeeding (67.6%) patients, and breast engorgement 27 (60.5%) [Table 2]. According to the χ2 test, there was a highly statistically significant difference in the prevalence of mastitis according to parity, feeding from both breasts, cleaning of the nipple after every lactation, presence diabetes mellitus, prenatal awareness, nipple crack, and breast engorgement, P = 0.000 [Table 2].
|Table 2: Maternal risk factor for mastitis among the studied group (n=400)|
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The prevalence of mastitis was higher among women who had babies with normal weight, 40 (89%) patients, and those with male babies, 25 (55%) patients. There was a highly statistically significant difference for infant risk factors among the studied group in terms of runny nose, inflamed gum, and weight of the neonate, P = 0.0000 [Table 3].
|Table 3: Infant risk factor for mastitis among the studied group (n=400)|
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The prevalence of mastitis was higher among women who had a bad position with baby during breastfeeding 30 (67.6%) patients [Table 4]. According to Logistic, regression analysis of the risk factors for mastitis among the studied group, there was a highly statistically significant difference for feeding from both breasts and cleaning nipple by soap and water, P = 0.000; also, there was a statistically significant difference in terms of prenatal awareness, P = 0.049 [Table 5].
|Table 5: Logistic regression analysis of the risk factors for mastitis among the studied group|
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| Discussion|| |
Despite the advantages of breastfeeding, women may not choose to breastfeed because of breastfeeding problems, which are common among mothers and can be very challenging for both mothers and infants . Lactational mastitis is one of the main medical causes of premature weaning because of pain and discomfort or because of inappropriate advice from a health professional. As breastfeeding provides a wide range of health benefits for mothers and infants, mastitis is a relevant public health issue . The current study was carried out to investigate the prevalence of mastitis and the potential risk factors that could be involved in infectious lactational mastitis.
The current study confirms that the prevalence rate of mastitis was (11.25%), 45 patients, this in the line with the study of Foxman et al. , which was carried out on 946 breastfeeding women from Michigan and Nebraska that showed that 9.5% of the women had lactational mastitis. This is in contrast with the study of Dener and Inan , who reported that the prevalence of mastitis was 33.3%; this may have been a result of the decreased rate of lactation of the participants of the Dener and Inan study as the patients were working.
The present study found a significant correlation between occupation and the prevalence of mastitis. The percentage of mastitis was higher among employed women (67%), 33 (33%) patients than unemployed women, 15 patients. These results are consistent with the previously reported study of Kasonka et al. , who reported that the prevalence of mastitis was higher among working women (23%), and are also in agreement with the study of Cropley and Herwehe , carried out in Riyadh, which showed that 66.6% of women who had breastfeeding problems were working as increase the rate of milk stasis in the breast and increase the breast engorgement. This is in contrast to the study carried out by Saied et al.  on Saudi women residing in Riyadh, who reported that unemployed women had a higher prevalence of mastitis (60.11%) than employed women as they refused to breastfeed their babies (39, 8%).
In the present study, the prevalence of women with mastitis was higher among women with nipple cracking, 39 (86.2%) cases. This is in agreement with the study of Amir et al.  and that of Kasonka and colleagues, who reported that the prevalence of mastitis was higher among women with cracked nipples, 416 (26%) cases, as crack facilitate entrance of bacteria to the breast.
The percentage of primigravida who had mastitis was 66.6% (33 patients). This is agreement with Amir et al. , who reported that the prevalence of mastitis was higher among primigravida (48%). This is in contrast to the study carried out by Egbe et al. , which was carried out on 245 women in Douala General Hospital, Cameroon. They reported that the percentage of multigravide who had mastitis was 68.6%, which was higher than that among the primigravida (31.4%), as most patients of this study were mutigravide and did not had prenatal awareness about breastfeeding.
The current study revealed that the prevalence of mastitis in female with frequency of lactation less than 5 h and 25 (55.6%) cases was more than female with frequency of lactation more than 5 h and had mastitis 15 (33.3%). This is in agreement with the study carried out by Foxman et al. , who reported that the prevalence of mastitis was higher among women who fed their babies nine times a day, 95%. This is in contrast to the study carried out by Egbe et al. , who reported that the prevalence of mastitis in women with frequency of lactation more than 5 h (82%) was higher than that in women with a frequency of lactation less than 5 h and those who had mastitis (18%) as they had bad prenatal awareness about breastfeeding.
The prevalence of mastitis in the present study was higher in women with male infant, 25 (55.5%) cases, than those with female infants, 20 (44.8%) cases. This in agreement with Kasonka et al. , who reported that the percentage of mothers who had mastitis and had male infants was higher than mothers who had mastitis and female infants as 85% of the women in this study had female infants.
In the present study, the prevalence of mastitis was higher among mothers who had bad position between them and their babies 30 (67.6%) cases, with a statistically significant difference, and this is in agreement with the study of Lawrence , who reported that the prevalence of mastitis was higher among women who had adopted a poor breastfeeding technique for position as the bad position increase the risk nipple crack.
| Conclusion|| |
According to our results, the current study showed that mastitis is a major problem that affects mothers and their babies, with a prevalence of 11.25% among lactating mothers attending the family health center in rural areas, Menoufia governorate. The current study also showed that nipple crack and breast engorgement are important risk factors for mastitis. Also, this study showed that mastitis was highly prevalent among lactating mothers who did not have prenatal awareness, working and primigravida.
Increase prenatal awareness of the mothers and encourage them for breastfeeding.
Primary health care physicians should use an evidence-based strategy for the diagnosis and management of breastfeeding problems.
Breastfeeding programs should focus on improved breastfeeding, decrease its risk factors.
Awareness should be raised about the magnitude of the problem.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI. Breastfeeding and the use of human milk. Pediatrics J 2005; 115
Hegney D, Fallon T, O'Brien M. Against all odds: a retrospective case-controlled study of women who experienced extraordinary breastfeeding problems. J Clin Nurs 2008; 17
Renfrew M. Time to get serious about educating health professionals. Matern Child Nutr J 2006; 2
Tang L, Lee AH, Qiu L, Binns CW. Mastitis in Chinese breastfeeding mothers: a prospective cohort study. Breastfeed Med 2014; 9
Ingram J. Multiprofessional training for breastfeeding management in primary care in the UK. Int Breastfeed J 2006; 1
Sun H, Dong S, Sen-Wen Teng S, Ben S, Sheng M, Ming S, Peng P. Combination of ultrasound-guided drainage and antibiotics therapy provides a cosmetic advantage for women with methicillin-resistant Staphylococcus aureus
breast abscess. Taiwan J Obstet Gynecol 2014; 53
Kinlay J, O'Connell D, Kinlay S. Risk factors for mastitis in breastfeeding women: results of a prospective cohort study. Aust N
Z J Public Health 2001; 25
Barbosa C, Schwartz K, Foxman B. Lactation mastitis. JAMA 2003; 289
Irusen H, Rohwer AC, Steyn DW, Young T. Treatments for breast abscesses in breastfeeding women. Cochrane Library 2015; 1
Spencer J. Management of mastitis in breastfeeding women. Am Fam Physician 2008; 78
Scott JA, Robertson M, Fitzpatrick J, Knight C, Mulholland S. Occurrence of lactational mastitis and medical management: a prospective cohort study in Glasgow. Int Breastfeed J 2008; 3
Dener C, Inan A. Breast abscesses in lactating women. World J Surg 2003; 27
Foxman B, D'Arcy H, Gillespie B, Bobo JK, Kendra S. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol 2002; 155
Ratain J, Hochberg M. Clinical trials. Arthritis Rheum 1990; 33
Mediano P, Fernández L, Rodríguez JM, Marin M. Case–control study of risk factors for infectious mastitis in Spanish breastfeeding women. BMC Pregnancy Childbirth 2014; 14
Kasonka L, Makasa M, Marshall T, Chisenga M, Sinkaia M, Chintu C, et al
. Risk factors for subclinical mastitis among HIV-infected and uninfected women in Lusaka, Zambia. Pediatr Perinat Epidemiol 2006; 20
Cropley L, Herwehe JC. Evaluation of institutional support for breastfeeding among low-income women in the metropolitan New Orleans area. J Am Diet Assoc 2002; 102
Saied H, Mohamed A, Suliman A, Anazi WAL. Breastfeeding knowledge, attitude and barriers among Saudi women in Riyadh. J Natl Sci Res 2013; 3
Amir LH, Forster DA, Lumley J, McLachlan H. A descriptive study of mastitis in Australian breastfeeding women: incidence and determinants. BMC Public Health 2007; 7
Egbe TO, Ngonsai DT, Tchounzou R. Prevalence and risk factors of lactation mastitis in three hospitals in Cameroon: a cross-sectional study. Br J Med Med Res 2015; 13
Lawrence RA. Invited commentary: mastitis while breastfeeding: old theories and new evidence. Am J Epidemiol 2002; 15
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]