Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh: a cross-sectional study

Prevalence and Determinants of Exclusive Breastfeeding Among Mothers of Children Aged 6-24 Months in the Aseer Region

Background Exclusive breastfeeding (EBF) is crucial for infant and maternal health, providing optimal nutrition and immune protection for infants while reducing maternal postpartum depression and cancer risk. However, global trends show an early cessation of breastfeeding and the introduction of other foods. This study aims to determine the prevalence and factors influencing EBF among mothers in the Aseer region of Saudi Arabia. Methodology A cross-sectional study using a multistage cluster sampling approach was conducted from January to March 2024 in primary healthcare centers across the Aseer region. Participants included mothers of children aged 6-24 months attending primary healthcare centers for immunizations or routine check-ups. A pretested structured questionnaire, developed after an extensive literature review and expert consultation, was used to interview consenting participants. The questionnaire covered sociodemographic data, obstetric and medical history, child data, EBF practices, maternal knowledge and perception of breastfeeding, counseling about breastfeeding, antenatal care, breastfeeding support, and barriers and motivators of EBF. Results A total of 1,008 eligible mothers were included. Only 131 (13%) fulfilled the World Health Organization criteria for EBF. Moreover, 257 (25.5%) mothers initiated breastfeeding within the first hour after delivery, and 387 (38.4%) exclusively breastfed for six months or more. EBF was less frequent among mothers with higher education (8%, n = 2) compared to those with lower education (23%, n = 23, p = 0.017). EBF was also less frequent among mothers who delivered via cesarean section (7.9%, n = 28) compared to those who had a vaginal delivery (15.8%, n = 103, p = 0.001). Conversely, EBF was more common among mothers with more than five pregnancies (15.8%, n = 45) compared to those with one to two pregnancies (9.4%, n = 37, p = 0.023). EBF was also more common among mothers who had breastfed more than four children (16.7%, n = 39) compared to those who had not (12.1%, n = 49, p = 0.048). Finally, EBF was more common among mothers without postpartum complications (13.4%, n = 131) or whose infants had no birth complications (13.4%, n = 128) compared to their respective counterparts (p = 0.029 and p = 0.048, respectively). Conclusions This study found a low prevalence of EBF in the Aseer region, despite high maternal knowledge and positive perceptions. Factors such as low education, medical barriers, unemployment, and high parity were associated with increased EBF rates. Interventions should focus on improving workplace support and increasing maternal awareness of EBF recommendations.

Prelacteal feeding is not associated with infant size at 3 months in rural Bangladesh: a prospective cohort study

BACKGROUND

Early and exclusive breastfeeding may reduce neonatal and post-neonatal mortality in low-resource settings. However, prelacteal feeding (PLF), the practice of giving food or liquid before breastfeeding is established, is still a barrier to optimal breastfeeding practices in many South Asian countries. We used a prospective cohort study to assess the association between feeding non-breastmilk food or liquid in the first three days of life and infant size at 3-5 months of age.

METHODS

The analysis used data from 3,332 mother-infant pairs enrolled in a randomized controlled trial in northwestern rural Bangladesh conducted from 2018 to 2019. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within approximately three days and three months post-partum. At each visit, interviewers collected data on breastfeeding practices and anthropometric measures. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. We used multiple linear regression to assess the association between anthropometric indices and PLF practices, controlling for household wealth, maternal age, weight, education, occupation, and infant age, sex, and neonatal sizes.

RESULTS

The prevalence of PLF was 23%. Compared to infants who did not receive PLF, infants who received PLF may have a higher LAZ (Mean difference (MD) = 0.02 [95% CI: -0.04, 0.08]) score, a lower WLZ (MD=-0.06 [95% CI: -0.15, 0.03]) score, and a lower WAZ (MD=-0.02 [95% CI: -0.08, 0.05]) score at 3-5 months of age, but none of the differences were statistically significant. In the adjusted model, female sex, larger size during the neonatal period, higher maternal education, and wealthier households were associated with larger infant size.

CONCLUSION

PLF was a common practice in this setting. Although no association between PLF and infant growth was identified, we cannot ignore the potential harm posed by PLF. Future studies could assess infant size at an earlier time point, such as 1-month postpartum, or use longitudinal data to assess more subtle differences in growth trajectories with PLF.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03683667 and NCT02909179.

Barriers and enablers to exclusive breastfeeding by mothers in Polokwane, South Africa

Background

Exclusive breastfeeding (EBF) for six months, with the introduction of appropriate complementary feeding thereafter, and breastfeeding continuing for up to 2 years and beyond, is highly recommended. This could save the lives of up to 1.4 million children each year worldwide. Despite this, breastfeeding rates in South Africa remain sub-optimal, with the recommended target of 50% by the World Health Assembly (WHA) not being achieved. The study aimed to investigate the reasons influencing mothers' practice of exclusive breastfeeding in the Polokwane municipality of Limpopo province in South Africa.

Methodology

A cross-sectional health facility-based quantitative and descriptive survey was conducted using a validated-structured questionnaire administered to 146 mothers. The data was analyzed using STATA. Chi-square tests were used to determine the relationship between selected demographic variables and their reasons not to breastfeed exclusively.

Results

Although 94% of the mothers had initiated breastfeeding, at the time of data collection 8% had stopped. Of those who had stopped breastfeeding, 5% did so within one month of starting. Thirty- nine percent of mothers' breastfed exclusively, while 61% practiced mixed feeding. A positive association between exclusive breastfeeding practices and the age of the mother were observed, with older mothers more likely to breastfeed. The reasons mothers stopped breastfeeding were: the mother was ill (45%) or they returned to school or work (27%). Reasons for not breastfeeding were cited as: medical conditions, not enough milk, and infant refusal to breastfeed (33%). Mothers believe that HIV-positive women should breastfeed their infants (57%), and health workers were found to be the main source of HIV information to mothers (77%).

Discussion

Exclusive breastfeeding during the first six months was less practiced. Infant formula and solid foods were introduced at an early age, usually within the first month of breastfeeding. This study sheds light on factors influencing the early initiation of breastfeeding and the practice of EBF as practiced in Polokwane.

Early Initiation of Breastfeeding (EIBF) and Its Associated Factors Among Mothers With Infants Aged 0 to 6 Months in Jashore District, Bangladesh: A Cross-Sectional Study

OBJECTIVE

Early initiation of breastfeeding (EIBF) is one of the most successful interventions for minimizing newborn morbidity and death. According to the database (Bangladesh Demographic Health Survey 2014), only around half of babies begin breastfeeding during the first hour of life in Bangladesh. The goal of this study was to determine the prevalence of EIBF in the Jashore area while also investigating its associated factors among mothers of infants aged 0 to 6 months in order to better understand the variables that impacted breastfeeding initiation.

METHOD

A cross-sectional study was conducted in the maternity wards of the 3 busiest hospitals in the Jashore district of Bangladesh from May to July 2019. Using random sampling, a total of 423 mother-infant pairs were chosen. Pearson chi-square test and bivariable and multivariable logistic regression statistical analysis were used to identify factors linked to EIBF.

RESULTS

The prevalence of EIBF was 46.3% (196/423). Mothers who had skin-to-skin contact after delivery (adjusted odds ratio [AOR], 2.25; 95% confidential interval [CI], 1.40-3.59), who did not deliver prelacteal food (AOR, 3.68; 95% CI, 1.65-8.21), and who provided colostrum (AOR, 5.89; 95% CI, 1.62-21.49) were more likely to begin breastfeeding within 1 hour than were their counterparts.

CONCLUSIONS

EIBF was found to be strongly linked with skin-to-skin contact after delivery, avoidance of prelacteal feeding, and colostrum feeding practice. As a result, we strongly urge public health officials and health care practitioners to encourage these feeding behaviors in order to increase EIBF.

Examining psychometric properties of the Iranian version of exclusive breastfeeding social support scale (EBFSS)

BACKGROUND

The exclusive breastfeeding (EBF) is undeniably proven significant in mothers' health and infants' growth and survival. Its persistence has many familial, social, and economical benefits. Social support is known to be an effective factor in EBF's success and sustainability. However, Exclusive breastfeeding social support (EBFSS) scale validity and reliability is not evaluated in Iran. This study aimed to determine the psychometric properties of EBFSS during postpartum period in Tabriz city, Iran.

METHODS

It is a cross-sectional study with descriptive survey method performed between March 2021 and August 2022. Psychometric properties were determined for the Persian version of EBFSS in six stages: translation process, evaluating content validity, face validity, construct validity, discriminant validity, and reliability. A group of experts (n = 10), followed by a group of women with EBF (n = 10), evaluated the instrument's items based on content and face validities, respectively. A cross-sectional study using the multi-stage cluster random sampling method on 348 women with EBF in the first four months after delivery was conducted to determine the construct validity. The internal consistency and repeatability (test-retest on 30 women, 2 weeks apart) were used to find out the reliability.

RESULTS

Content validity ratio (CVR), content validity index (CVI), and impact score were 0.98, 0.98, and 3.54 for EBFSS, respectively. This indicates a good content and face validity. Exploratory factor analysis (EFA) was performed on 16 items to examine the construct validity identified emotional, instrumental, and informational factors. These factors explained 59.26% of the cumulative variance. The fit indices (CFI = 0.98، TLI = 0.95، χ2/df = 4.20، RMSEA = 0.07 and SRMSEA = 0.05) confirmed the validity of the model in a confirmatory factor analysis (CFA). The internal consistency was examined through Cronbach's alpha and McDonald's omega coefficients that were 0.90 and 0.92, respectively. Finally, Repeatability and reproducibility were found 0.97 (95% CI: 0.92 to 0.99) using Intra-class correlation. This shows an appropriate reliability of the instrument.

CONCLUSIONS

The research findings indicate that the Persian version of the EBFSS has appropriate psychometric properties for evaluating the social support in Iranian women with EBF. This means healthcare providers can use it for screening social support in EBF. Researchers also can use it as a valid instrument.

Examining the prevalence and determinants of early initiation of breastfeeding: Evidence from the 2017/2018 Benin demographic and health survey

Early initiation of breastfeeding has been noted as one of the well-known and successful interventions that contributes to the reduction of early childhood mortality and morbidity. The Government of Benin has established multi-sectoral institutions and policies to increase the prevalence of early initiation of breastfeeding. However, there is little information on the prevalence and the determinants of early initiation of breastfeeding in Benin. This study therefore sought to examine the prevalence and determinants of early initiation of breastfeeding among women in Benin. This is a secondary data analysis of the 2017/2018 Benin demographic and health survey. The study included weighted sample of 7,223 women between the ages of 15 and 49. STATA was used for the data analysis. We used a multilevel logistic regression to investigate the factors of early breastfeeding initiation in Benin. To determine the significant relationships, the data were reported as odds ratios (ORs) with 95% confidence intervals (CIs) and p-value 0.05. The prevalence of early initiation of breastfeeding among mothers was 56.0%. Early initiation of breastfeeding was lower among employed women (aOR = 0.80, 95% CI = 0.69-0.94), women who had caesarean section (aOR = 0.21, 95% CI = 0.16-0.28), those exposed to mass media (aOR = 0.85, 95% CI = 0.75-0.96) and women who received assistance at birth from skilled worker (aOR = 0.57, 95% CI = 0.46-0.71). The findings of this study showed that four in ten children miss early initiation of breastfeeding in Benin. The findings, therefore, call for the need for policymakers to shape existing programs and consider new programs and policies to help improve early initiation of breastfeeding practices in Benin. It is, therefore, recommended that information, education and communication programs targeting mothers who are less likely to practice early initiation of breastfeeding be formulated, implemented, and monitored accordingly by the Ministry of Health.

How is parental education associated with infant and young child feeding in Bangladesh? a systematic literature review

BACKGROUND

Education is expected to bring about positive behavioral changes which could lead to improved health behaviors. Parental education is a primary determinant of child health and development. However, some evidence showed inverse associations between high parental education and recommended infant and young child feeding (IYCF) in Bangladesh. How the association of parental education differs with specific IYCF components has not been reviewed. Therefore, the role of parental education on optimal IYCF practices in Bangladesh appears to be inconclusive. The objective of this review is to summarize how parental education is associated with IYCF practices in Bangladesh.

METHOD

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A systematic literature search was conducted in PubMed, Web of Science, Embase, and Google Scholar. Record searching, study selection, and data extraction was performed using Endnote online and Covidence tool, respectively. The Newcastle-Ottawa scale was used for quality assessment of the included studies.

RESULTS

Out of 414 initial hits, 34 studies were included for this review. Of the included studies, 32 were cross-sectional, one was a randomized controlled trial, and one was a retrospective cohort. Most of the studies (n = 24) were nationally representative whereas 10 studies had populations from district and sub-district level. Included studies considered different IYCF-related indicators, including breastfeeding (n = 22), complementary feeding (n = 8), both breastfeeding and complementary feeding (n = 2), both breastfeeding and bottle feeding (n = 1), and pre-lacteal feeding (n = 1). Parental education was found to be positively associated with complementary feeding practices. However, the role of parental education on breastfeeding, in general, was ambiguous. High parental education was associated with bottle-feeding practices and no initiation of colostrum.

CONCLUSION

Public health interventions need to focus not only on non- and/or low-educated parents regarding complementary feeding but also on educated mothers for initiation of colostrum and proper breastfeeding practices.

TRIAL REGISTRATION

This systematic review is registered to PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) with registration ID: CRD42022355465.

The trend in exclusive breastfeeding practice and its association with maternal employment in Bangladesh: A multilevel analysis

Exclusive breastfeeding (EBF) is essential for infant and child health. This study aimed to explore the trend in the EBF over the last decade in Bangladesh and investigated if there was a significant association with maternal employment by analyzing the data extracted from three consecutive nationally representative surveys: Bangladesh Demographic and Health Surveys (BDHS) of 2011, 2014, and 2017-2018. Prevalence of EBF (95% confidence interval) with the Cochran-Armitage test was reported to see the trend in EBF. A chi-square (χ²) test was applied to find the potential factors associated with EBF. Finally, a three-level logistic regression was utilized to find the significant association between maternal employment and EBF while adjusting other covariates. We observed no increase in the practice of EBF over the last decade (P = 0.632). The prevalence of EBF was 64.9% (95% CI: 61.41, 68.18) in 2011, followed by 60.1% (95% CI: 56.25, 64) in 2014, and 64.9% (95% CI: 61.82, 67.91) in 2017. Regression results showed that employed mothers had 24% (p < 0.05) lower odds of EBF than unemployed mothers. Early initiation of breastfeeding was also found to be significantly associated [Adjusted odds ratio (AOR): 1.22, P < 0.05] with EBF. Government and policymakers must come forward with new interventions to increase the practice of EBF, providing basic education and campaigns on the topic of EBF. Maternity leave should be extended up to 6 months of the child's age to achieve an optimal level of EBF.

Qualitative exploration of perceived barriers of exclusive breastfeeding among pregnant teenagers in the Greater Accra Region of Ghana

BACKGROUND

The World Health Organization endorses exclusive breastfeeding for the first six months of every child's life since exclusive breastfeeding has the potential of saving thousands of infants' lives. The global exclusive breastfeeding rate among mothers is sub-optimal. This predisposes infants born to teenage mothers to all types of ailments. Therefore, this study explored the factors that inhibit the practice of exclusive breastfeeding as perceived by pregnant teenagers in the Greater Accra Region of Ghana which is an urban area.

METHODS

The study used techniques in qualitative descriptive exploration to collect data from 30 pregnant teenagers through focus group discussions. Six focus group discussions were conducted and each group was made up of five participants. Informed consent was obtained from participants who were 18 years and above as well as parents of participants below 18 years while informed assent was obtained from participants below 18 years after purposive sampling. Interviews were audiotaped, transcribed and data were analysed through content analysis.

RESULTS

Two major themes and eight sub themes emerged from the data after analysis. Personal related barriers (negative emotional feelings, irrational thinking, perceived health risks to the baby and perceived self-inefficacy) and social related barriers (provider-client interaction, disapproval of exclusive breastfeeding by close relatives, unfriendly workplace policies and social myths) were the perceived factors that discouraged exclusive breastfeeding among teenage mothers.

CONCLUSION

Health professionals should be trained to provide culturally sensitive care to teenage mothers in order to promote exclusive breastfeeding. The media, religious leaders and politicians should help debunk misconceptions about breastfeeding expressed by participants in the study.

Barriers to breastfeeding are shaped by sociocultural context: an exploratory qualitative study in Bangladesh

Background

Breastfeeding practice is still not optimum in Bangladesh. Understanding barriers to breastfeeding is needed to prevent harmful practices. This study aimed to understand barriers to breastfeeding among infants and young children in Bangladesh.

Methods

This qualitative study was conducted in five rural sub-districts and one urban slum in Bangladesh. We conceptualized that barriers to breastfeeding can be broadly grouped into individual, society, and system level barriers. We conducted in-depth interviews with 33 breastfeeding mothers and 13 grandmothers of breastfed children (total n = 46 interviews). We observed 23 of these infants and young children being breastfed. These data were supplemented by 3 focus group discussions held with the children’s fathers. We managed the data using Atlas.ti software and analyzed the data thematically using an inductive approach.

Results

Important individual-level barriers perceived to influence breastfeeding included misconceptions about the adverse effects of breastfeeding on maternal health, nutrition and physical appearance, and lack of awareness of the value of breastfeeding among family members. Perceived society-level barriers included sociocultural norms, beliefs, and practices such as mother obliged to give more attention on household chores than breastfeeding to become a good housewife and feeding formula milk perceived as a symbol of parents’ financial solvency in the society. System-level barriers included attractive advertisements of breastmilk substitutes, and inadequate facilities and support processes in mothers’ work environments.

Conclusion

A range of barriers at individual, society and system level have important implications for infant and young children’s breastfeeding practices in Bangladesh. Development of interventions that address the range of barriers that many mothers face is essential to support breastfeeding practices. Potential interventions include strengthening information-giving during interaction between mothers and health workers on breastfeeding techniques, and engaging fathers and other “significant others” in counseling on breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41043-022-00312-y.

Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia

BACKGROUND

World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months of life. EBF has sustainable long-term health benefits for both infants and mothers. Despite its benefits, the practice of EBF in Ethiopia is lower than the internationally recommended one. This study aimed at identifying factors influencing EBF practice among under-6 month infants in Ethiopia.

METHODS

This study used data drawn from the 2019 Ethiopian Mini Demographic and Health Survey (2019 EMDHS) data. A multivariable logistic regression model was employed to investigate factors significantly associated with EBF practice among under-6 month infants in Ethiopia. An adjusted odds ratio with 95% confidence interval was used to measure the association of factors with EBF practice.

RESULTS

A total of 566 infants under the age of 6 months were included in the study. The prevalence of exclusive breastfeeding practice was 83% (95% CI: 79.70-86%). Urban residences (AOR: 0.40, 95% CI: 0.22-0.73), mothers having secondary education (AOR: 1.54, 95% CI: 1.29-1.84) and higher education (AOR: 3.18, 95% CI: 0.68-15.02), mothers having ANC visits of 1 to 3 times (AOR: 1.52, 95% CI: 1.24-1.88) and ANC visits of 4 and more times (AOR: 4.27, 95% CI: 1.06-17.25), family size of more than 5 (AOR: 0.45, 95% CI: 0.26-0.88), caesarean births (AOR: 0.63, 95% CI: 0.42-0.95), and deliveries at health facilities (AOR: 2.51, 95% CI: 1.12-5.63) were factors significantly associated with EBF practice among under-6 month infants.

CONCLUSION

In this study, EBF practice among under-6 month infants was significantly associated with place of residence, maternal educational level, ANC visits, family size, mode of delivery, and place of delivery. Therefore, encouraging ANC visit and promotion of institutional (health facility) delivery are recommended. Furthermore, special attention has to be given to mothers with no or less education to make them better aware of the EBF and its benefits to enhance exclusive breastfeeding practice.

Violations of International Code of Breast-milk Substitutes (BMS) in commercial settings and media in Bangladesh

The International Code of Marketing of Breast‐milk Substitutes (BMS) instituted to protect breastfeeding against unethical marketing, has been adopted by many countries, including Bangladesh. Despite national adoption, evidence suggests violations occur and inadequate BMS Code implementation is an issue. The study aimed to assess violations of the International BMS Code and the national ‘Breast‐milk Substitutes, Infant Foods, Commercially Manufactured Complementary Foods and the Accessories Thereof (Regulation of Marketing) Act, 2013’ of Bangladesh in commercial settings (retail outlets and media) in Bangladesh, for different types of milk, bottles, and teats using a standardized Network for Global Monitoring and Support for Implementation of the Code and Subsequent relevant World Health Assembly Resolutions (NetCode) protocol. This cross‐sectional quantitative study was conducted in Bangladesh from January to September 2018 in Dhaka, Chattogram, and Sylhet cities. Descriptive statistics were reported and χ² tests were conducted to assess differences between categorical variables of interest. Data were analysed using SPSS version 20. In retail outlets, there were higher proportion of violations observed in Dhaka than in Sylhet and Chattogram (p < 0.001). Significantly greater proportion of violations in product labels occurred among products sold without local distributors compared to others (p < 0.05); violations were higher among “other milk” for children aged 0 to <36 months compared to formulas and growing‐up milk (p < 0.05). Among media channels, internet clips had significantly higher proportions of violations compared to television, radio and newspaper (p < 0.001). BMS Code violations were prevalent in product labels and promotion of products through retail outlets. The study findings highlight the need for specific multisectoral strategies for better enforcement of BMS Code and points to the need for periodic assessment of Code violations.

This is the first known study documenting violations in retail outlets, online stores, and media using the standard NetCode protocol in Bangladesh.

BMS Code violations were high in retail stores and were more prevalent in the capital city compared to others.

Violations were significantly higher in the internet compared to radio, television, and newspapers, highlighting the need for strengthening the monitoring of internet‐based promotions.

It is essential to allocate resources to sensitize retail stores to the BMS Code to enhance the implementation of the law.

Attitudes and Views Concerning Human Milk Banking Among Mothers Residing in a Rural Region of Bangladesh

BACKGROUND

Human milk banks play an essential role by providing human milk to infants who would otherwise not be able to receive mother's milk.

STUDY AIM

To determine the opinions and attitudes among possible donor mothers regarding human milk banks in one rural region in Bangladesh.

METHODS

A prospective, cross-sectional study following a probability type of stratified cluster sampling technique was used. Included in the study (N = 121) were mothers aged 20-49 years, with at least one child, who was currently lactating or had breastfed her child, and who resided in the rural community of Bangladesh where the study was conducted. Data were collected through a 21-item, close-ended questionnaire and a face-to-face interview conducted by the researcher at each participant's home.

RESULTS

Among the participants, 98.3% (n = 119) said that they had not heard about human milk banks before speaking with the researchers. Most participants (71.9%, n = 87) said would obtain human milk from milk banks if necessary, but 28% (n =34) of mothers indicated that they would not receive milk from a milk bank, even if it was necessary for their children. Only 8.3% (n = 10) said human milk banks were not appropriate according to Islam and 99.2% (n = 120) did not know about the acceptance of human milk banking practices in Bangladesh.

CONCLUSIONS

For those with religious concerns, a framework for both the donors and recipients can be established. It can be recommended that health education through healthcare personnel (midwives, nurses, gynecologists, pediatricians, and other health professionals) and religious leaders may strengthen the belief and increase awareness among family members about milk banking practices.

Child Feeding Practices of Childbearing Mothers and Their Household Food Insecurity in a Coastal Region of Bangladesh

The current condition of ensuring WHO-recommended newborn and young child feeding practice is becoming a challenge in many developing nations, particularly in places where family food security is threatened. Because many households in underdeveloped nations frequently face acute food shortage due to poverty, optimal child nutrition is jeopardized. The purpose of this study was to analyze the child feeding behaviors of mothers with children aged 0-24 months and to investigate their household food insecurity in a coastal region of Bangladesh, Suborno Char (one of Noakhali District's coastal neighbourhoods) was studied from October 2019 to April 2020. In this study, a cross-sectional survey with multistage sampling technique was employed, and Suborno Char of Noakhlai district was purposely sampled of 400 women and their children aged 0-24 months. Data were obtained using a standard questionnaire and were analyzed using statistical functions in SPSS 20.0.0. Exclusive breastfeeding 53.5%, timely supplemental feeding 75.5%, and feeding children meals from homemade, canned/formula/fortified, both homemade and canned, milk these 4 food groups were at 22.2%. The moms' education level was strongly associated with their child feeding practices. Mothers from food insecure homes were less likely to exclusively breastfeed than mothers from food secure households after drawing interpretation of univariate & multivariate analysis of variables crude odds ratio (COR) and adjusted odds ratio (AOR) and confidence interval (CI) (COR .233 at 95% CI 0.083, .655 and AOR .478 at 95% CI 0.133, 1.713). Similar outcomes were seen for early complementary feeding and minimal dietary diversification of children. In conclusion, this study discovered a less dietary inclusion trend of child feeding practices among moms (0-24 months childbearing) in Bangladesh's coastal region.

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.

Prevalence and determinant factors of exclusive breastfeeding practices among mothers in Marrakesh province, Morocco: A cross- sectional survey

BACKGROUND: Exclusive breastfeeding is the best form of nutrition for infants during the first 6 months of life. Nevertheless, the practice of breastfeeding is currently declining throughout the world. OBJECTIVE: The objective of this study was to assess the prevalence of exclusive breastfeeding (EBF) practice and its associated factors among mothers living in Marrakesh province, Morocco. METHODS: The data were collected using an interviewer administered questionnaire. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with exclusive breastfeeding practice. RESULTS: Prevalence of exclusive breastfeeding was 50.2%. Mothers with age more than 30 years, residing in rural area, receiving counseling related breastfeeding during antenatal follow up and having knowledge about duration of breastfeeding were more likely to practice exclusive breastfeeding than their counterparts. CONCLUSION: Although the prevalence of breastfeeding in Marrakesh was higher than the last national survey report but it is still insufficient. These findings have to stress authorities and deciders to sensitize mothers and future mothers to increase exclusive breastfeeding practice notably through the involvement of health professionals.

Determinant of Mother's Health Promotional Measures Practice of Infant with Age 6-12 Months in a Tertiary Hospital of Nepal

Background

Promotion of health is vital for the optimal growth and development of every infant. Globally, many infants died due to common problems such as diarrhoea and respiratory infection; most of these problems are related to inadequate breast feeding, improper complimentary feeding, lack of immunization, and home accident. Infant and child health status depends upon mothers' knowledge and practice regarding health promotional measures. This study aimed to determine practice and its determinants regarding health promotional measures of infant with 6–12 months age amongst the mothers attending Pediatrics Outpatient Department of Universal College of Medical Science and Teaching Hospital, Bhairahawa, Rupandehi, Nepal.

Methods

Hospital-based cross-sectional study was conducted in Universal College of Medical Science, Bhairahawa, Rupandehi, Nepal, among 414 mothers attending pediatrics outpatient department from September 2019–March 2020. Purposive sampling technique was used to select mothers of infants aged 6–12 months. Bivariate analysis was used primarily to assess the association between dependent and independent variables. Variables which were associated in bivariate analysis with p < 0.05 were entered into a multivariable logistic regression model to identify associated factors of health promotional measures. The goodness of fit of multivariate logistic regression was checked by Nagelkerke R square and variation inflation factor.

Results

The mean age and family size was 25.89 ± 4.81 years and 5.94 ± 2.48, respectively. A total of 71.5% mothers have good practice of health promotional measures. Mothers from Dalit caste (adjusted odds ratio = 0.04, confidence interval: 0.005–0.30), mothers with below school leaving certificate education (AOR = 0.08, CI: 0.02–0.27), fathers engaged in nonagricultural work (AOR = 7.21, CI: 2.59–20.11), birth space of index child greater than 2 years (AOR = 12.88, CI: 3.49–47.58), and family monthly income greater than 20000 Nepalese rupees (AOR = 3.29, CI: 1.16–13.32 were significantly associated with good practice of health promotional measures.

Conclusions

More than one-fourth of the mothers have poor practice of health promotional measures. Ethnicity, mothers' education, fathers' occupation, birth space of index child, and family monthly income were found to be independent determinants of practice of health promotion measures. Thus, policy makers should provide specific education regarding health promotional measures to both parents.

Prevalence and Associated Factors of Early Cessation of Exclusive Breastfeeding Practice in Noakhali, Bangladesh: A Mixed-Method Study

PURPOSE

Though the benefits of exclusive breastfeeding (EBF) till the age of six months are unanimously perceived and ubiquitously accepted, there are several factors that impede this great practice all over the world, and Bangladesh is no exception.

DESIGN AND METHODS

A clinic-based, mixed-method, cross-sectional study was conducted to investigate the EBF practice and the possible causes of early cessation in Noakhali district, Bangladesh. The Kaplan-Meier survival curve with a log-rank test was used to compare the survival differences of recommended and observed EBF practices. The life table for EBF practice was also presented, and the multivariate cox proportional regression model was used to identify the predictors of EBF duration. Two focus group discussions were conducted to generate qualitative data on EBF cessation.

RESULTS

The mean duration of EBF was five months; only 30% of mothers did not complete EBF, and the cumulative survival curve showed a sharp fall after four months of breastfeeding. However, factors such as mother's advanced age (30 years or above; AHR: 0.376, 90% CI: 0.158-0.893) and low level of education increase the risk of the EBF cessation, while being housewife mothers, preceding birth interval of more than 2 years and living in urban areas decreases the risk of EBF termination. Perceived inadequacy of breast milk and some cultural norms were among the cessation factors revealed in qualitative analysis.

CONCLUSIONS

Although the completion rates of EBF practice seem to be high in this study population, some socio-cultural issues remain to be addressed, and further promotional efforts should be made to continue and improve the EBF practice.

Variation and determinants of early initiation of breastfeeding in high and low neonatal mortality settings in India

Early initiation of breastfeeding (EIBF) is considered one of the most cost-effective interventions for infant survival and well-being. This study aimed to examine the variations in, and determinants of, early initiation of breastfeeding among women in high and low neonatal mortality rate (NMR) settings in India using data from the fourth round of the National Family Health Survey conducted in 2015-16. At 35%, EIBF was found to be disproportionately low in the high NMR group of states compared with 52% in the low NMR group, with the national average being 44%. The chance of EIBF significantly increased if childbirth was vaginal, delivery took place in a health institution, the mother received breastfeeding advice and the birth was a planned one in both high and low NMR settings. In the high NMR group of states, the probability of initiating breastfeeding immediately after birth improved to a great extent if childbirth was assisted by a trained person and if the mother was exposed to any type of mass media. There is an urgent need to increase the access of mothers to breastfeeding advice during pregnancy and to increase their exposure to mass media, particularly in high NMR states. In addition, achieving universal access to institutional deliveries and deliveries assisted by a skilled birth attendant, especially in high NMR settings, and promoting early breastfeeding, especially in the case of Caesarean deliveries, would further improve the level of EIBF in the country as a whole. These interventions can potentially increase the prevalence of early initiation of breastfeeding and help India attain the neonatal mortality rate target of Sustainable Development Goal 3.

Antibiotic exposure among young infants suffering from diarrhoea in Bangladesh

AIMS

Appropriate rehydration has always been significant in treating diarrhoeal diseases in children. Irrational antibiotic use among diarrhoeal children has remained a major public health concern. Information regarding antibiotic use in young infants suffering from diarrhoea is very limited and a unique aspect of research. We aimed to investigate the prevalence of antibiotic use in the community among 2-6 months infants with diarrhoeal illnesses and having different nutritional status.

METHODS

We investigated a total of 5279 infants aged 2-6 months at Dhaka hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between September 2018 and June 2019. Among them, 257 infants were suffering from severe acute malnutrition (SAM). History of taking antibiotics was ascertained by direct observation of a prescription by a physician, the bottle of antibiotic or asking the caregiver about the name of antibiotic or its price that is very close to the usual market price of an antibiotic.

RESULTS

Overall, 52% of infants received antibiotics before hospital admission. Non-SAM infants had higher odds of receiving antibiotics (adjusted odds ratio [aOR] = 1.52, 95% confidence interval: 1.18, 1.97, P value = 0.003) compared to infants with SAM and use of antibiotics increased with age (aOR = 1.11, 95% confidence interval: 1.06, 1.17, P value<0.001). Commonly used antibiotics were azithromycin (13.3%), ciprofloxacin (7.7%), erythromycin (7.7%) and metronidazole (2.6%). The proportion of receiving ciprofloxacin was significantly lower in infants with SAM compared to their non-SAM counterparts (2.7% vs. 7.97%, P value = 0.004).

CONCLUSIONS

The study underscores the excessive use of antibiotics among diarrhoeal infants, which is already a major public health concern in low- and middle-income countries.

Clinical Profile, Severity Pattern and Socio-demographic Risk Factors of Acute Lower Respiratory Tract Infection (ALRTI) in Children in Enugu, Nigeria

Introduction:

Acute lower respiratory tract infection (ALRTI) is a major public health problem that causes significant morbidity and mortality and is the main reason for utilization of health services among children.

Obectives:

The study aimed to evaluate the clinical profile, severity pattern, and sociodemographic risk factors of ALRTI in hospitalized children under the age of five years in two tertiary hospitals in South East Nigeria.

Materials and Methods:

This is a cross-sectional study of children aged two months to five years in two teaching hospitals in the country. They were evaluated for ALRTI, focusing on their clinical profile and socio-demographic risk factors.

Results:

Two hundred children presented with features of ALRTI, mostly pneumonias and bronchiolitis. ALRTI occurred throughout the year with a peak in October. The majority had severe disease and risk factors for severity were infancy, type of ALRTI, presence of comorbidity and lack of measles vaccination or vitamin A supplementation, and exposure to wood smoke. Fast breathing was the most sensitive symptom, while breathlessness was the most specific for ALRTI.

Conclusion:

Bronchopneumonia and bronchiolitis are the most common ALRTI in under-five age children with bronchopneumonia occurring in severe forms. Poor breastfeeding, infancy, poor rate of immunization and exposure to biomass smoke are all risk factors for severity.

Trends and Determinants of EBF among Adolescent Children Born to Adolescent Mothers in Rural Bangladesh

Exclusive breastfeeding (EBF) has proven benefits for both mothers and infants; however, adolescent mothers have poor EBF practices globally. In Bangladesh, the practice of EBF among adolescent mothers remains unexplored. The aim of our study was to understand the EBF practices among adolescent mothers and their determinants in both the Health and Demographic Surveillance (HDSS) system areas of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) service area (ISA) and government service area (GSA) in rural Matlab, Bangladesh. For the purpose of our study, we collected relevant information from the database of the Health and Demographic Surveillance System (HDSS) of icddr,b and performed analysis to understand the trends and identify the determinants of EBF and identify the determinants of EBF among adolescent mothers living in two areas between 2007 and 2015. In total, 2947 children born to adolescent mothers were included in our final analysis. We used the Kaplan–Meier and the Cox-proportional hazards models to determine the differences in EBF practices in the two areas. We noted a lower trends of EBF in the ISA compared to the GSA in bivariate analysis. However, after adjusting for confounding variables, EBF status was 15% lower in the GSA than the ISA (HR: 0.85, 95% CI: 0.72–0.99). The father’s education was significantly different among the two populations. In both study areas, the coverage of EBF among adolescent mothers was lower than the national average (42% vs. 65%). Ensuring that adolescent mothers receive optimal care may improve EBF behavior.

Assessment of Exclusive Breastfeeding Practice and Associated Factors among Mothers in West Shoa Zone, Oromia, Ethiopia

BACKGROUND

The World Health Organization (WHO) recommends mothers worldwide to exclusively breastfeed infants for the child's first six months to achieve optimal growth, development, and health. Even though appropriate feeding practice is the most cost-effective intervention to reduce child morbidity and mortality, exclusive breastfeeding practices in developing countries are still low.

OBJECTIVE

The objective of the study was to assess exclusive breastfeeding practice and associated factors among mothers in West Shoa zone.

METHODS

Community-based cross-sectional study design was conducted from May to December 2018 in the West Shoa zone, Ethiopia, among 710 mothers with 6-9-month-old infants. The multistage stage sampling technique was employed. A pretested structured interviewer-administered questionnaire was used to collect the data. Epi Info version 7.1.2.0 was used to enter the data, and we transferred to SPSS version 25 for analysis. The association between factors and the exclusive breastfeeding were analyzed with bivariate and multivariate logistic regression.

RESULT

A total of 710 women were included with a response rate of 97.9%. The prevalence of unintended pregnancy was 38.7%, and only 65.35% of the respondents reported that they have exclusively breastfed for the first six months of their infant's life. Marital status (AOR 2.467 (1.333-4.564)), ANC visit (AOR 2.562 (1.250-5.252)), pregnancy intentionality (AOR 4.727 (3.217-6.945)), postnatal care clinic attendance (AOR 3.373 (2.293-4.963)), and counseling on exclusive breastfeeding AOR 2.544 (1.239-5.225) were the factors associated with exclusive breastfeeding. Exclusive breastfeeding practice is still low and actions need to be taken like educating the community about the importance of exclusive breastfeeding using every accessible media. Maternal health service centers should provide counseling and education for women about breastfeeding.

A Qualitative Exploration of the Determinants of Exclusive Breastfeeding (EBF) Practices in Wajir County, Kenya

Background

The World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya.

Method

This study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences.

Results

The exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding.

Conclusions

Deeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law’s and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.

Knowledge and practices of exclusive breastfeeding among mothers in rural areas of Rajshahi district in Bangladesh: A community clinic based study

BACKGROUND

World Health Organization (WHO) suggests that exclusive breastfeeding (EBF) is the best nutrition for the neonate. Still, it remains a big challenge to establish EBF not only in Bangladesh but also in any developing countries.

OBJECTIVE

The aim of this study was to determine the level of knowledge and practices on EBF and its relationship between different socioeconomic and demographic factors among mothers having at least one child of aged 6-12 months in the rural area of Rajshahi District, Bangladesh.

METHODOLOGY

A community clinic (CC) based study has been conducted by using semi-structured questionnaire. A total of 513 mothers having at least one child aged 6-12 months from 32 different CC in the rural area of Rajshahi District, Bangladesh during September to December 2015. A composite index, chi-square test, and logistic regression model were utilized in this study.

RESULTS

The prevalence of knowledge and practices on EBF were 34.5% and 27.9% among mothers having at least one child aged 6-12 months. From the analyses, mothers age of ≥21 years were (adjusted odds ratio (AOR) = 13.840, 95% CI: 7.394-25.904; p<0.001) times more likely to have knowledge on EBF and (AOR = 0.084, 95% CI: 0.050-0.143; p<0.05) times less likely to have practices of EBF compared to mother's age ≤20 years. Service holders mothers were (AOR = 9.992, 95% CI: 4.485-22.260, p<0.05) times more likely to have practices than that of house wife. Home delivery mothers was (AOR = 0.208, 95% CI: 0.111-0.389; p<0.05) times less likely to have practices of EBF than that of the hospital delivery mothers. Those mothers monthly family income ≥10,000 Bangladeshi taka (BDT) currency was (AOR = 0.092, 95% CI: 0.050-0.168, p<0.05) times less likely to have practices of EBF compared to their counterparts.

CONCLUSIONS

This study was found poor knowledge and practices on EBF. This study suggested that education and EBF related intervention could play an important role to increase good knowledge and practices on EBF among mothers. Malnutrition will be decreased if EBF was widely established in Bangladesh.

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.

The influence of ergonomic breastfeeding training on some health parameters in infants and mothers: a randomized controlled trial

Background

Breastfeeding is considered as a protective factor against non-communicable diseases in infants and mothers. The first aim of this study was to assess the influence of ergonomic breastfeeding training on the infants’ growth. The second aim was to investigate the effectiveness of this training for improving musculoskeletal disorders in mothers.

Methods

In this randomized control trial, 104 participants who were referred to the health centers in Shiraz for breastfeeding care were randomly allocated into the intervention or comparison group using a size-four block sampling method. At birth, 2, 4, and 6 months later childbirth, Rapid Upper Limb Assessment was used to assess musculoskeletal disorders in participants, and the severity of their discomfort was measured with the Visual Analog Scale. During the 6 months of the study (March to September, 2017), the weight and height of the neonates were measured every 2 months.

Results

Significant differences were found between groups in the priority level for corrective action in mothers’ postures determined by Rapid Upper Limb Assessment at 2, 4 and 6 months after childbirth (p < 0.001). Based on the Visual Analog Scale results in mothers at 6 months after childbirth, fewer back pain was reported by the intervention group (p = 0.03). No significant difference were found in the infants^’ weights and heights in boys and girls at all growing stages between the two study groups (p > 0.05). However, the mean height for age of the girl infants at age of 6 months was higher among intervention groups compared to the controls (p = 0.01).

Conclusion

This study demonstrated that ergonomic breastfeeding training reduced the incidence of musculoskeletal disorders in mothers but seems not to have any significant and consistent impact on the infants’ growth.

Trial registration

fa.irct.ir IRCT2014042317398N1.

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.

Exclusive breastfeeding among Saudi mothers: Exposing the substantial gap between knowledge and practice

Background:

Rates of exclusive breastfeeding are exceedingly low in the Arabic world. This study aims to estimate the local prevalence of, and knowledge about, exclusive breastfeeding in Saudi Arabia.

Method:

This is a cross-sectional survey of mothers of infants aged 6–12 months who attended Taif-based “well-baby clinic.” A structured questionnaire was developed to explore predictors of, and participants’ knowledge about, exclusive breastfeeding.

Results:

Participants in the study were 202 mothers. The rate for initiation of breastfeeding in the first hour after childbirth was 13.9%. The prevalence of exclusive breastfeeding was 16.3%. Knowledge level was great among participating mothers as 65.3% of mothers scored over 75% of the total knowledge score and 95% got more than half of the questions right. Only having 3–6 children (P = 0.023) and 1-year interpregnancy interval (P = 0.005) were associated with the positive likelihood of exclusive breastfeeding. Baby age (P = 0.0218), birth in a private facility (P = 0.00843), and university education (P = 0.0131) were associated with better knowledge.

Discussion and Conclusion:

Rates of exclusive breastfeeding practice are low in Saudi Arabia despite adequate knowledge about its benefits and necessity.

Effects of Early Initiation of Breastfeeding on Exclusive Breastfeeding Practices of Mothers in Rural Haiti

INTRODUCTION

Rates and relationships of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) of mothers in rural Haiti were examined. Prelacteal and complementary feedings were identified.

METHODS

With a cross-sectional descriptive design, survey data from mothers (N = 195) were collected at three intervals after birth. Data were analyzed for indicators of EIBF, EBF, and complementary feedings.

RESULTS

Overall, 148 (75.9%) mothers reported EIBF, and 75 (38.5%) reported EBF. EIBF was associated with EBF, with an adjusted relative risk 1.35 (95% confidence interval = [0.84, 2.18]). Several nutritive and nonnutritive substances interrupted EBF during the first 6 months of life.

DISCUSSION

Haiti has an under-five mortality rate of 67.0/1,000 live births, exceeding the mean of 46.5/1,000 live births for developing regions. Both EIBF and EBF are associated with decreased neonatal and early infant mortality. Country-specific data are needed to inform and develop breastfeeding initiatives and community-level campaigns to improve the prevalence of EIBF and EBF in Haiti.

Association Between Stressful Life Events and Exclusive Breastfeeding Among Mothers in the United States

Background: Despite the known benefits of breastfeeding, many women in the United States do not exclusively breastfeed for the recommended 6 months due to various factors. Limited studies have examined the association between prenatal stressful life events and exclusive breastfeeding duration. The aim of this study was to examine the association between prenatal stressful life events and exclusive breastfeeding duration for 3 months among mothers in the United States. Materials and Methods: We analyzed data from 2009 to 2011 (Phase 6) Pregnancy Risk Assessment and Monitoring System (PRAMS; n = 43,934). Multivariable logistic regression analyses were performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: Overall, 43% of the study participants exclusively breastfed for 3 months and 52.1% reported having no stressful life events during pregnancy. In the multivariable model, there was a statistically significant interaction between maternal age and number of stressful life events on 3-month exclusive breastfeeding, the odds of exclusive breastfeeding for 3 months were lower among women ≤24 years old who experienced at least ≥2 stressful life events compared with women who did not experience any stressful life events: OR 95% CI 0.80 (0.66-0.98) for 1-2 stressful life events, 0.67 (0.54-0.82) for 3-5 stressful life events, and 0.58 (0.43-0.80) for ≥6 stressful life events, respectively. Conclusions: Identification of stressful life event exposure among young mothers is important for extending support toward this population to increase exclusive breastfeeding duration.

Predicting Exclusive Breastfeeding among Iranian Mothers: Application of the Theory of Planned Behavior Using Structural Equation Modeling

BACKGROUND

Identifying the factors that lead to the beginning, continuing, or stopping the Exclusive Breastfeeding (EBF) by mothers can be of great assistance in the design of interventions to strengthen this behavior. The aim of this study was to predict EBF among mothers with Infants Less than Six Months of Age (ILSMA) according to the Theory of Planned Behavior (TPB).

MATERIALS AND METHODS

The study was a cross-sectional one that conducted among 304 mothers with ILSMA in Khorramabad-Iran in 2017 using Structural Equation Modeling (SEM). The sampling method was a combination of census, stratified random, and systematic random sampling. The data collection tool was a contextualized, valid, and reliable questionnaire according to the TPB. Data were collected by a trained interviewer. Data were analyzed using SPSS-16 and AMOS-20 software programs and SEM.

RESULTS

Perceived Behavioral Control (PBC) could explain 65% of mothers' EBF intention. Intention and PBC were able to predict 79% of the variance in EBF together. The fitness indices of EBF model in the current study were acceptable (RMSEA = 0.07, CMIN/DF = 2.58, NFI = 0.81, CFI = 0.87, and GFI = 0.83).

CONCLUSIONS

TPB is an appropriate model for predicting the intention and behavior of EBF. Policy makers and health system managers are recommended for taking some measures to add a standardized questionnaire in the electronic health record to predict EBF according to TPB of pregnant women and mothers with ILSMA. In this way, they can empower primary healthcare providers to design and implement a theory-based interventional plan.

Determinants of exclusive breastfeeding among mothers of infants aged 6 to 12 months in Gwanda District, Zimbabwe

Background

In 2016, 98% of children in Zimbabwe received breastmilk, however only 40% of babies under six months were exclusively breastfed 24 h prior to data collection. A 2014 survey revealed that Matabeleland South Province had the country’s highest starvation rates and food insecurities were rife. This study aimed at investigating maternal, infant, household, environmental and cultural factors influencing exclusive breastfeeding (EBF) practice in Gwanda District.

Methods

A cross-sectional study was conducted from January to March 2018. Interviews used pretested structured questionnaires for 225 mothers of infants aged between six and twelve months at immunization outreach points and health facilities. Descriptive statistics, bivariate and multivariate analysis estimated the association between the dependent and independent variables. Exclusive breastfeeding was defined as feeding an infant on breast milk only from birth up to the age of six months.

Results

The majority of mothers (n = 193; 89%) had knowledge about EBF and 189 (84%) expressed a positive attitude towards the practice, however, only 81 (36%) practiced exclusive breastfeeding. The most common complementary food/fluid given to the infants was plain water (n = 85; 59%). Predictors for EBF were: maternal Human Immuno-deficiency Virus positive status (Odds Ratio [OR] 0.30; 95% Confidence Interval [CI] 0.17, 0.56) and being economically independent (OR 0.41; 95% CI 0.21, 0.79). Barriers to practicing EBF were: being a young mother under 25 years of age (OR 3.05; 95% CI 1.67, 5.57), having one or two children (OR 2.49; 95% CI 1.29, 4.79), living in less than two rooms (OR 3.86; 95% CI 1.88, 7.93) and having a baby of low birthweight (OR 1.05; 95% CI 0.40, 2.71). After multivariate analysis, only the mother’s economic independence was associated with practicing EBF (Adjusted OR [AOR] 0.83; 95% CI 0.30, 0.92). Key informants identified traditional family practices as the major barrier to EBF.

Conclusion

The exclusive breastfeeding rates were low despite the mothers’ high knowledge levels and positive attitudes towards the practice. In addressing the multiple factors influencing the cost effective practice, there is need to channel supportive measures through a system-wide approach. This can be achieved by realigning breastfeeding policy directives as well as community attitudes and values towards the exclusive breastfeeding.

Impact of Routine Counseling on Breastfeeding Status in Hospitalized Infants Below 6 Months: Observation From a Large Diarrheal Disease Hospital in Bangladesh

Background. Breastfeeding counseling (BFC) plays a crucial role in improving infant and young child feeding practices. To evaluate the impact of activities of BFC unit (BFCU) on breastfeeding practices of infants who were hospitalized for diarrheal illness through their regular counseling, assistance and support, and motivation. Methods. In this retrospective chart analysis conducted at Dhaka Hospital of icddr,b using an electronic database, data were collected from mothers of infants younger than 6 months of age who visited the BFCU from 2011 to 2015. Results. Among a total of 3420 infants enrolled during study period, 429 (12.5%) were predominantly breastfed, 2457 (71.8%) partially breastfed, 531 (15.5%) non-breastfed, and 3 (0.1%) exclusively breastfed (EBF) at home. Through counseling of BFCU (following 24-hour recall technique), 2212 (65%) infants became EBF and 1186 (35%) failed to be EBF during discharge. Logistic regression analysis after adjusting for potential covariates, such as maternal age <18 years and receiving breast milk with other liquid at home, revealed that infants having severe underweight, maternal perception of “baby does not suck,” and “there is not enough milk” were less likely to be associated with EBF during discharge. Among 531 non-breastfed infants, 455 (85.7%) became partial breastfeeding and only 23 (4.3%) became EBF. Conclusion. Counseling of mothers even during acute illness of infants in the hospital can help promote breastfeeding. Therefore, there is great importance of robust counseling on breastfeeding practices and may help establish re-lactation of acutely ill babies.

Reasons for formula feeding among rural Bangladeshi mothers: A qualitative exploration

In Bangladesh the exclusive breastfeeding rate remains low and prelacteal, formula and bottle feeding is increasing. This study aims to explore reasons behind infant formula feeding practices from mothers, caregivers, and health care provider's perspective. This was a qualitative study carried out in four sub-districts of Sylhet and Jessore of rural Bangladesh. Data were collected through focus group discussions (12), in-depth interviews (4) and key informant interviews (12) from January to February 2014. The qualitative data collected and were analyzed using thematic content analysis. This study clearly showed the factor behind formula feeding by Bangladeshi rural women. One of the major findings was that women could not differentiate between formula and other milk. Main differences between formula and powder milk were the type of consumer where formula only was taken by infant and children less than 2 years. Other major reasons include; poor breastfeeding practices, lack of appropriate breastfeeding practices, superficial knowledge on harmful effect on infant formula; perceived insufficient breast milk production, the influence of family and society and authoritarian power of hospital staff. Rural mothers have intension to feed infant formula to their infants due to various factors including individual, social, cultural and institutional. These identified factors can contribute to policy making and develop more specific interventions targeting expected mother and their family members that can contribute to stop formula feeding and increase breastfeeding practices in rural Bangladesh.

Predictors of exclusive breastfeeding across three time points in Bangladesh: an examination of the 2007, 2011 and 2014 Demographic and Health Survey

Background

The objective of this study was to explore predictors of exclusive breastfeeding (EBF) in Bangladesh using data from 2007, 2011 and 2014, specifically focusing on potential reasons why rates of EBF changed over those time periods.

Methods

Data on mother/infant pairs with infants <6 months of age were examined at the three time points using the Bangladesh Demographic and Health Survey. The EBF prevalence, changes in EBF since the previous survey and determinants of EBF at each time period were examined using t-tests, χ² and multilevel logistic regression.

Results

The prevalence of EBF was 42.5, 65 and 59.4% in 2007, 2011 and 2014, respectively. The age of the child was significantly associated with EBF across all time points. The largest changes in EBF occurred in the 3- to 5-month age group. Predictors of EBF in this specific age group were similar to overall predictors (e.g. age of the child and region). Participation of the mother in household decisions was a significant predictor in 2014.

Conclusions

EBF prevalence in Bangladesh increased between 2007 and 2011 and then decreased between 2011 and 2014. The increase in 2011 may have been the result of widespread initiatives to promote EBF in that time frame. Due to the unexplained decrease in EBF between 2011 and 2014, there is still a need for interventions such as peer counselling, antenatal education and community awareness to promote EBF.

Initiation and continuation of breastfeeding among Jordanian first-time mothers: a prospective cohort study

Objective

This study aimed to examine the rates of initiation and continuation of breastfeeding (BF) and their relationship with mothers' sociodemographic, obstetric, neonatal, and medical interventions.

Methods

Data were collected from 199 first-time Jordanian mothers using medical records, face-to-face interviews within 24 hours of birth, and two telephone interviews at 6 weeks and 6 months after birth.

Results

The rate of BF initiation within the first 4 hours after birth was only 13%. The rate of exclusive BF at 6 weeks was 25.5%, and this rate dropped to 2.1% at 6 months. Mothers who initiated BF before discharge were older, were employed, had normal vaginal birth, and had undergone antenatal or after-birth BF education. Infants' birth weight or gender was not interrelated with BF initiation. There was no relationship between initiation and continuation of BF and use of medications for labor pain or for induction/augmentation. The only significant relationship was found between the dose of ergometrine and BF failure and painful BF at 6 weeks.

Conclusion

There is a need for increasing health care providers and public awareness about the role of intrapartum medications and procedures on the initiation and continuation of BF at 6 weeks and 6 months after birth.

Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka's slums: a mixed method study

Background

Despite the substantial impact on child and maternal health, breastfeeding practices for infants remain at the suboptimum level in Bangladesh. Yet the understanding of why these practices are suboptimal, especially surrounding urban slum dwelling mothers, is unclear. The purpose of this study was to assess early infant feeding practices, examine associations with maternal factors, and uncover the facilitators and barriers to early feeding practices in selected slums of Dhaka, Bangladesh.

Methods

A mixed method study was conducted from June to September 2016 using both quantitative and qualitative methods among mothers with children under the age of 6 months. The survey included 342 mother-infant pairs and 18 in-depth interviews were conducted. Univariate and multiple logistic regression was used to determine status of early infant feeding practices and factors associated with exclusive breastfeeding (EBF) within the previous 24 h. Transcripts were coded to uncover the facilitators and barriers surrounding early infant feeding practices.

Results

Sixty four percent (220/342) of mothers initiated breastfeeding within 1 h, 96.5% (330/342) reported feeding colostrum, and 36.3% (124/342) infants were EBF in the last 24 h. After adjusting for child gender, maternal age, education, diet and household income; infant’s age (adjusted odds ratio (AOR) for 61–120 days 6.42; 95% CI 3.42, 12.1; AOR for 121–180 days 45.6; 95% CI 18.33, 113.45), prelacteal feeding (AOR 2.53; 95% CI 1.14, 4.58), lack of planning for EBF during pregnancy (AOR 4.06; 95% CI 1.09, 15.12) and infants delivered by cesarean section (AOR 2.76; 95% CI 1.34, 5.67) were negatively associated with EBF. During the 18 interviews, eight mothers reported a cesarean delivery and none of these mothers initiated breastfeeding within 1 h or exclusively breastfed. Moreover, all eight mothers gave their infants prelacteal feeds.

Conclusions

The status of early infant feeding practices in Dhaka’s slums was poor. The negative impact of cesarean section on all early infant feeding practices was evident in both quantitative and qualitative analysis.

Fecal Indicator Bacteria along Multiple Environmental Transmission Pathways (Water, Hands, Food, Soil, Flies) and Subsequent Child Diarrhea in Rural Bangladesh

Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. We aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. We measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0-60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea (3 or more loose stools in a 24-h period) was positively associated with the concentration of E. coli on child hands measured on the first visit (incidence rate ratio [IRR] = 1.23, 95% CI 1.06, 1.43 for a log₁₀ increase), while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. Our findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh.

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.

Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh

This study aimed to evaluate the impact of peer counselling on early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) rates for mother-infant pairs living in urban slums, Dhaka, Bangladesh. This randomized controlled trial enrolled 350 mother-infant pairs from selected slums between September 2014 and July 2016. The women assigned to intervention group received peer counselling from locally recruited, trained community female volunteers starting in third trimester of pregnancy until 6 months after delivery; control group received no intervention. EIBF, any liquids given after birth, and EBF were compared between groups. Follow-up was scheduled at enrolment, following childbirth, and every 2 months up to 6 months after delivery. Multiple logistic regressions were used to assess the effect peer counselling and other associated factors on EIBF and EBF practices. EIBF rate was higher in the intervention group than in the control group (89.1% vs. 77.4%, p = .005). More mothers in intervention group were exclusively breastfeeding at 5 months than mothers in the control group (73% vs. 27%, p < .005). Control mothers were twice as likely to not practice EIBF compared with intervention mothers (adjusted odds risk [aOR]: 2.53, CI [1.29, 4.97], p = .007). Overall, caesarean section was associated with an 8.9-fold higher risk of not achieving EIBF (aOR: 8.90, CI [4.05, 19.55], p < .001). Intervention mothers were 5.10-fold more likely to practice EBF compared with control mothers (aOR: 5.10, CI [2.89, 9.01], p < .001) at 5 months. This study demonstrates peer counselling can positively influence both EIBF and EBF among mothers living in urban area.

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.

Only half of the mothers practiced early initiation of breastfeeding in Northwest Ethiopia, 2015

Background

Early initiation of breastfeeding has been well-recognized in reducing neonatal mortality; however, it remains sub-optimal in Ethiopia. This study therefore assessed the prevalence of early initiation of breastfeeding and associated factors among mothers with children aged 6–24 months in Dabat Health and Demographic Surveillance System (HDSS) site, northwest Ethiopia, where literature on the issue is markedly scarce.

Methods

This community-based cross-sectional survey was carried out from May to June, 2015, at Dabat HDSS site, Dabat District. Eight hundred twenty-two mother–child pairs were included in the study. A multivariable logistic regression model was employed to identify factors associated with early initiation of breastfeeding.

Results

This study demonstrated that the prevalence of early initiation of breastfeeding was 53.3%. Institutional delivery (AOR = 4.9; 95% CI 3.2, 7.4), higher Infant and Young Child Feeding (IYCF) knowledge (AOR = 2.3; 95% CI 1.6, 3.3), higher wealth status (AOR = 4.1, 95% CI 2.8, 6.0) and low fathers’ education (AOR = 0.3, 95% CI 0.2, 0.6) were significantly associated with early initiation of breastfeeding in the multivariate analysis.

Conclusion

In summary, the coverage of early initiation of breastfeeding in Dabat HDSS site was low, considerably below the national target. Therefore, efforts should be intensified to step-up early initiation of breastfeeding by focusing on the identified determinants.

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications

OBJECTIVE

Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low- and middle-income countries and discuss implications for programmes.

DESIGN

A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF.

SETTING

Low- and middle-income countries.

SUBJECTS

Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review.

RESULTS

Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h post-delivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from cross-sectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF.

CONCLUSIONS

Improving the counselling skills of health workers to address breast-feeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low- and middle-income countries.

Factors Influencing Exclusive Breastfeeding in Tabuk, Saudi Arabia

Background:

Breast milk contains all the nutrients infants need for their first 6 months of life. However, only a minority of Saudi Arabian mothers exclusively breastfeed, so the influencing factors must be examined to encourage more to do so. The study aimed to determine the prevalence of exclusive breastfeeding at 6 months and its associated factors in Tabuk, North West Saudi Arabia.

Methods:

A total of 589 mothers of healthy infants aged between 6 and 24 months were interviewed while attending Well-Baby Clinics within 5 primary health care centers. Interviews deployed a structured questionnaire to collect sociodemographic information and detailed data concerning breastfeeding practices. A logistic regression analysis was then performed on the data to identify the factors independently associated with exclusive breastfeeding practice for infants at 6 months.

Results:

Exclusive breastfeeding was practiced by 31.4% of mothers for the first 6 months of their infant’s life. The logistic regressions indicated that exclusive breastfeeding at 6 months was less likely to be practiced by working mothers, Saudi nationals, and for babies born via cesarean delivery or at low birth weights. Conversely, the mother’s awareness of the recommended exclusive breastfeeding duration was positively associated with exclusive breastfeeding.

Conclusions:

Programs promoting 6 months of exclusive breastfeeding should target high-risk groups. Two factors identified by this study are modifiable: working mothers and mothers’ awareness of the exclusive breastfeeding duration recommendation. Strategies to improve exclusive breastfeeding rates should therefore focus on workplace facilities and increasing awareness of the exclusive breastfeeding recommendation.

Exclusive breastfeeding practice and associated factors among mothers in Motta town, East Gojjam zone, Amhara Regional State, Ethiopia, 2015: a cross-sectional study

Background

Exclusive breastfeeding means babies are given only breast milk and nothing else: no other milk, food, drink, not even water for one day (24 hrs) before the survey was conducted. It prevents 13% of childhood mortality; i.e, at least 1.2 million children worldwide would be saved every year. The objective of this study was to assess the prevalence exclusive breastfeeding (EBF) practice and its associated factor among mothers who have infants less than six months of age in Motta town, East Gojjam, Amhara Regional State, Ethiopia.

Method

A community based quantitative cross-sectional study was conducted from April 7, 2015 to May 7, 2015. A simple random sampling technique was applied after taking all registered mothers who have infants less than six months old from local health extension workers of each kebele. A total of 423 mothers with infant less than six months old were included in this study.

The data was collected using an interviewer administered questioaire. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with exclusive breastfeeding practice.

Result

Prevalence of exclusive breastfeeding was 50.1%. Mothers with young infants aged 0-1 month (Adjusted Odds Ratio [AOR] 3.86: (1.64, 9.07), unemployed mothers (AOR 3.01: 1.46, 6.20), low income mothers (AOR 3.61: 1.75, 7.45), mothers who received breastfeeding counseling in pregnancy (AOR 2.76: 1.52, 4.99), fed colostrum (AOR 3.50: 1.45, 8.45), didn't give prelacteal feeds (AOR 4.48: 1.82, 11.03) and were supported by their husband (AOR 2.67: 1.04, 6.95) were more likely to practice exclusive breastfeeding than their counterparts.

Conclusions

Prevalence of exclusive breastfeeding practice in study area was lower than country recommended level. Age of the child, maternal occupation, income, breastfeeding counseling during antenatal care, husband support of breastfeeding and colostrum feeding were independent predictors of exclusive breastfeeding practice. Recommendations to increase exclusive breastfeeding practice are revising postpartum maternity leave, increasing health professional's habit of breastfeeding counseling through training, involving husbands during counseling, educating mothers and the community as a whole to avoid traditional practices that hinder exclusive breastfeeding up to six months.

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.

Early newborn ritual foods correlate with delayed breastfeeding initiation in rural Bangladesh

Background

Early and exclusive breastfeeding may improve neonatal survival in low resource settings, but suboptimal breastfeeding still exists in areas with high infant mortality. Prelacteal feeding, the practice of giving a non-breastmilk food as a neonate’s first food, has been associated with suboptimal breastfeeding practices. We examined the association of feeding a non-breastmilk food in the first three days of life (early neonatal food, or ENF) with time from birth to initiation of breastfeeding among 25,286 Bangladeshi mother-neonate pairs, in a secondary analysis of a randomized controlled trial in northwestern rural Bangladesh conducted from 2001–2007.

Methods

Trained interviewers assessed the demographic characteristics during pregnancy. At three months postpartum, the interviewers visited participants again and retrospectively assessed demographic and breastfeeding characteristics surrounding the birth. We assessed the relationship between ENF and time to initiation of breastfeeding in hours in both unadjusted and adjusted linear regression analyses. We also calculated reverse cumulative distribution curves for time to initiation of breastfeeding and analyses were stratified by an infant’s ability to breastfeed normally at birth.

Results

The mean ± SD time from birth to initiation of breastfeeding was 30.6 ± 27.9 hours. Only 2,535 (10.0%) of women reported initiating breastfeeding in the first hour after birth and 10,207 (40.4%) reported initiating breastfeeding in the first 12 hours after birth. In adjusted linear regression analyses, feeding ENF was associated with a significant increase in time, in hours, to breastfeeding initiation both among children not able to breastfeed at birth (37.4; 95% CI 33.3, 41.5) and among children able to breastfeed at birth (13.3; 95% CI 12.7, 14.0).

Conclusions

Feeding ENF was strongly associated with delayed initiation of breastfeeding, even after adjusting for other related factors and stratifying on the neonate’s ability to suckle normally after birth. More research is needed to understand the impact of these findings on optimal breastfeeding in this setting. It is possible that ENF feeding and the ability to breastfeed immediately after birth are interrelated in their respective associations to suboptimal breastfeeding initiation. This study in a large population representative of other populations in rural South Asia, demonstrates significantly longer times to breastfeeding initiation than previously appreciated, with a possible important role of ENF feeding.

Trial registration

The randomized controlled trial on which this analysis is based, “Impact of Maternal Vitamin A or Beta-Carotene Supplementation on Maternal and Infant Mortality in Bangladesh”, was registered with ClinicalTrials.gov as trial number ID GHS-A-00-03-00019-00 and identifier NCT00198822. The identifier was first received September 12, 2005 (retrospectively registered). The first participant was enrolled in August 2001.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0090-9) contains supplementary material, which is available to authorized users.