Determinants of infant and young child feeding practices by mothers in two rural districts of Sindh,Pakistan: a cross-sectional survey

Background

Infant and young child feeding (IYCF) practices during the first two years of life are important for the growth and development of a child. The aim of this study was to assess IYCF practices and its associated factors in two rural districts of Pakistan.

Methods

A cross-sectional study was conducted in two rural districts of Sindh province, Pakistan as part of a stunting prevention project between May and August 2014. A standard questionnaire on IYCF practices recommended by World Health Organization was used to collect information from 2013 mothers who had a child aged between 0 and 23 months.

Results

Only 49% of mothers initiated breastfeeding within one hour of birth. Thirty-seven percent of mothers exclusively breastfed their infants for six months. Seventy-percent mothers introduced complementary feeding at 6–8 months of age. Eighty-two percent of mothers continued breastfeeding for at least one year and 75% for at least two years of age. IYCF practices were not significantly different for boys and girls in the study area. Being an employed mother (AOR 2.14; 95% CI 1.02, 4.51) was positively associated with the early initiation of breastfeeding. Children who were born at a health facility (AOR 0.65; 95% CI 0.50, 0.84) and were aged six to eleven months (AOR 0.70; 95% CI 0.54, 0.90) were less likely to be have an early initiation of breastfeeding. Mothers aged 25 to 29 years (AOR 1.83; 95% CI 1.05, 3.18), being literate (AOR 1.79; 95% CI 1.15, 2.78), and higher income (AOR 10.6; 95% CI 4.40, 25.30) were more likely to have an improved dietary diversity. Being an employed mother (AOR 2.18; 95% CI 1.77, 4.03) and higher income were more likely to have minimum acceptable diet (AOR 9.7; 95% CI 4.33, 21.71).

Conclusion

IYCF practices were below the acceptable level and associated with maternal age, maternal illiteracy, unemployment, and poor household wealth status. Emphasis should be given to improve maternal literacy and reduction in poverty to improve IYCF practices.

     

Breast-feeding in Bangladesh

In this paper the duration of breastfeeding is examined in relation to demographic and socioeconomic characteristics of women and households. 98% of Bangladesh mothers breastfeed their children from birth. In data from the Bangladesh Fertility Survey conducted in 1975-1976 on 4998 live births, the mean duration of breastfeeding was 27.3 months. Duration of breastfeeding was positively related with the age of women. Female children were breastfed for periods about 5 months shorter than male children. Children born to urban mothers were breastfed for shorter durations than children born to rural mothers of all age groups. The duration of breastfeeding decreased with the increase of education of the mother. Promotion of breastfeeding should be a primary responsibility of family planning clinics. Further decline in the duration of breastfeeding would increase levels of fertility and infant and child mortality.     

Community volunteers can improve breastfeeding among children under six months of age in the Democratic Republic of Congo crisis

Background

Promotion of proper breastfeeding practices for the first six months of life is the most cost-effective intervention for reducing childhood morbidity and mortality. However, the adherence to breastfeeding recommendations in many developing countries is not satisfactory. The aims of the study were to determine breastfeeding and infant feeding patterns at nine months of age and to assess factors influencing exclusive breastfeeding practices.

Methods

In Bhaktapur, Nepal, we carried out a cross-sectional survey of 325 infants who came for measles vaccination at the age of nine months. Mothers were interviewed on details regarding feeding of their child and health since birth.

Results

Three quarters of all mothers reported that they did not receive any information on breastfeeding during the antenatal visit. Two hundred and ninety five (91%) mothers gave colostrum and 185 (57%) initiated breastfeeding within one hour of delivery. The prevalence of exclusively breastfeeding at 1, 3 and 6 months were 240 (74%), 78 (24%) and 29 (9%), and partial feeding was initiated in 49 (15%), 124 (38%) and 257 (79%) babies, respectively. The main reason, according to the mother, for introducing other foods before six months of age was insufficient breast milk. In logistic regression analyses, mother's knowledge on how long child should be given only breast milk and not living in joint families were associated positively with exclusive or predominant breastfeeding for four months or beyond.

Conclusions

Despite the high proportion of mothers who initiated breastfeeding immediately after birth, continuation of exclusive breastfeeding for up to six months was not common. Very few mothers received any information on breastfeeding during the antenatal visit, indicating a need for counseling on exclusive breastfeeding. Possible options for this counseling could be during antenatal visits and at regular clinic visits for vaccination.     

Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study

Background

Exclusive breastfeeding (EBF) during the early months of life reduce infant morbidity and mortality. Current recommendation in Sri Lanka is to continue exclusive breastfeeding up to six months of age. Exclusive breastfeeding rates are generally assessed by the 24 recall method which overestimates the actual rates. The objective of this study was to determine actual exclusive breast feeding rates in a cohort of Sri Lankan children and to determine the reasons that lead to cessation of breastfeeding before six months of age.

Methods

From a cohort of 2215 babies born in Gampaha district, 500 were randomly selected and invited for the study. They were followed up at two (n?=?404), four (n?=?395) and six (n?=?286) months. An interviewer administered questionnaire asked about feeding history and socio-demographic characteristics. Child health development record was used to assess the growth.

Results

Exclusive breastfeeding rates at two, four and six months were 98.0%, 75.4% and 71.3% respectively. The main reasons to stop exclusive breastfeeding between two to four months was concerns regarding weight gain and between four to six months were mothers starting to work. Majority of the babies that were not exclusively breastfed still continued to have breast milk. Mothers above 30 years had lower exclusive breastfeeding rates compared to younger mothers. Second born babies had higher rates than first borns. There was no significant association between maternal education and exclusive breastfeeding rates.

Conclusions

Exclusive breastfeeding rates were high among this cohort of children. A decrease in EBF was noted between two and four months. EBF up to six months does not cause growth failure. Mothers starting to work and concerns regarding adequacy of breast milk were the major reasons to cease EBF. The actual exclusive breastfeeding rates up to six months was 65.9%.

     

Determinants of exclusive breastfeeding in infants less than six months of age in Hawassa,an urban setting,Ethiopia

Background

The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first six months of life. However, the proportion of EBF in Ethiopia is 58%. The EBF practice and factors affecting it have not been studied in Hawassa, Southern Ethiopia. The aim of this study was to assess the prevalence and determinants of EBF practice among infants less than six months age in Hawassa city, Ethiopia.

Methods

A total of 529 mothers with infants aged 0–6 months were involved in this study between November 2015 and January 2016. Trained interviewers collected data from the mothers of the infants. Exclusive breastfeeding was assessed based on infant feeding practice in the prior 24 h. Multivariable logistic regression analysis was conducted.

Results

Infants aged 0–5.9 months were studied with comparable gender composition (51.4% females). The exclusive breastfeeding prevalence was 60.9% (95% CI 56.6, 65.1). Mothers with infants aged 0–1.9 months and 2–3.9 months practiced EBF more likely than mothers with infants aged 4–6 months (Adjusted odds ratio [AOR] 3.59; 95% CI 2.07, 6.2) and (AOR 2.08; 95% CI 1.23, 3.5), respectively. Married mothers practiced EBF more likely than singles (AOR 2.04; 95% CI 1.03, 4.06). Housewives practiced EBF more likely than employed mothers (AOR 2.57; 95% CI 1.34, 4.9). Mothers who had a vaginal birth were more likely to practice EBF than mothers who gave birth via Cesarean section (AOR 2.8; 95% CI 1.7, 4.6). Mothers who gave birth at a healthcare facility were more likely to practice EBF than mothers who gave birth at home (AOR 8.8; 95% CI 5.04, 15.4). Mothers without a breast complication practiced exclusive breastfeeding more than mothers with breast complications (AOR 2.05; 95% CI 1.5, 4.1).

Conclusions

This study showed a low prevalence of exclusive breastfeeding. Younger infants, babies born to married women, who are housewives, having a vaginal birth in a health facility, and whose mother’s breasts were healthy, were predictors for EBF. The promotion of an institutional delivery, optimal breastfeeding practices, and designing strategies to better support employed mothers are recommended.

     

Higher likelihood of 6-months exclusive breastfeeding among HIV infected than uninfected mothers: a household survey in Kenya

Background

Exclusive breastfeeding (EBF) (breast milk feeding without additional food or drink, except medicine) is associated with deceased risk of postnatal transmission of HIV from mother to child.

Methods

This analysis used data from a household survey in Western Kenya in 2011. Participants were mothers with HIV and uninfected mothers, aged ≥14 years who gave birth in the prior year (ever breastfed) within the Kenya Medical Research Institute/US Centers for Disease Control and Prevention (KEMRI/CDC) Health and Demographic Surveillance System. Data on breastfeeding counseling and knowledge and practices regarding breastfeeding were collected. Rates and correlates of EBF were determined using multivariable logistic regression.

Results

Of 652 mothers enrolled in the study, 435 were included in this analysis. Median age was 28 years among 154 mothers with HIV and 25 years among 281 uninfected mothers. Mothers with HIV were more likely than uninfected mothers to report breastfeeding counseling at a health facility (88.9% vs. 51.6%, respectively, p?<? 0.001) and EBF for 6-months (64.9% versus 34.5%, p?<? 0.001). Premastication (pre-chewing of food by adults prior to feeding to children) was less prevalent among mothers with HIV (3.9% vs. 13.2% p?=?0.001) who were also more knowledgeable about potential risk of HIV transmission through premastication (83.1% vs 71.2% p?=?0.005). Mothers with HIV who EBF for six months were 3.68-fold more likely to report counseling on EBF (aOR 3.68; 95% CI: 1.00,13.70). Uninfected mothers with polygamous marriage, any antenatal care visit, unskilled delivery and delayed breastfeeding initiation (>?1 h) were less likely to practice EBF for six months 62% (aOR 0.38; 95%CI: 0.20,0.94), 72% (aOR 0.28; 95%CI: 0.10,1.00), 54% (aOR 0.46; 95% CI: 0.22,1.00) and 46% (aOR 0.54; 95%CI: 0.30,1.00) respectively.

Conclusions

Mothers with HIV were more likely to report breastfeeding counseling at a health facility, EBF for six months and less likely to practice premastication than uninfected mothers. Lessons learned from breastfeeding counseling in mothers with HIV could be used to improve awareness and change breastfeeding practices for all mothers.

     

Community mothers' programme: randomised controlled trial of non-professional intervention in parenting.

OBJECTIVE--To see whether non-professional volunteer community mothers could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year. DESIGN--Randomised controlled trial. SETTING--A regional health authority in Dublin. SUBJECTS--262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin; 30 experienced mothers from the same community recruited as community mothers. INTERVENTIONS--All the first time mothers received standard support from the public health nurse. In addition, those in the intervention group received the services of a community mother, who was scheduled to visit monthly during the first year of the child''s life. RESULTS--232 (89%) first time mothers completed the study--127 in the intervention group, 105 controls. At the end of the study children in the intervention group were more likely to have received all of their primary immunisations, to be read to, and to be read to daily, played more cognitive games; and were exposed to more nursery rhymes. They were less likely to begin cows'' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein, non-animal protein, wholefoods, vegetables, fruit, and milk. Mothers in the intervention group also had a better diet than controls. At the end of the study they were less likely to be tired, feel miserable, and want to stay indoors; had more positive feelings; and were less likely to display negative feelings. CONCLUSION--Non-professionals can deliver a health promotion programme on child development effectively. Whether they can do so as effectively as professionals requires further study.     

Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trial

Background

Exclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors.

Methods

A clinic based cross-sectional study was conducted in the Medical Officer of Health area, Beruwala, Sri Lanka in June 2006. Mothers with infants aged 4 to 12 months, attending the 19 child welfare clinics in the area were included in the study. Infants with specific feeding problems (cleft lip and palate and primary lactose intolerance) were excluded. Cluster sampling technique was used and consecutive infants fulfilling the inclusion criteria were enrolled. A total of 219 mothers participated in the study. The statistical tests used were survival analysis (Kaplan-Meier survival curves and Cox proportional Hazard model).

Results

All 219 mothers had initiated breastfeeding. The median duration of exclusive breastfeeding was four months (95% CI 3.75, 4.25). The rates of exclusive breastfeeding at 4 and 6 months were 61.6% (135/219) and 15.5% (24/155) respectively. Bivariate analysis showed that the Muslim ethnicity (p = 0.004), lower levels of parental education (p < 0.001) and being an unemployed mother (p = 0.021) were important associations of early cessation of exclusive breastfeeding. At the time of the study, 62% (135/219) of infants were receiving feeds via a bottle and 23% (51/219) were receiving infant formula. Muslim ethnicity was significantly associated with bottle and formula feeding (p < 0.001). Bottle feeding was also significantly higher among mothers with a low level of education and among employed mothers.

Conclusion

The rate of breastfeeding initiation and exclusive breastfeeding up to the fourth month is very high in Medical Officer of Health area, Beruwala, Sri Lanka. However exclusive breastfeeding up to six months is still low and the prevalence of inappropriate feeding practices is high.     

Breastfeeding and its impact on daily life in women with type 1 diabetes during the first six months after childbirth: a prospective cohort study

Background

For mothers with diabetes, breastfeeding is a great challenge due to their struggle with potentially unstable blood glucose levels. This paper explores breastfeeding attitudes and impact of breastfeeding on the daily life of mothers with type 1 diabetes compared with non-diabetic mothers.

Methods

We performed a prospective cohort study of 108 mothers with type 1 diabetes and a reference group of 104 mothers in the west of Sweden. Data were collected through medical records and structured telephone interviews at 2 and 6 months after childbirth.

Results

Women in both the diabetes group and the reference group had high levels of confidence (84% and 93% respectively) in their breastfeeding capacity before childbirth, and 90% assessed breastfeeding as a positive and an important experience during the six months of follow-up. About 80% assessed breastfeeding as influencing daily life ‘very much’ or ‘quite a lot’ at 2 months as did 60% at 6 months, with no difference between the groups. In mothers with diabetes, the impact of breastfeeding on the priority of other duties decreased over time, as did feelings of time pressure and negative effects on patterns of sleep. Compared to the reference group, mothers with diabetes at 6 months remained more affected by disruptions in daily life and they felt more worried about their health both at 2 and 6 months after childbirth. For the reference group mothers’ sensitivity to unexpected disruptions in daily routines decreased between 2 and 6 months after childbirth, and they expressed a greater need to organize their time than mothers with diabetes.

Conclusion

Mothers with diabetes type 1 express more worry for own health and are more sensitive to distruptions. To balance their everyday life and to reduce the risk of stress and illhealth they are therefor, compared to other mothers, likely to need additional professional and peer support.

     

Factors associated with exclusive breastfeeding at discharge during the COVID-19 pandemic in 17 WHO European Region countries

Both the consumption of breastmilk in infancy and a person’s season of birth influences his or her health, educational, professional, and behavioral outcomes. Further, season of birth effects differ by sex. However, current research, for the most part, neglects to examine if season of birth and breastfeeding are related. This paper examines the impact of sex-based variations in season of birth on breastfeeding likelihood and duration in the U.S. Using data from children born to female respondents of the National Longitudinal Survey of Youth 1979 (born between 1970 and 2012), this study examines with Probit, Negative Binomial, and Ordinary Least Squares (OLS) regressions if a child’s season of birth and sex are correlated with breastfeeding incidence and duration. The breastfeeding incidence and duration data are self-reported by the mother. Season of birth has a small but statistically significant impact on the incidence and duration of breastfeeding, which varies depending on the sex of the infant. Mothers giving birth to sons in the spring are 13.5% less likely to breastfeed than those giving birth to sons in the winter (with a p - value of 0.0269). Mothers with daughters born in the summer or fall (autumn) breastfeed slightly longer than mothers with daughters born in the spring. On average, mothers of summer-born daughters breastfeed 4.1% longer (with a 95% confidence interval of 0.3 - 7.8) and those with fall-born daughters 3.8% longer (with a 95% confidence interval of 0 - 7.5). Mothers giving birth to daughters in the spring are also significantly less likely to reach the breastfeeding six-week duration target (compared to fall and winter births) and the one-year duration target (compared to fall births). These findings suggest that the costs and benefits of breastfeeding an infant vary with the season of birth and the sex of the child. This finding could explain some of the season of birth effects previously identified in the literature. Further, policymakers seeking to increase breastfeeding rates should consider the reduced breastfeeding rates and durations for children born in the spring.     

Determinants of exclusive breastfeeding among mothers in Ghana: a cross-sectional study

Background

Mothers are encouraged to practice exclusive breastfeeding for the first six months of a child’s life. The general objective of the study was to assess the predictors of exclusive breastfeeding among mothers in Ghana.

Methods

This was a cross-sectional study using data from the 2008 Ghana Demographic and Health Survey (GDHS). The study sample (n = 316) was based on infants (0–5 months old) during the survey period; extracted from the individual (women) data set. Binary logistic regression was used to examine the association between selected independent variables.

Results

In general, the rate of exclusive breastfeeding was 64 percent. Marital status, region and place of delivery were found to be associated with the practice of exclusive breastfeeding. The logistic regression model illustrated mothers from the Volta Region, those who delivered in a government health facility, and mothers who perceived their infants to be average in size were more likely to practice exclusive breastfeeding.

Conclusion

Appropriate health education programmes by the Ministry of Health targeting mothers who are less likely to practice exclusive breastfeeding are recommended.

     

Breastfeeding in the United States

The breastfeeding of US infants born in 1974-76 is analyzed using data form the 1976 National Survey of Family Growth. Life table estimates of the proportion of children breastfed by duration since birth and mean breastfeeding durations are presented. The life tables reported are constructed by standard cohort table methods. To compare life tables for children of mothers in various attribute categories, generalised Wilcoxon tests are used, together with multiple classification analysis for continuation at select durations. Variables considered include mother's age at the birth, ethnicity, educational level, education by ethnicity, region of residence and the child's birth order. Findings are restricted to infants remaining with their mothers for at least 2 months following delivery and surviving as of the survey date in January-September 1976. It is found that the proportion of infants breastfed was increasing rapidly, with the highest rates found among white (39%), college-educated (56%), western (56%) mothers and lowest rates among black mothers (17%) mothers with less than a high school education (19%) and mothers living in the south (24%). By age, the highest proportions are mothers at ages 25-29 (44%), followed closely by the mothers under 25 (29%). The proportions breastfeeding were also found to be higher in urban than in rural areas (38% vs. 28%) and higher at parities 1-2 (29%). A multiple classification analysis of the factors most strongly influencing breastfeeding in 1975 shows educational level to be the strongest single predictor of breastfeeding, followed by western residence and white ethnicity. Age effects were found to correlate strongly with education. Reviewing 1971-1981 changes, the proportion of mothers with less than a college education who breastfed their children increased from 19% to 51% over the decade, while the proportion among college-educated mothers rose from 42% to 74%. For children who were breastfed, the median duration was about 4.5 months. The mean was 5.5 months, with a range from about 3.0 months among black mothers with less than a high school education, to 6.0 months among college-educated white women. The nationwide changes in breastfeeding patterns and duration may confer modest health benefits on current generations of youngsters, although not benefits that are easily measured, since human milk substitutes are routinely subjected to rigourous testing for nutritional adequacy.     

Poor Adherence to National and International Breastfeeding Duration Targets in an Australian Longitudinal Cohort

Objectives

To report on the proportion and characteristics of Australian infants who are fed, and mothers who feed, in accordance with the national and international breastfeeding duration targets of six, 12 and 24 months. Furthermore, to examine the longitudinal breastfeeding duration patterns for women with more than one child.

Methods

Breastfeeding duration data for 9773 children have been self-reported by a national sample of 5091 mothers aged 30–36 years in 2009, participating in the Australian Longitudinal Study on Women’s Health.

Results

Only 60% of infants received the minimum recommended 6 months of breast milk, irrespective of breastfeeding exclusivity. Less than 30% of infants received any breast milk at 12 months, and less than 3% were breastfed to the international target of 24 months. Young, less educated, unmarried or low-income women were at an increased risk of premature breastfeeding cessation. For women with three or more children, nearly 75% of women who breastfed their first child for at least six months reached this breastfeeding duration target for their next two children.

Conclusion

While national breastfeeding rates are typically evaluated in relation to the infant, a novel component of our study is that we have assessed maternal adherence to breastfeeding duration targets and the longitudinal feeding practices of women with more than one child. Separate evaluations of maternal and infant breastfeeding rates are important as they differ in their implications for public health policy and practice.     

Breastfeeding policy and practices at the general paediatric outpatient clinic of a teaching hospital in Lagos,Nigeria

Background

Hospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria.

Methods

This was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding.

Results

Although the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months.

Conclusion

Breastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding.

     

Predictors of non-exclusive breastfeeding at 6 months among rural mothers in east Ethiopia: a community-based analytical cross-sectional study

Background

Exclusive breastfeeding in infants aged under six months is a simple and cost-effective feeding method that ensures better infant and child survival and boosts the achievement of child related Millennium Development Goals in the developing world. Identifying factors associated with good breastfeeding practice helps to increase its coverage and maximize its advantages through improved advocacy. The objective of this study was to identify the predictors of non-exclusive breastfeeding in the rural areas of eastern Ethiopia.

Methods

A community-based analytical cross-sectional study was conducted on mother/caregiver–child pairs in east Ethiopia from July to August 2011. Data on infant feeding practices were collected by trained interviewers who used a pretested and structured questionnaire. Odds ratio with a 95% confidence interval was estimated for the predictors of non-exclusive breastfeeding using the multivariable logistic regression.

Results

The prevalence of non-exclusive breastfeeding in infants aged under six months, was 28.3%. Non-exclusive breastfeeding was more likely to be practiced by mothers who were not married at the moment [AOR (95% CI) = 2.6 (1.1, 6.0)], mothers who had no access to health facility [AOR (95% CI) = 2.9 (1.9, 4.3)], and mothers whose knowledge about infant and young child feeding practices was low [AOR (95% CI) = 3.4 (2.4, 4.7)].

Conclusion

Non–exclusive breastfeeding was more common among mothers with no marital relationships, poor access to health facilities, and inadequate knowledge about infant and young child feeding practices. Family support, education, and behavior change communication on infant feeding, especially on exclusive breastfeeding, at the community level may improve the knowledge, behavior, and practice of mothers on optimal infant and young child feeding practices.

     

Prevalence of exclusive breastfeeding and barriers for its continuation up to six months in Kandy district,Sri Lanka

Background

Since 2005, the national policy on breastfeeding in Sri Lanka is exclusive breastfeeding up to 6 months, as recommended by World Health Organization. The objective of this study was to assess the prevalence of exclusive breastfeeding and barriers for its’ continuation up to 6 months, in Kandy District, Sri Lanka.

Methods

A clinic based cross-sectional study was conducted from August to November 2016, in six randomly selected Medical Officer of Health areas in the Kandy District. The sample was selected proportionate to the population of each Medical Officer of Health area and 354 mothers with infants aged 6 months, attending the child welfare clinics were recruited. Data were collected by an interviewer administered questionnaire using mother recall data since birth. A focus group discussion was conducted on 21 mothers who discontinued exclusive breastfeeding early. The infant taking only breast milk and no additional food, water, or other fluids with the exception of medicines and vitamins or mineral drops for the first 6 months was used as the definition of exclusive breastfeeding.

Results

The prevalence of exclusive breastfeeding for 6 months was 50.8% (180/354) while the median duration was 6 months. Mother being employed (AOR 3.01; 95% CI 1.45, 6.29), mother’s poor knowledge on what she meant by exclusive breastfeeding (AOR 3.75; 95% CI 2.14, 6.54) and mother’s poor attitudes towards exclusive breastfeeding (AOR 2.98; 95% CI 1.76, 5.03) were independently associated with early cessation of exclusive breastfeeding. Unsupported environment in public places was not significantly associated with early cessation of exclusive breastfeeding. Focus group discussion revealed controversial health messages on exclusive breastfeeding delivered at different points of healthcare delivery, cultural practices which discouraged exclusive breastfeeding and difficulties in obtaining maternity leave as barriers for exclusive breastfeeding.

Conclusions

The prevalence of exclusive breastfeeding up to 6 months was not satisfactory and there were barriers identified in healthcare system, family and work places towards exclusive breastfeeding. For further improvement in the prevalence of exclusive breastfeeding these issues need to be addressed and necessary changes in legislation implemented.

     

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban,Latina mothers: a prospective cohort study

Background

The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups.

Methods

In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders.

Results

In our cohort of Latina mothers, breastfeeding a previous infant was associated with breastfeeding initiation (OR 8.29 [95% CI 1.00, 68.40] p = 0.05) and breastfeeding at 6 months (OR 18.34 [95% CI 2.01, 167.24] p = 0.01). College education was associated with increased exclusive breastfeeding at 6 months (OR 58.67 [95% CI 4.97, 692.08] p = 0.001) and having other children was associated with reduced breastfeeding at six months (OR 0.08 [95% CI 0.01, 0.70] p = 0.02). A higher IIFAS score was not associated with breastfeeding initiation, breastfeeding at 6 or 12 months or exclusive breastfeeding at 6 months of age.

Conclusions

Initial choices about breastfeeding will likely influence future breastfeeding decisions, so breastfeeding interventions should specifically target new mothers. Mothers with other children also need additional encouragement to maintain breastfeeding until 6 months of age. The IIFAS, while predictive of breastfeeding decisions in other population groups, was not associated with feeding decisions in our population of Latina mothers.

     

Patterns of breastfeeding practices among infants and young children in Abu Dhabi,United Arab Emirates

Background

Despite the ongoing efforts to improve infant feeding practices, low rates of breastfeeding and early introduction of complementary feeding have been reported in many countries. Systematic documentation of breastfeeding practices in the United Arab Emirates (UAE) is needed in order to directing successful strategies. The aim of this study was to evaluate breastfeeding practices among mothers in Abu Dhabi, UAE, using the World Health Organization (WHO) infant and young child feeding indicators.

Methods

In this cross-sectional study, mothers of children below the age of two were recruited from the community and health centers located in different areas in Abu Dhabi. Following informed consent, a structured questionnaire including WHO-indicators was used for in-person interviews on sociodemographics and breastfeeding. Exclusive breastfeeding (EBF) was calculated as the percentage of babies 0 – <?6?months of age who had been exclusively breastfed in the last 24?h.

Results

A total of 1822 mothers participated in the study; 95.6% (1741/1822) of mothers initiated breastfeeding and 59.8% (1089/1822) initiated breastfeeding within the first hour. Exclusive breastfeeding among infants 0–6?months was 44.3% (362/818). Although the median duration of “any breastfeeding” was 12?months (95% CI 11.2, 12.7), the median duration of EBF was 3 months (95% CI 2.8, 3.3). Most of the children (894/1004, 89%) aged 6 months and above were receiving complementary feeding, but 21.7% (218/1004) of them had had an early introduction of complementary feeding, i.e. before 6 months of age. Using “the WHO infant and young child feeding indicators” as standard for comparative evaluation, breastfeeding initiation was rated “good”, the proportion of children being exclusively breastfed until 6 months was rated “fair” and the duration of EBF was considered “poor”.

Conclusions

According to the WHO infant feeding indicators the breastfeeding practices were suboptimal in several aspects with a low proportion of children being exclusively breastfed, short breastfeeding duration and early introduction of complementary feeding, despite high socioeconomic status. These findings suggest that there is a need to understand potential barriers towards breastfeeding in order to develop appropriate strategies to promote and support breastfeeding in Abu Dhabi.