Behavior Change Communication and Breastfeeding Practices Measured by Deuterium-Oxide Turnover Method Among Infants Aged 4-5 Months in Rural Senegal

Abstract

Breastfeeding promotion is widely recognized as one of the most cost-effective investments in promoting optimal child health, growth, and development. Several studies have shown that breastfeeding education and counseling interventions have a significant impact on improving breastfeeding practices, including exclusive breastfeeding (EBF) rates. However, very few studies have evaluated the association between breastfeeding education and infant breast milk intake. The objective of this study was to assess the contribution of behavior change communication provided by the Nutrition Enhancement Program (NEP) on improving infant breast milk intake and breastfeeding practices. A comparative cross-sectional study was conducted in 12 Local Communities in rural Senegal, of which 6 were located in the NEP intervention area and the remaining, in the non-intervention area. Breast milk intake and EBF were measured using the deuterium dose-to-mother isotope dilution (DTM) in 140 mother-infant (4-5 mo.) pairs. Breastfeeding and complementary feeding practices were also assessed by questionnaire. Student's t-test, ANOVA, chi-square test and McNemar test were used to compare means and percentages. A mixed model linear regression was performed to identify the associated factors of breast milk intake, measured by DTM. Breast milk intake was significantly higher in infants from the NEP area (994.7 ±197.3 g/d), compared to those from the non-NEP area (913.6 ± 222.8) g/d), p=0.023. Consumption of water from sources other than breast milk was not different between the groups. EBF rates measured by DTM were 37.0% and 28.4% in the NEP area and the non-NEP area, respectively. There was no difference on exclusive breastfeeding rate between the two areas regardless of evaluation method. Stunting and wasting were associated with lower milk intake of 107.1 g/d and 211.9 g/d, respectively. Mothers' participation in behavior change communication activities improved infants' breast milk intake, but not EBF rates. Lower breast milk consumption was associated with stunting and wasting.