Prevalence and predictors of exclusive breastfeeding among women in Kilimanjaro region, Northern Tanzania: a population based cross-sectional study

Trends of Exclusive Breastfeeding Practices and Its Determinants in Tanzania from 1999 to 2016

Introduction: The benefits of exclusive breastfeeding (EBF) are widely reported. However, it is crucial to examine potential disparities in EBF practices across different regions of a country. Our study uses Tanzania demographic and health survey data to report on the trends of EBF across regions from 1999 to 2016, the patterns of the practice based on geographical location and socioeconomic status, and explores its determinants across the years. Methods: Descriptive statistics were used to establish the trends of EBF by geographical location and wealth quintile. A generalized linear mixed model was developed to incorporate both infant and maternal attributes as fixed covariates while considering enumeration areas and regions as clusters. The fitted model facilitated the estimation of EBF proportions at a regional level and identified key determinants influencing EBF practices across the survey periods. Moreover, we designed breastfeeding maps, visually depicting the performance of different regions throughout the surveys. Results: Across the various survey rounds, a notable regional variation in EBF practices was observed, with coastal regions generally exhibiting lower adherence to the practice. There was a linear trend between EBF and geographical residence (p < 0.05) and socioeconomic standing (p < 0.05) across the survey periods. Rural-dwelling women and those from the least affluent backgrounds consistently showcased a higher proportion of EBF. The prevalence of EBF declined as infants aged (p < 0.001), a trend consistent across all survey waves. The associations between maternal attributes and EBF practices displayed temporal variations. Furthermore, a correlation between exclusive breastfeeding and attributes linked to both regional disparities and enumeration areas was observed. The intra-cluster correlation ranged from 18% to 41.5% at the regional level and from 40% to 58.5% at the enumeration area level. Conclusions: While Tanzania's progress in EBF practices is laudable, regional disparities persist, demanding targeted interventions. Sustaining achievements while addressing wealth-based disparities and the decline in EBF with infant age is vital. The study highlights the need for broad national strategies and localized investigations to understand and enhance EBF practices across different regions and socioeconomic contexts.

Breastfeeding Practice of Children Age Less than Two Years in South Wollo Zone, Northeast Ethiopia

BACKGROUND

Suboptimal breastfeeding causes substantial numbers of child morbidity and mortality in Ethiopia. This study was designed to assess suboptimal breastfeeding practice and its associated factors among children age less than two years in South Wollo, northeast Ethiopia.

METHOD

A community-based cross-sectional study was conducted among 636 women-child pairs. The study participants were selected by a multi sage random sampling technique. Data were collected using a structured interviewer-administered questionnaire, then it was entered into Epi-Data version 3.1, and exported into SPSS version 24.0 for analysis. A Binary Logistic Regression Model with a backward elimination method was used to determine the association of factors and suboptimal breastfeeding practice of babies at a 95% confidence interval.

RESULT

Six hundred and thirty-six participants were included with a response rate of 99.7%. The study showed that 36.3% babies age less than 2 years were received suboptimal breastfeeding. Cesarean delivery [AOR: 8.81; 95% CI (4.92-15.77)], lack of breastfeeding counseling [AOR: 3.22; 95% CI (1.93-5.36)], maternal feeding less than 5 times/day during breastfeeding [AOR: 2.01; 95% CI (1.20-3.34)], child health problems [AOR: 3.57; 95%CI (2.17-5.85)], and babies age less than 6 months [AOR:1.92; 95%CI (1.24-2.97)] were positively associated with suboptimal breastfeeding practice.

CONCLUSION

Suboptimal breastfeeding practice is highly prevalent in Ethiopia. Health service-related and socio-cultural factors were associated with the high prevalence of suboptimal breastfeeding practice. Emphasis should be given to the breastfeeding practices of children age less than years in Ethiopia. Moreover, counseling regarding the importance of breastfeeding practices should be strengthened.

Determinants of exclusive breastfeeding practices among mothers in Ethiopia

BACKGROUND

Exclusive breastfeeding (EBF) is the most cost-effective intervention to reduce infant morbidity and mortality worldwide. It is crucial since human milk contains nutrients, living cells, and defensive factors which enable infants to have better immunity, physical and mental development. Therefore, this study aimed at identifying the predictors of exclusive breastfeeding practices among mothers in Ethiopia using Ethiopian Demographic and Health Survey (EDHS) 2016 data.

METHODS

EDHS 2016 data were used for the analysis. A total of 1,066 mothers were included in the analysis. The binary logistic regression model was used to identify the determinants of EBF practice among mothers. The result presented using adjusted odd ratio (AOR) with a 95% confidence interval.

RESULTS

The prevalence of EBF was 58% of infants under age 6 months. Mothers age 25-34 (AOR = 1.74; 95% CI 1.31-2.32), child age 4-5 months (AOR = 0.74; 95% CI 0.66-0.84), married marital status (AOR = 1.26; 95% CI 1.06-1.50), mothers attained secondary education or higher (AOR = 2.00; 95% CI 1.54-2.58), husband attained secondary education or higher (AOR = 1.70; 1.39-2.13), richer wealth index (AOR = 0.35; 95% CI 0.18-0.69), accessed to the media (AOR = 1.77; 95% CI 1.38-2.27), number of living children 3-4 (AOR = 0.49; 95% CI 0.25-0.95), health facility (AOR = 1.87; 95% CI 1.09-3.20), rural residence (AOR = 0.66; 95% CI 0.49-0.89) and mothers living in Afar (AOR = 100.2; 95% CI 15.68-640.61), Somali (AOR = 52.65; 95% CI 8.48-326.77), SNNPR (AOR = 6.94; 95% CI 1.05-45.79), Harari (AOR = 61.94; 95% CI 9.75-393.44), Addis Ababa (AOR = 13.07; 95% CI 2.06-82.99), and Dire Dawa (AOR = 28.91; 95% CI 4.38-190.86) were associated with EBF practice.

CONCLUSIONS

The practice of exclusive breastfeeding remains low in Ethiopia. Therefore, the stakeholders should be taken into consideration those determinant factors identified in this study in policies and programmes to increase EBF practice among mothers. Moreover, designing and implementing specific strategies to enhance the rate of exclusive breastfeeding practices through community-based education is recommended.

Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa

Exclusive breastfeeding (EBF) is not a norm in many communities in South Africa despite the World Health Organizations' recommendations for EBF in the first six months of infant's life. Thus, South Africa continues to observe suboptimal and poor practices of EBF. The purpose of the study was to explore the experiences of mothers who are HIV-positive and negative on EBF and examine the extent to which initiation and sustenance of EBF is influenced by cultural beliefs, societal norms, and family norms and practices in Mpumalanga Province. Three focus group discussions and twelve in-depth interviews were conducted among thirty mothers who were purposively selected during their visits to the facilities for childcare services. Interviews were audiotaped, transcribed verbatim, and transcripts were analysed through thematic analysis using NVivo version 10. Mothers were aged between 18 and 42 years, most were unemployed and were living in poor sociodemographic backgrounds in extended family households. We found evidence of factors that influence the decision to EBF and mix feed infants among mothers. Traditional and cultural beliefs and norms that exist within their communities informed decisions mothers took to EBF. These beliefs existed alongside mothers' opinions on breastfeeding (BF) and HIV infection, as well as the fears of harming the baby through HIV infection, leading to early cessation of BF. Mothers were also advised by family members, friends, and even some healthcare workers to use traditional medicines while BF. The association of EBF with sagging breasts and weight loss as well as discomfort with public BF are personal beliefs that influenced initiation and early cessation of EBF. Breastfeeding messages ought to be context specific to improve the knowledge, understanding, acceptance and practice of EBF among HIV-positive and negative mothers. Culturally appropriate counselling messages that address the known cultural practices of the populations affected are essential to changing the beliefs and norms of the communities including extended families of EBF mothers.

Knowledge, attitudes, and predictors of exclusive breastfeeding practice among lactating mothers in Noakhali, Bangladesh

Background

Mothers' knowledge, attitudes, and practices toward exclusive breastfeeding are crucial to both child and mother's health and wellbeing. Hence, This study aimed to assess knowledge, attitudes, and practices of exclusive breastfeeding among lactating mothers as well as the predictors of their exclusive breastfeeding practice.

Methodology

This cross-sectional study included 397 mothers having infants aged 0-6 months who sought care at Noakhali Sadar Upazila, Noakhali, Bangladesh. A field-tested and validated Food and Agriculture Organization of the United Nations (FAO) questionnaire was utilized to collect information from participants.

Results

Of those evaluated; 29.0% of mothers could not define exclusive breastfeeding accurately, 11.3% and 59.3% did not know the benefits of exclusive breastfeeding for babies and mothers, respectively. More than half (51.4%) of the mothers reported feeling good about exclusive breastfeeding for six months, did not find difficulties to breastfeed exclusively for six months (39.5%) and on-demand (58.2%). The mothers had an overall favorable attitude towards exclusive breastfeeding; however, 38.3% of mothers did not exclusively breastfeed their children. Literate mothers tended to exclusively breastfeed more (AOR: 3.06, 95% CI: 1.01-9.32; P = 0.049) than illiterate mothers. Mothers having one baby were more likely to breastfeed exclusively (AOR: 3.07, 95% CI: 1.21-7.78; P = 0.018) than mothers having more than one baby. Moreover, mothers with higher knowledge and favorable attitude had more than two times (AOR: 2.58, 95% CI: 1.315.07; P = 0.006) and forty-three times (AOR: 43.18, 95% CI: 21.513-86.66; P < 0.001) the higher tendency of exclusive breastfeeding compared to others.

Conclusion

Despite having satisfactory knowledge and attitude, the practice of exclusive breastfeeding among mothers was poor. We recommend that interventions must be focused more on ensuring exclusive breastfeeding practice among mothers in addition to improving their knowledge and attitudes.

Enablers and inhibitors of exclusive breastfeeding: perspectives from mothers and health workers in Accra, Ghana

Background

Despite the health and economic benefits of exclusive breastfeeding, there is evidence of a decline globally and in Ghana. Previous studies addressing this problem are mostly quantitative with only a few of such studies using qualitative or mixed methods to examine the predictors, benefits, ways of improving and managing exclusive breastfeeding, and the challenges associated with exclusive breastfeeding from the perspective of exclusive and nonexclusive breastfeeding mothers, and health workers. This study employs the health belief model to examine the experiences of mothers and health workers regarding exclusive breastfeeding to fill this gap in the literature.

Methods

A cross-sectional qualitative study involving in-depth interviews was conducted among health workers and mothers attending child welfare clinic at two polyclinics in Madina, Accra-Ghana in 2019. Purposive sampling was used to select health facilities and participants for the study. Twenty participants comprising ten exclusive breastfeeding mothers, six non-exclusive breastfeeding mothers and four health workers were interviewed for the study. The data were analyzed based on emerging themes from inductive and deductive coding.

Results

The decision to practice exclusive breastfeeding was based on mothers’ work, advertisement on exclusive breastfeeding and education on breastfeeding provided by health workers. Insufficient flow of breast milk, pressure from family and friends, and insufficient breast milk for infants were among the reasons for discontinuing exclusive breastfeeding. The factors that help improve exclusive breastfeeding include eating healthy food and breastfeeding on demand, while counselling and monitoring, restricting advertisement on infant formula and granting maternity leave for breastfeeding mothers were identified as factors that can  facilitate the practice of exclusive breastfeeding.

Conclusion

Different levels of experience affect and shape exclusive breastfeeding practice in Ghana. The decision to practice exclusive breastfeeding, as well as the challenges and strategies employed in managing exclusive breastfeeding, emanates from mothers’ personal experiences and interactions with institutional factors. In view of this, there should be counselling on the management of challenges associated with exclusive breastfeeding and provision of accurate information on exclusive breastfeeding to enable mothers practice exclusive breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00462-z.

Likelihood of infectious diseases due to lack of exclusive breastfeeding among infants in Bangladesh

BACKGROUND

Bangladesh is a South Asian developing country trying to achieve the Sustainable Development Goals (SDG)-3 and the objective of the Rural Electrification Board (REB) regarding child mortality. Infectious diseases are leading causes of child mortality, and lack of exclusive breastfeeding (EBF) among infants aged 0-6 months increases child morbidity and mortality from various infectious diseases in developing countries. However, as per existing literature, no study has been conducted yet to determine the lack of EBF practice effect on child mortality in Bangladesh. With this backdrop, the authors intend to measure the likelihood of infectious diseases due to the lack of EBF of infants aged 0-6 months in Bangladesh.

MATERIALS AND METHODS

This study used Bangladesh Demographic and Health Survey (BDHS) data over 1996-97 to 2017-18. The mothers of infants aged 0-6 months who were willingly participated in the BDHSs were considered to include in our analysis. Initially, there were 9,133 cases in the combined dataset. After filtering, there were 5,724 cases in the final dataset. We have considered diarrhea (D), acute respiratory infection (ARI) separately as well as the presence of either D or ARI or both and named as CoDARI as outcome variables. This study used both graphical and statistical techniques (Chi-square test, Wald test, and logistic regression) to analyze the data. The odds ratio (OR) and 95% confidence interval (CI) were used to quantify the likelihood of infectious diseases due to lack of EBF practice and its elasticity, respectively.

RESULTS

The EBF practice got a conspicuous increasing trend, but the prevalence of infectious diseases was declined from 0 to 3 months of age of infants, whereas an inverse scenario is observed between 4-6 months. The significance of that inverse relationship was confirmed by p-value corresponding to the chi-square test and the Wald test of the adjusted regression coefficients after adjusting the associated factor's effect on infectious diseases. The adjusted ORs also concluded that the lack of EBF practice up to six months of age could enhance the risk of D, ARI, and CoDARI by 2.11 [95% CI: 1.56-2.85], 1.43 [95% CI: 1.28-1.60], and 1.48 [95% CI: 1.32-1.66] times higher, respectively.

CONCLUSION

Findings of this study emphasize the importance of EBF up to six months of age of infants against diarrhea and ARI specific morbidity and mortality. Our results also agreed to the recommendation of the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and National Nutrition Programme of Ethiopia (NNPE) that the EBF practice for the first six months of age could be a best, cost-effective, long-lasting natural preventive way to reduce the child morbidity and mortality due to infectious diseases in developing countries. Therefore, findings would help policymakers ensuring the achievement target of REB and SDG-3 associated with the health sector in Bangladesh.

Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities

BACKGROUND

The effects of breastfeeding practices on children's health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria.

METHODS

Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC.

RESULTS

The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers' education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment.

CONCLUSION

Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators.

A systematic review of hot weather impacts on infant feeding practices in low-and middle-income countries

BACKGROUND

Increased rates of exclusive breastfeeding could significantly improve infant survival in low- and middle-income countries. There is a concern that increased hot weather due to climate change may increase rates of supplemental feeding due to infants requiring fluids, or the perception that infants are dehydrated.

OBJECTIVE

To understand how hot weather conditions may impact infant feeding practices by identifying and appraising evidence that exclusively breastfed infants can maintain hydration levels under hot weather conditions, and by examining available literature on infant feeding practices in hot weather.

METHODS

Systematic review of published studies that met inclusion criteria in MEDLINE, EMBASE, Global Health and Web of Science databases. The quality of included studies was appraised against predetermined criteria and relevant data extracted to produce a narrative synthesis of results.

RESULTS

Eighteen studies were identified. There is no evidence among studies of infant hydration that infants under the age of 6months require supplementary food or fluids in hot weather conditions. In some settings, healthcare providers and relatives continue to advise water supplementation in hot weather or during the warm seasons. Cultural practices, socio-economic status, and other locally specific factors also affect infant feeding practices and may be affected by weather and seasonal changes themselves.

CONCLUSION

Interventions to discourage water/other fluid supplementation in breastfeeding infants below 6 months are needed, especially in low-middle income countries. Families and healthcare providers should be advised that exclusive breastfeeding (EBF) is recommended even in hot conditions.

Role of clusters in exclusive breastfeeding practices in Tanzania: A secondary analysis study using demographic and health survey data (2015/2016)

BACKGROUND

While the benefits of exclusive breastfeeding are widely acknowledged, it continues to be a rare practice. Determinants of exclusive breastfeeding in Tanzania have been studied; however, the existence and contribution of regional variability to the practice have not been explored.

METHODS

Tanzania demographic and health survey data for 2015/2016 were used. Information on infants aged up to 6 months was abstracted. Exclusive breastfeeding was defined using a recall of feeding practices in the past 24 h. Enumeration areas and regions were treated as random effects. Models without random effects were compared with those that incorporated random effects using the Akaike information criterion. The determinants of exclusive breastfeeding were estimated using the generalized linear mixed model with enumeration areas nested within the region.

RESULTS

The generalized linear mixed model with an enumeration area nested within a region performed better than other models. The intra-cluster variability at region and enumeration area levels was 3.7 and 24.5%, respectively. The odds of practicing exclusive breastfeeding were lower for older and male infants, for mothers younger than 18, among mothers residing in urban areas, among those who were employed by a family member or someone else, those not assisted by a nurse/midwife, and those who were not counseled on exclusive breastfeeding within 2 days post-delivery. There was no statistical evidence of an association between exclusive breastfeeding practices and the frequency of listening to the radio and watching television. When mapping the proportion of exclusive breastfeeding, a variability of the practice is seen across regions.

CONCLUSION

There is room to improve the proportion of those who practice exclusive breastfeeding in Tanzania. Beyond individual and setting factors, this analysis shows that a quarter of the variability in exclusive breastfeeding practices is at the community level. Further studies may explore the causes of variabilities in regional and enumeration area and how it operates. Interventions to protect, promote, and support exclusive breastfeeding in Tanzania may target the environment that shapes the attitude toward exclusive breastfeeding in smaller geographical areas.

Socioeconomic inequalities in early initiation and exclusive breastfeeding practices in Bangladesh: findings from the 2018 demographic and health survey

BACKGROUND

Optimal breastfeeding practices including early initiation of breastfeeding and exclusive breastfeeding (EBF) are associated with positive health outcomes. Socioeconomic inequalities in key breastfeeding indicators may play a role in the prevalence of breastfeeding practices. The objective of this study was to examine the socioeconomic inequalities in early initiation of breastfeeding and EBF practices in Bangladesh based on the 2018 Bangladesh Demographic and Health Survey (BDHS).

METHODS

This was a secondary data analysis of the nationally representative 2018 BDHS. Data on 4950 women of reproductive age who had ever given birth and 924 children aged 0-5 months were extracted, for early initiation of breastfeeding and EBF. Early initiation of breastfeeding was determined from children who were put to the breast within the first hour of birth. Exclusive breastfeeding was estimated from children aged 0-5 months who were exclusively breastfed.

RESULTS

The weighted prevalence of early initiation of breastfeeding and EBF were 60.8% (95% CI; 59.0, 62.6%) and 66.8% (95% CI; 63.1, 70.3%), respectively. The estimated prevalence of early initiation among the poorest, poorer, middle, richer and richest households were 67.8, 66.3, 58.4, 56.3 and 54.4%, respectively. Similarly, early initiation prevalence of 64.4, 65.0, 61.1 and 52.3% were estimated among women with no formal education, primary, secondary and higher education, respectively. The estimated prevalence of EBF among the poorest, poorer, middle, richer and richest households were 63.0, 65.2, 67.7, 66.7 and 69.9%, respectively. Similarly, the estimated EBF prevalence were 62.5, 66.0, 66.3 and 68.9% among women with no formal education, primary, secondary and higher education, respectively. Early initiation of breastfeeding was higher among lower household wealth (Conc. Index = - 0.049; SE = 0.006) and lower educational attainment groups (Conc. Index = - 0.035; SE = 0.006).

CONCLUSIONS

Improving optimal breastfeeding practices in Bangladesh should be given utmost priority. A need to address the socioeconomic inequalities in breastfeeding practices was also identified.

A systematic review of qualitative research on barriers and facilitators to exclusive breastfeeding practice in sub-Saharan African countries

BACKGROUND

Studies reporting factors associated with exclusive breastfeeding are mostly quantitative. No study has performed a systematic qualitative summary to document the recurring constraints and facilitators to exclusive breastfeeding in sub-Saharan African countries from breastfeeding mothers' perspective. This study systematically reviews the literature reporting barriers and facilitators to exclusive breastfeeding from the breastfeeding mothers' perspective in sub-Saharan Africa to develop an educational intervention to optimize exclusive breastfeeding.

METHODS

A systematic literature review of qualitative studies such as phenomenological studies, followed by a risk of bias and methodological assessment of the included studies' quality using the Critical Appraisal Skills Programme (CASP) tool was conducted. MEDLINE and Google Scholar were searched from January 1990 to October 2019 to retrieve studies of breastfeeding mothers who had infants aged between 0 and 12 months. Two authors independently carried out the review process and resolved disagreements through consensus. We analyzed the data thematically.

RESULTS

After reviewing 92 studies, 20 studies involving 836 participants from 11 countries were eligible. Of the 72 studies excluded, 39 were not conducted in sub-Saharan Africa, and 33 included other participants such as fathers. Three themes emerged as barriers to exclusive breastfeeding (EBF) and five additional themes were identified with facilitators of maternal-infant factors being the most significant in both cases. Maternal employment and knowledge of the benefits of EBF were the most common maternal-infant factors that served as a barrier and a facilitator, respectively. The study's limitations were that the review involved only primary research among breastfeeding mothers living in sub-Saharan Africa and excluded studies not available in the English language. The information synthesized from this review could be used to develop communication strategies employed during individual and group patient education in the hospitals to improve breastfeeding mothers' understanding, acceptance, and practice of exclusive breastfeeding. This review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020133761.

CONCLUSIONS

This review found that maternal-infant factors have the most significant influence over the practice of exclusive breastfeeding. Therefore, interventions targeted towards maternal-infant factors will improve and optimize exclusive breastfeeding significantly and, ultimately, improve maternal-child health outcomes.

Complementary feeding in Kongwa, Tanzania: Findings to inform a mycotoxin mitigation trial

Complementary feeding of 6‐ to 24‐month‐old infants and young children with adequate, safe and developmentally appropriate food is essential to child health. Inappropriate complementary foods and feeding practices are linked to the high incidences of undernutrition among infant and young children in most developing countries, including Tanzania. Mycotoxin risk is an additional concern, given the documented presence of aflatoxin and fumonisin in food systems of Africa, especially maize and groundnut. In preparation for a trial of mycotoxin mitigation, we conducted focus group discussions and recipe trials to explore complementary foods and feeding practices in Kongwa, a rural district of central Tanzania. Sixty mothers of infants from 6 to 18 months of age in five villages across the district were purposefully sampled. During focus group discussions, mothers reported to mostly feed their children with cereal and groundnut‐based foods as thin or thick porridges. The most common porridge preparations contained cereal (mostly, maize) ranging from 66.7% to 80.0% by weight and groundnuts from 7.7% to 33.3%. The ratio of cereal to groundnut ranged from 3:1 to 4:1. For the recipe trial sessions, mothers chose similar ingredients reported during discussions to prepare complementary foods. The reliance on maize and groundnuts in complementary foods predisposes the children to undernutrition and exposure to aflatoxins and fumonisins. These formative research results suggest multiple intervention points to improve complementary feeding and reduce mycotoxin exposure in this population, including education messages package on feeding practices, mycotoxin control practices and complementary food formulation.

Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa

BACKGROUND

Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first 6 months among mothers on antiretroviral therapy in the Eastern Cape, South Africa.

METHODS

This was a cross-sectional study conducted between January to May 2018, on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice.

RESULTS

The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. E Exclusive breastfeeding's prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women (adjusted odds ratio [AOR] 1.66, 95% Confidence Interval [CI] 1.08-2.56) and those with grade 12 or less level of education (AOR 2.76, 95% CI 1.02-7.49) had a higher likelihood of practising EBF for 6 months since birth while mothers who consumed alcohol (AOR 0.54, 95% CI 0.34-0.85) were less likely to practice EBF for 6 months.

CONCLUSIONS

The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.

Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda

Background

Mothers in low-income countries face many challenges to appropriately feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child’s life.

Methods

This qualitative longitudinal study recruited a purposive sample of 17 mothers who followed the infant and young child feeding recommendations (IYCF). They were selected from a larger study of 36 mothers. In-depth interviews were conducted with mothers of the total group (36 mothers) within the first week, at 4^th, 6^th, 9^th and 12^th months postpartum. Interviews were audio-recorded, transcribed verbatim and analyzed thematically.

Results

Coping strategies included improving mothers’ own diet for adequate breastmilk production, prioritizing child feeding over livelihood chores, livelihood diversification and mothers’ anticipatory behaviors such as preparing child’s food in advance. Some of those coping strategies were shifting overtime depending on the development of the children. Personal factors such as breastfeeding self-efficacy, religious beliefs and perceived benefits of breastfeeding were among the facilitating factors. Additionally, social support that mothers received from family members, other mothers in the community, Community Health Workers (CHWs) and health professionals played an important role.

Conclusion

In challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support. Nutrition promotion interventions that aim to improve IYCF should consider strengthening mothers’ capability in gaining greater control of their IYCF practices and the factors facilitating their appropriate IYCF practices.

[A quantitative and qualitative study of exclusive breastfeeding intention by high-risk pregnant women]

The scope of this research was to assess the breastfeeding intention among high-risk pregnant women and related factors. It is a cross-sectional, qualitative and quantitative study, with 1,118 high-risk pregnant women who attended the prenatal care unit at a specialized center of the Unified Health System. The dependent variables were exclusive breastfeeding intention, intended duration and conditions that might interfere with breastfeeding. The Epi Info 7.4.1, Bioestat 5.3 and IRAMUTEQ 0.7.2.0 programs were used for data processing. The results showed that 8.76% of the pregnant women had conditions that could affect lactation. Among the women, 93.83% affirmed having exclusive breastfeeding intention, of which 69.86% intended to breastfeed until the child was six months old, revealing an association with sociodemographic variables (p<0.05). The intended breastfeeding duration was related to the age (p=0.0041), marital status (p=0.0053) and level of education (p=0.0116). The main reasons reported for not providing exclusive breastfeeding were the following: HIV, use of medications, work and lack of information. This research concluded that a small cohort of high-risk pregnant women presented conditions that could interfere with breastfeeding. Most of them intended to breastfeed exclusively for six months.

Determinants of exclusive breastfeeding in infants of six months and below in Malawi: a cross sectional study

BACKGROUND

UNICEF and WHO recommend that all children should be exclusively breastfed for the first 6 months of life as breastmilk contains all the nutrients an infant needs during this period. In Malawi, exclusive breastfeeding has been declining from 72% (2009), 70.2% (2014) and 61% in the most recent survey (2015-16). We aimed to determine factors associated with exclusive breastfeeding in Malawi.

METHODS

We used data from the Malawi Demographic and Health Survey (MDHS) 2015-2016. Survey records for 2059 mothers of children aged 6 months and below were identified and potential factors influencing infant feeding were examined. Logistic regression analysis was carried out to model determinants of exclusive breastfeeding (EBF).

RESULTS

EBF declined in proportion to the age of the infant. Significant associations with continuing EBF were age of the mother, ethnicity of the mother, sex of infant and number of siblings. Members of the Tumbuka (OR = 1.71, CI. 1.13-2.59) and Ngoni (OR = 2.05, CI. 1.38-3.05) communities were more likely to practice EBF. In addition, mothers with female babies (OR = 1.35, CI. 1.08-1.70) and those with 3-4 children (OR = 1.47, CI. 1.04-2.08) were more likely to engage in EBF.

CONCLUSION

We identify important variations in EBF practices among population sub-groups in Malawi that need to be considered when framing health education messaging. Work is needed to assess the impact of more targeted messaging, whether delivered via 'ten steps' to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI) programming or other health education and awareness campaigns to sensitize communities on implications of some cultural practices on the lives of babies. The potential role for mass media, targeted Health Surveillance Assistants' (HSA) home visits and male involvement also require exploration.

Exclusive breastfeeding patterns in Tanzania: Do individual, household, or community factors matter?

BACKGROUND

Although there is a broad knowledge about exclusive breastfeeding among women in Tanzania, exclusive breastfeeding (EBF) remained lower than 50% for about 50 years since her independence in 1961. Previous research has mainly focused on either individual or household determinants of breastfeeding patterns. This study takes a holistic approach and examines the extent to which combined individual, household, and community factors matter in explaining exclusive breastfeeding patterns in Tanzania.

METHODS

A cross-sectional analysis was carried out using a nationally representative sample from the 2015/16 Tanzanian Demographic and Health Survey. The dependent variable was exclusive breastfeeding, defined as the proportion of infants below 6 months of age who were exclusively breastfed in the last 24 h. Univariable and multivariable logistic regression analyses were conducted to determine factors associated with exclusive breastfeeding.

RESULTS

In general, the rate of exclusive breastfeeding was 59%. Delivery in the short rainy season (95% Confidence Interval [CI] Adjusted Odds Ratio [AOR] 1.21, 2.65) was associated with higher odds of practicing exclusive breastfeeding. On the one hand, mothers aged between 15 and 19 years of age (95% CI AOR 0.36, 0.93), the average size of infants at birth (95% CI AOR 0.38, 0.80), whether postnatal check-up was attended by a doctor (95% C AOR 0.06, 0.46), and the infant's age above 2 months (95% CI AOR 0.23, 0.53) were associated with lower odds of practicing exclusive breastfeeding. There was weak evidence (95% CI AOR 0.48, 1.05) that living in an urban area was associated with a reduced practice of exclusive breastfeeding.

CONCLUSION

Breastfeeding rates are lower among young mothers, mothers whose husbands/partners decide on childcare, and mothers whose postnatal check-ups were conducted by doctors. Thus, breastfeeding programs and interventions need to focus more on young mothers, husbands/partners, and on training female nurses and midwives to increase the EBF rates. Women who tend to practice exclusive breastfeeding most often live in rural areas. There is an urgent need to understand why exclusive breastfeeding rates among urban women are lower.

Prenatal infant feeding intentions and actual feeding practices during the first six months postpartum in rural Rwanda: a qualitative, longitudinal cohort study

Background

Exclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0–1 month to 81% among those aged 4–5 months. Little is known about what influences mothers’ breastfeeding practices. This study aimed to gain insights into expectant mothers’ prenatal feeding intentions, the underlying reasons, actual practices after birth, and factors facilitating or impeding EBF for the first 6 months of a child’s life in Muhanga District, Rwanda.

Methods

This qualitative longitudinal study, conducted between December 2016 and October 2017 as part of a larger study, recruited a purposive sample of 39 pregnant women attending prenatal consultations during their last trimester in two rural health centers. Women were interviewed during pregnancy, within the first week after birth and at 4 and 6 months postpartum to explore intentions, actual practices, critical transition points, and facilitating or impeding factors. Interviews were recorded, transcribed verbatim, and analyzed thematically.

Results

Of the 39 participants, 38 intended to breastfeed within the first hour after birth, and 32 intended to breastfeed exclusively for the first 6 months. In practice, 34 initiated breastfeeding within the first hour, and 12 breastfed exclusively for 6 months. Impeding factors include perceived breastmilk insufficiency, pressure from family members, past experiences, mothers’ concerns over their infants’ health, mothers’ heavy workload, poverty and food insecurity. Factors facilitating early initiation and EBF include mothers’ awareness of EBF’s advantages, confidence in their breastfeeding ability, and support from health professionals and family members.

Conclusion

Despite participants’ intentions about breastfeeding, there was a gap between intentions and actual practices. An interplay of barriers at individual, group and societal levels impeded women from EBF for the first 6 months. EBF promotion interventions should consider supporting and equipping breastfeeding mothers with skills to deal with perceived breastmilk insufficiency and to recognize the true signs of baby hunger cues. Furthermore, important influential family and community members should be targeted to support mothers to breastfeed. Interventions that consider addressing the issue of poverty-driven food insecurity should not be overlooked either.

Prevalence and factors associated with exclusive breastfeeding among rural mothers of infants less than six months of age in Southern Nations, Nationalities, Peoples (SNNP) and Tigray regions, Ethiopia: a cross-sectional study

Background

Exclusive breastfeeding (EBF) is the global recommended nutrition for infants less than 6 months of age. The prevalence of exclusive breastfeeding in Ethiopia is much lower than the recommendations of World Health Organization (WHO). This study aimed to assess the prevalence and associated factors of EBF among rural mothers of infants less than 6 months of age in two regions, Southern Nations, Nationalities and Peoples (SNNP) and Tigray Regions, of Ethiopia.

Methods

The research was based on the secondary data analysis of community-based cross-sectional study conducted in 56 rural woredas (districts) in two regions of Ethiopia for impact evaluation of Alive & Thrive multi-year project. The 24-h recall dietary data were collected from 600 mother-infant dyads where the infant was less than 6 month of age, using multistage cluster sampling technique and 584 dyads were found eligible for analysis. Bivariate and multivariable logistic regressions were applied to identify the associated factors of exclusive breastfeeding.

Results

The prevalence of EBF of infants less than 6 months of age was 88.0% (95% CI 84.9, 90.4%). The odds of practicing EBF were significantly higher among infants less than 2 months of age (AOR 4.47, 95% CI 2.41, 8.27), married mothers (AOR 4.35, 95% CI 1.50, 12.67), mothers who gave birth in health facilities (AOR 2.07, 95% CI 1.15, 3.73) and mothers who received breastfeeding counseling during pregnancy (AOR 2.23, 95% CI 1.26, 3.96).

Conclusions

The prevalence of EBF was relatively high when compared with previous studies in Ethiopia but close to the WHO recommendations of 90 %. Infant age, marital status of mothers, delivery place and breastfeeding counseling during pregnancy were identified as factors associated with EBF practices in 24 h preceding the survey. Devising appropriate strategies on breastfeeding messaging/counseling and support in addressing poor breastfeeding practices through existing government-led health intervention packages are recommended.

Exclusive breastfeeding for the first six months of life and its associated factors among children age 6-24 months in Burao district, Somaliland

Background

Adequate nutrition during early childhood ensures growth and development of children and breast milk is better than any other products given to a child. However, studies on exclusive breastfeeding practice are limited in Somaliland. Therefore, this study was aimed to assess exclusive breastfeeding for the first 6 months of life and its associated factors among children 6–24 months of age in Burao district, Somaliland.

Methods

A community-based cross-sectional study was conducted from 26 August to 10 October 2018, in Burao district among randomly, selected 464 mothers with children 6–24 months of age. Data were collected through face-to-face interview using pretested structured questionnaire.

Results

The prevalence of exclusive breastfeeding was 20.47% (95% CI 18.84, 23.63%). Exclusive breastfeeding practice was associated with: having female child (AOR 0.48; 95% CI 0.29, 0.80)), lack of formal education (AOR 0.32; 95% CI 0.19, 0.53), household monthly income 100$-200$ (AOR 0.35;95% CI 0.18, 0.68), lack of husband’s support (AOR 0.32; 95% CI 0.19, 0.53), and mothers who were not counselled on breastfeeding during antenatal care (AOR = 0.33; 95% CI 0.16, 0.66).

Conclusions

Exclusive breastfeeding practice was very low as compared to recommendations of infant and young child practice (IYCF) which recommends children to exclusively breastfeed for the first 6 months of life. Exclusive breastfeeding practice was associated with a mother’s lack of formal education, monthly income less than 100$, being a female child, lack of advice on exclusive breastfeeding during antenatal care and lack of husband support. The promotion of education for women, husband’s engagement, encouraging antenatal care follow-up and counseling of exclusive breastfeeding during antenatal care was recommended to improve exclusive breastfeeding practice.

Prevalence of exclusive breastfeeding practice in the first six months of life and its determinants in Iran: a systematic review and meta-analysis

Background

Exclusive breastfeeding (EBF) in the first 6 months of life is the best and most complete option for an infant, in that supplies the vitamins and minerals the baby needs. Several studies in Iran have been conducted concerning the prevalence of EBF. The aim of this study was to determine the prevalence of EBF in the first 6 months of life and associated factors in Iran synthesizing published studies.

Methods

We searched PubMed/MEDLINE, Embase, Scopus, ISI/Web of Science, the Cochrane Library, Directory of Open Access Journals Directory (DOAJ) and Google Scholar as well as Iranian databases (Barakathns, MagIran and the Scientific Information Database or SID) up to November 2018. The Newcastle-Ottawa Scale was used to assess the quality of studies. Analyses were performed by pooling together studies using DerSimonian-Laird random-effects model with 95% confidence interval. To test for heterogeneity, I² test was used. The Egger’s regression test and funnel plot were used to evaluate the publication bias. The strength of EBF determinants was assessed computing the Odds-ratios (OR) using the Mantel–Haenszel method.

Results

In the initial search 725 records were found. Finally, 32 studies were selected based on inclusion/exclusion criteria. The sample size of studies varied between 50 and 63,071 subjects. The overall prevalence of EBF in Iran was 53% (CI 95%; 44–62). The OR for breastfeeding education received before pregnancy was 1.13 (0.94–1.36), for mother’s job 1.01 (0.81–1.27), for education level 1.12 (0.89–1.42), for type of delivery 1.16 (0.98–1.37), and for gender of child 1.03 (0.83–1.28).

Conclusion

In Iran health policy- and decision-makers should try to take interventions that encourage mothers to use their milk to breastfeed the infants.

Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers

BACKGROUND

Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival.

OBJECTIVE

We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding.

METHODS

We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically.

RESULTS

Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores.

CONCLUSION

Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.

Factors associated with cessation of exclusive breastfeeding at 1 and 2 months postpartum in Taiwan

Background

Breastfeeding benefits both mothers and infants. Even though Taiwan national policy promotes exclusive breastfeeding (EBF), the rates in Taiwan are below those in other developed countries. This study aimed to investigate factors associated with EBF cessation at 1 and 2 months postpartum.

Methods

This study was conducted in a community hospital in southern Taiwan between December 2016 and June 2017. Birth mothers (n = 1077) were interviewed by telephone at 1 and 2 months postpartum to collect information on infant feeding patterns (EBF since birth or not) and reasons for EBF cessation. Multivariate logistic regression models were used to determine risk factors associated with EBF cessation at 1 and 2 months.

Results

At 1 month, 432 participants (40.1%) maintained EBF. Factors associated with cessation were lack of tertiary education, primiparity, perceived low milk quantity, mother/infant separation, medical condition in mother, inconvenience/fatigue due to breastfeeding, and baby-centered factors. At 2 months, 316 participants (29.3%) maintained EBF. Factors associated with cessation were lack of tertiary education, primiparity, perceived low milk quantity, and return to work.

Conclusions

Education level, primiparity, perceived low milk quantity, and return to work are associated with premature cessation of EBF in Taiwan. Strategies about health education, family support, and baby-mother friendly environment can be used to achieve higher EBF rate.

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey

Background: Pre-lacteal feeding (PLF) is a barrier to optimal breastfeeding and increases the risk of diarrhoea and acute respiratory tract infections in infants.The prevalence and predictors of PLF are not well studied in South Sudan. Understanding the predictors of PLF is crucial in designing interventions to increase exclusive breastfeeding (EBF) rates.

Objective: To assess the prevalence and factors associated with PLF in Jubek State, South Sudan.

Method: This was a community based cross-sectional study of 810 mothers of children under two years of age in Jubek State, South Sudan. Mothers were interviewed in their homes using a semi-structured questionnaire to collect data on PLF, socio-demographic and birth characteristics. Multivariable analysis was used to identify factors independently associated with PLF.

Results: A total of 426/810 (53 %), 95% confidence interval (CI) [48 %, 59 %] mothers had given pre-lacteal feeds to their infants. The commonest pre-lacteal feeds included glucose solution (54%), water (26%), and infant formula (14%). Having received antenatal breastfeeding counselling decreased the odds of PLF [adjusted odds ratio (AOR) 0.60; 95% CI (0.43, 0.82)]; while discarding of colostrum increased the use of pre-lacteal feeds [AOR 1.57; 95% CI (1.17, 2.11)].

Conclusion: The prevalence of PLF in South Sudan is high. Predictors of PLF included lack of breastfeeding counselling and discarding of colostrum. Infant feeding counselling should be given to all pregnant women in the health facilities and communities. The counselling should emphasize the health benefits of colostrum and discourage the practice of discarding it.

Prevalence and factors associated with early initiation of breastfeeding among Bangladeshi mothers: A nationwide cross-sectional study

Background

Early initiation of breastfeeding (EIBF) is associated with better health of the mothers and reduced risk of neonatal mortality. The objective of this study was to determine the prevalence of EIBF and associated factors among Bangladeshi mothers.

Methods

The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 4,092 married non-pregnant Bangladeshi mothers who had at least one child aged 2 years or younger were included in this study. A two-level logistic regression model was used to remove the clustering effect for finding the impact of socio-economic and demographic factors on EIBF.

Results

The prevalence of EIBF among Bangladeshi mothers was 51.4% (urban: 47.1% and rural: 53.4%). A two -level logistic regression model showed that mothers living in the Sylhet division (p<0.01) and rural environment (p<0.05) were more likely to practice EIBF. Mothers who were obese or overweight (p<0.01), had secondary (p<0.05) or higher education (p<0.01) were less likely to provide early breastfeeding to their newborn babies compared to their counterparts. Those who delivered by caesarian-section (p<0.01) were less likely to perform EIBF while those who attended an antenatal care clinic more than 3 times (p<0.05) were more likely to do so.

Conclusions

About half of the Bangladeshi mothers did not start breast-feeding within one hour after birth. This study identified several geographical and socio-demographic factors that were associated with EIBF, and hope that this information will help the government to focus their resources to promote early breastfeeding.

Exclusive Breastfeeding Practice and Associated Factors among Mothers in Boditi Town, Wolaita Zone, Southern Ethiopia, 2018: A Community-Based Cross-Sectional Study

Background

Exclusive breastfeeding tops the table of life-saving interventions for newborns. A child who is exclusively breastfed is 14 times less likely to die in the first six months compared to its counterpart. Approximately 18,000 children globally still die every day and if current trend continues, some 60 million children under age 5 will die between 2017 and 2030, and half of them will be newborns. Five countries, including Ethiopia, accounted for half of all newborn deaths in the world.

Objective

To assess the prevalence and associated factors of exclusive breastfeeding practice among mothers who have infants 6-12 months of age in Boditi Town, Wolaita Zone, Southern Ethiopia, 2018.

Methods

Community-based cross-sectional study was conducted among 412 randomly selected mothers having 6 to 12 month infants from April 1 to 14, 2018. A pretested interviewer administered questionnaire was used for data collection. The data were entered using Epi Data version 3.1 and analyzed using SPSS version 20. Descriptive statistics was made. Bivariate and multivariate logistic regression was also carried out to see the effect of each independent variable on the dependent variable.

Results

Of 412 mother-infant pairs sampled, 403 were participated, which made a response rate of 97.8%. Prevalence of EBF computed using since birth dietary recall method was 64.8% (95% C.I= 60.0, 69.0). From multivariable analysis, child birth attended by health care provider (AOR = 5.303, 95% C.I = 1.613, 17.436), postnatal care utilization (AOR = 1.91, C.I = 1.083, 3.370), and mothers who did not report any breast related problem for the first six months after child birth (AOR = 1.864, C.I = 1.090, 3.189) were factors positively associated with exclusive breastfeeding practice.

Conclusion

Although the prevalence of exclusive breastfeeding practice in this study was relatively high, more effort to meet World Health Organization (WHO) recommendations is still necessary to benefit from its intervention. There is a need to promote child births to be attended by health care providers and postnatal care utilization. Further, women should be educated on what to do and where to seek care if breast problem occurs after child birth.

Exclusive Breastfeeding Rates and Factors Associated with Exclusive Breastfeeding Practices in Northern Tanzania: Measurement using Two Different Methodologies-24 Hours Recall and Recall Since Birth

BACKGROUND

Exclusive breastfeeding (EBF) has many benefits to the child from mental to physical growth and development; however, methods of measuring EBF have raised a number of policy and programmatic questions. This study assesses EBF rates and factors associated with EBF practices in Northern Tanzania using two different methodologies, namely, the 24-hours recall and recall-since-birth.

METHODS

A cohort study was conducted from October 2013 to December 2015 among mother-infants' pairs. Mothers with child delivery information (N=430) were followed and included in the analyses. We enrolled pregnant women who were in their third trimesters and interviewed them with the help of questionnaires at enrollment, delivery, 7 days and thereafter monthly up to nine months after delivery. At each visit after delivery, information on breastfeeding using the two methods (24 hours recall and recall-since-birth) was collected.

RESULTS

The prevalence of EBF dropped from one month to six months when using both the 24 hours recall and the recall since birth methods, but at different rates. At six months, 24.2% of the mothers practiced EBF when measured with the recall since birth method, compared to 38.8% when measured with the 24 hour recall. Predictors of EBF were also different. When using the recall since birth method, women who had received counseling on infant feeding had increased odds of practicing EBF compared to those who did not receive counseling, [AOR=2.3; 95% CI (1.2, 3.7)]. When using 24 hours recall, women who were unemployed had increased odds of practicing EBF compared to those who were employed [AOR=1.5;95% CI(1.1,2.5)], and women aged 35 - 49 years had decreased odds of practicing EBF compared to younger women[AOR=0.28; 95 % CI(0.1,0.7)].

CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS

The two methods for EBF give substantially different results, both in the prevalence of EBF and factors associated with EBF. The higher EBF obtained with 24 hours recall represents an overestimation and thereby an overly positive picture of the situation.

Increasing trend of exclusive breastfeeding over 12 years period (2002-2014) among women in Moshi, Tanzania

BACKGROUND

The World Health Organization has recommended that all infants under 6 months should be exclusively breastfed. An understanding of the trend of exclusive breastfeeding (EBF) over years and over smaller geographical areas is crucial to monitor the progress made in improving the proportions of infants' EBF.

METHODS

Data on infant feeding practices on 2315 mother-infant pairs from 2002 to 2014 were extracted from cohorts of women who delivered in the Moshi Municipality. Descriptive statistics were used to establish the trend of EBF up to 1, 3 and 6 months across waves (2002/2004 = wave I, 2005/2012 = wave II and 2013/2014 = wave III), to relate EBF up to 6 months to wealth quintiles and to HIV status of mothers.

RESULTS

The number of mothers in waves I, II and III were 1656 (71.5%), 256 (11.1%) and 403(17.4%) respectively. The percentages of EBF up to 6 months increased from 5.5, 13.7 to 16.9% from wave I to III. Overall, across the waves, the proportion of EBF up to 6 months among the mothers in the low wealth quintile was 4, 9 and 42%, and 7, 26 and 15% for the ones in the highest wealth quintile. The proportion of EBF up to 6 months has been increasing among HIV positive mothers while fluctuating among their counterparts across the waves.

CONCLUSION

The proportion of EBF up to 6 months has been increasing in the Moshi municipality but is below the national average. While establishing trends of EBF at the national level is commendable, research to establish trends over smaller geographical areas is needed to provide a true picture that may otherwise be masked.

"We give water or porridge, but we don't really know what the child wants:" a qualitative study on women's perceptions and practises regarding exclusive breastfeeding in Kilimanjaro region, Tanzania

Background

World Health Organization (WHO) recommends exclusive breastfeeding (EBF) as the optimal way to feed infants below 6 months of age. The benefits of EBF are well documented. However, in Tanzania, EBF is still rarely practised. This study explored the knowledge, attitudes and practises of EBF among mothers in Kilimanjaro region of northern Tanzania.

Methods

This is a qualitative research study. The three districts in Kilimanjaro region namely Same, Moshi Municipal Council and Rombo districts were selected. In each district, three focus group discussions (FGDs) with mothers of infants aged 0–12 months were conducted. A total of 78 mothers participated in the focus group discussion.

Results

The main result is that most of the mothers had a theoretical knowledge of the benefits of EBF but were not able to practise this knowledge for a range of reasons. The reasons for not practising EBF in real life included poor maternal nutrition, the pressure for women to return to work, inadequate knowledge about expressing breast milk, and perceived insufficiency of milk supply. Additionally, mothers received conflicting advice from a range of sources including close relatives, community members and health care providers, and they often choose the advice of their elders. Mothers also offered suggestions on ways to improve EBF including educating the community on the benefits of EBF.

Conclusion

The results show that the women need support from close relatives and employers to successfully practise EBF. This presents a need for involving close relatives in EBF interventions, as they are important sources of breastfeeding information in the community. Additionally, behavioural interventions that promote optimal breastfeeding practises might help to improve exclusive breastfeeding.

Exclusive breastfeeding practice in Ethiopia and its association with antenatal care and institutional delivery: a systematic review and meta-analysis

Background

Despite the World Health Organization recommendation of exclusive breastfeeding (EBF) for the first six months of life, the rate remains low both in developed and developing countries. In Ethiopia, findings regarding the prevalence of EBF have been highly variable. Antenatal care and institutional delivery are the most important factors contributing to the practice of EBF however; their effect has not been investigated in Ethiopia.

Methods

In this systematic review and meta-analysis, international databases were systematically searched. All observational studies reporting the prevalence of EBF and its association with antenatal care and institutional delivery in Ethiopia were considered. Two authors independently extracted all necessary data using a standardized data extraction format. A random effects meta-analysis model was computed to estimate the pooled prevalence of exclusive breastfeeding. Moreover, the association of antenatal care and institutional delivery with EBF was determined.

Results

After reviewing 619 studies, 32 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of EBF in Ethiopia was 59.3% (95% Confidence Interval [CI] 53.8, 64.8). The subgroup analysis indicated that the highest prevalence was observed in Afar region (65.6%), followed by SNNP (63.8%), and then by Oromia (61.8%). Additionally, mothers who attended antenatal visits were 2.1 times more likely to practice EBF compared to their counterparts (Odds Ratio [OR] 2.1; 95% CI 1.5, 2.8). Moreover, mothers who gave birth at a health institution were 2.2 times more likely to practice EBF compared to mothers who gave birth at home (OR 2.2; 95% CI 1.3, 3.5).

Conclusions

Exclusive breastfeeding in Ethiopia was significantly lower than the global recommendations. There was evidence that mothers who attended antenatal visits and who gave birth at health institutions had better EBF practices. Based on our findings, we strongly recommended that the utilization of antenatal care and institutional delivery should be improved through health extension workers.

Prevalence of Exclusive Breastfeeding and Factors Associated With Exclusive Breastfeeding of Children in Trongsa District, Bhutan

The World Health Organization estimated that about 800 000 infant deaths could be prevented annually by exclusively breastfeeding infants for the first 6 months of life. This study aimed to examine the prevalence of exclusive breastfeeding and its associated factors. A total of 192 mothers participated. The prevalence of exclusive breastfeeding practice in Trongsa district was 97% at 1 month, declining to 58% at 6 months. Mothers who returned to formal work were less likely to exclusively breastfeed than those who were farmers or housewives. The main reasons stated by the mothers for not exclusively breastfeeding were lack of the mother's self-confidence that the child is getting enough breastmilk and mothers having to return to work, 59% and 22%, respectively. The rate of exclusive breastfeeding in Trongsa district of Bhutan is high, and every effort should be made to maintain and improve this rate.

Exclusive breastfeeding practice during first six months of an infant's life in Bangladesh: a country based cross-sectional study

BACKGROUND

Breastfeeding offers incredible health benefits to both child and mother. It is suggested by World Health Organization that an able mother should practice and maintain exclusive breastfeeding for first six months of her infant's life. The objective of this study was to determine the prevalence and factors associated with exclusive breastfeeding for first six months of an infant's life in Bangladesh.

METHODS

Data was extracted from Bangladesh Demographic and Health Survey (BDHS-2014). BDHS-2014 collected data from 17,863 Bangladeshi married women in reproductive age from the entire country using two stages stratified cluster sampling. We included only mothers having at least one child currently aged not less than 6 months. Mothers who did not have child to breastfeed, some incomplete information and missing samples were excluded from the data set and consequently 3541 mothers were considered in the present study. Chi-square test, binary logistic regression models were used in this study.

RESULTS

The prevalence of exclusive breastfeeding (EBF) for first six months of an infant's life in Bangladesh was 35.90%. Binary multivariable logistic regression model demonstrated that relatively less educated mothers were more likely to exclusively breastfeed their children than higher educated mothers. (AOR = 2.28, 95% CI: 1.05-4.93; p < 0.05). Housewife mothers were more likely to be EBF than their counterparts (AOR = 1.20, 95% CI: 1.02-1.42; p < 0.05). Higher rate of EBF was especially found among mothers who were living in Sylhet division, within 35-49 years old, and had access to mass media, had more than 4 children, had delivered at home and non-caesarean delivery, took breastfeeding counseling, antenatal and postnatal cares.

CONCLUSIONS

Stepwise regression model exhibited that most of the important predictors were modifiable factors for exclusive breastfeeding. Authorities should provide basic education on EBF to educated mothers, and organize more general campaign on EBF.

Exclusive breastfeeding and associated factors among mothers in Gozamin district, northwest Ethiopia: a community based cross-sectional study

Background

Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, except drops or syrups consisting of vitamins, mineral supplements or medicine. Exclusive breastfeeding is one of the essential actions for infant development and survival. However, the prevalence of exclusive breastfeeding in Ethiopia has been estimated at 52% which is far less than the World Health Organization (WHO) recommendations. Moreover, there are inconsistencies among estimates in different districts of the country. Therefore, this study aimed to assess the prevalence and associated factors of exclusive breastfeeding among mothers in Gozamin district, northwest Ethiopia.

Methods

Using the simple random sampling technique, seven kebeles (lowest administrative units) were selected as the primary sampling unit of the district. Sample mother-infant pairs were then selected using the systematic random sampling technique that involved our moving from house to house in each village. Data were collected from 506 mother-infant pairs using interviews. Factors associated with exclusive breastfeeding were determined using logistic regression. The measure of association used was the odds ratio, and statistical tests with p-values of less than 0.05 were considered as statistically significant.

Results

In this study, the prevalence of exclusive breastfeeding among mothers was 74.1% (95% CI 70.80, 79.10). For government employee mothers, the odds of exclusive breastfeeding were reduced by half compared to housewives (AOR 0.49, 95% CI 0.26, 0.94). Mothers who did not receive breastfeeding counseling after delivery were 0.43 times less likely to practice exclusive breastfeeding compared with mothers who received the services (AOR 0.43, 95% CI 0.25, 0.72). Mothers who gave birth at health institutions were more likely to practice exclusive breastfeeding.

Conclusion

Even though the estimated prevalence is relatively high, more effort to meet WHO recommendations is still necessary. Therefore, we suggest health institutions encourage hospital birthing and increase breastfeeding counseling after delivery, and employers needs to give longer maternity leave to improve exclusive breastfeeding practice.

Mothers' education and ANC visit improved exclusive breastfeeding in Dabat Health and Demographic Surveillance System Site, northwest Ethiopia

INTRODUCTION

Despite its proven benefit in reducing child mortality and morbidity, the coverage of exclusive breastfeeding (EBF) remains sub-optimal. In Ethiopia, about 52% of infants under six months of age were exclusively breastfed, implying the need for further identification of the barriers to optimal EBF practice. Therefore, this study aimed to investigate EBF and its determinants in the predominantly rural northwest Ethiopia.

METHODS

The study was conducted at the Dabat Health and Demographic Surveillance System (HDSS) site, which is located in Dabat District, northwest Ethiopia. A total of 5,227 mothers with children under five years of age were included for analysis. Multivariable binary logistic regression analysis was employed to identify factors associated with EBF. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A P-value of <0.05 was used to declare statistical significance.

RESULTS

About 54.5% [95% CI: 51.9, 57.1] of the mothers practiced EBF. Mothers' education [AOR = 2.10; 95% CI: 1.63, 2.71], age (20-35 years) [AOR = 1.39; CI: 1.07, 1.80], urban residence [AOR = 1.28; 95% CI: 1.07, 1.54], at least one ANC visit [AOR = 1.41; 95% CI: 1.23,1.61], initiation of breastfeeding within one hour of birth [AOR = 1.32; 95% CI: 1.15,1.50], richer household [AOR = 1.34; 95% CI: 1.07, 1.65], and withholding prelacteal feeds [AOR = 1.34; 95% CI: 1.17, 1.53] were found important determinants of EBF.

CONCLUSION

In this study area, the prevalence of EBF is lower than the national as well as the global recommendation for universal coverage of EBF. Therefore, strengthening the implementation of Infant and Young Child Feeding strategy (IYCF) and maternal health care utilization are essential for stepping up EBF coverage. Moreover, attention should be given to uneducated, rural resident, and adolescent mothers.

Predictors of appropriate breastfeeding knowledge among pregnant women in Moshi Urban, Tanzania: a cross-sectional study

Background

Knowledge on infant feeding among pregnant women is essential when promoting optimal breastfeeding practices. This study aimed to assess the knowledge of women on optimal breastfeeding during pregnancy and associated factors as well as performance of the health system in reaching women with information on breastfeeding and infant feeding issues.

Methods

A cross-sectional study was conducted from October 2013 to April 2014 among pregnant women, in their third trimester, attending for routine care at two primary health care facilities in Moshi urban, northern Tanzania.

Results

A total of 536 women were enrolled, with mean age of 25.9 (SD 5.7) years. Only 51% (n = 274) reported to have received counselling on breastfeeding from their healthcare providers during the current pregnancy.

More than seven out of ten pregnant women were knowledgeable about key issues regarding appropriate breastfeeding practices: importance of colostrum (95%), time of breastfeeding initiation (71%), exclusive breastfeeding (EBF) (81%), and time of introducing complementary feeding (83%).

Receiving counselling on breastfeeding during the current pregnancy (Adjusted Odds Ratio [AOR] 3.7; 95% Confidence Interval [CI]: 2.4, 5.7), having two children (AOR 2.6; 95% CI: 1.5, 4.4), having three or more children (AOR 3.5; 95% CI: 1.8, 6.9) and intention to breastfeed the child exclusively (AOR 3.6; 95% CI: 2.0, 6.5) were significantly associated with appropriate breastfeeding knowledge.

Conclusions

The health system failed to reach the 49% of women who did not receive counselling on infant feeding. Pregnant women who had received counselling on optimal breastfeeding and women with more than one child were more likely to have knowledge of optimal breastfeeding practices.

Factors influencing exclusive breastfeeding among Iranian mothers: A longitudinal population-based study

Background: Exclusive breastfeeding (EBF) contributes to the health and survival of the newborns. Many factors influence the EBF behavior. This study aimed to identify the determinant factors in order to improve the practice of EBF among Iranian mothers. Methods: A longitudinal study was carried out in 1445 mothers with newborns in Qazvin city, Iran (September 2015-March 2016). Demographic variables as well as the constructs of theory of planned behavior (TBP) were measured by questionnaires. Bivariate analysis using Pearson and Spearman correlation tests with analysis of variance were used to investigate the associations among the variables. Both hierarchal multiple regression and logistic regression were applied to identify potential determinative factors for the EBF. Results: Nearly, 80% (CI: 77.97-82.63%) of the participants had the intention of EBF. All TPB constructs, moral norms, and self-identity were significantly correlated with each other (r: 0.09- 0.40, P < 0.01). Some demographic variables such as age, income, employment and primiparity were also correlated with the EBF (r: 0.11-0.15, P < 0.05). The constructs of the TPB were able to predict the EBF behavior, which account for 49% of the variance in the predicting factors (df = 8, F = 7.70). The self-identity and moral norms accounted for an additional 15% of the variance (df = 10, F = 3.16). Younger mothers with lower socio-economic status were at higher risk of EBF cessation. The intention has a greater impact on the initiation of EBF than perceived behavioral control (PBC) but not for the maintenance of EBF (OR, 2.88 [CI: 2.38-3.48] & 1.13 [CI:1.03- 1.23] vs. OR, 1.27 [CI:1.15-1.39] & 2.66 [CI: 2.02-3.49]). Conclusion: The interventions to promote knowledge, attitude and behavioral control towards the EBF should be considered especially in the young mothers with low socio-economic status.

Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania: A Mixed Method Community Based Study

Objectives

Estimates shows exclusive breastfeeding (EBF) has the potential to prevent 11.6 % of all under-five deaths in developing countries. Prevalence of EBF is low globally (35 %), and in sub Saharan Africa ranges between 22 and 33 %. Like other developing countries the prevalence of EBF is 50 % in Tanzania. There is limited information in Tanzania on factors influencing EBF apart from information specific for HIV positive women. This study aimed at examining factors that affect EBF practice among women in Muheza district, Tanga region, northeastern Tanzania.

Methods

A community based cross-sectional study using both qualitative and quantitative methods was conducted from April to June 2014. To collect relevant information, a total of 316 women with infants aged 6–12 months were interviewed using a questionnaire and 12 key informants using in-depth interview guide. Qualitative data was analyzed using thematic analysis while bivariate and multivariate logistic regression analysis were used assess association between EBF and predictor variables.

Results

The prevalence of EBF was 24.1 %. The perception that mothers’ breast milk is insufficient for child’s growth, child being thirsty and the need to introduce herbal medicine for cultural purposes were among the important factors for early mixed feeding. In multivariate analysis advanced maternal age (OR 2.6; 95 % CI 1.18–5.59) and knowledge on EBF duration and advantages (OR 2.2; 95 % CI 1.2–3.8) remained significantly associated with EBF practice.

Conclusions

The prevalence of EBF in our study is low compared with the national prevalence. Strategies to target beliefs that breast milk is insufficient for growth need to be strengthened in the community. Furthermore opportunity to increase EBF training during ante and postnatal visits for women should be enhanced as more than 90 % of women in the district use skilled attendants during pregnancy and delivery.

Predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa: a prospective study

Background

Although breastfeeding is common in Democratic Republic of the Congo, the proportion of women who exclusively breastfeed their babies up to 6 months remains low. This study aimed at identifying predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa.

Methods

A prospective study was carried out from October 2012 to July 2013 among 422 mother-child pairs recruited shortly after discharge from twelve maternities in Kinshasa and followed up to six months. Interviews were conducted at each woman’s house during the first week after birth, and at one, two, three, four, five and six months. Collected data included history of child’s feeding and mother’s socio-demographic and psychosocial characteristics. The Cox Proportional Model was used to identify predictors of discontinuing exclusive breastfeeding before six months.

Results

The median duration of exclusive breastfeeding was 10.9 weeks (Inter Quartile Range 4.3 to 14.9). At six months, 2.8 % of infants were exclusively breastfed. The factors independently associated with the discontinuation of exclusive breastfeeding before six months were: not confident in the ability to breastfeed [Adjusted hazard ratio (AHR) = 3.90; 95 % CI 1.66, 9.16)], no plan on the duration of EBF (AHR = 2.86; 95 % CI 1.91, 4.28), breastfeeding problems during the first week (AHR = 1.54; 95 % CI 1.13, 2.11), low level of breastfeeding knowledge (AHR = 1.52; 95 % CI 1.08, 2.15), and experienced less than five Baby-friendly practices during the maternity stay (AHR = 1.47; 95 % CI 1.05, 2.06).

Conclusions

Confidence in the ability to breastfeed and intention to exclusively breastfeed were the most important predictors of discontinuing exclusive breastfeeding before six months. To have a greater impact on the duration of exclusive breastfeeding, interventions should focus on these factors.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-015-0044-7) contains supplementary material, which is available to authorized users.