Abstract
BackgroundDeterminants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. The present study aimed to identify factors associated with discontinuation of EBF in a municipality in northeastern Brazil, including variables that have received little or no attention in previous literature.MethodsThis cohort study involved 1,344 mother-child pairs selected from maternity hospitals in Feira de Santana, Bahia, Brazil. Subjects were followed up for 6 months through monthly home visits, and discontinuation of EBF was recorded. Possible determinants were tested using Cox’s four-level hierarchical survival model, taking into consideration the temporal proximity of the predisposing factors to interruption of EBF. Median duration of EBF was estimated using Kaplan-Meier’s survival curve.ResultsMedian duration of EBF was 89 days. Out of the 19 variables tested, 9 showed an association with EBF cessation; of these, two had never been evaluated in Brazilian studies, namely, mother partner’s appreciation for breastfeeding (hazard ratio [HR] 0.62; 95% confidence interval [95% CI] 0.48-0.79) and limiting the number of nighttime feeds at the breast (HR 1.58; 95% CI 1.11-2.23). Another two variables that had been previously evaluated, but had never been described as determinants of discontinuation of EBF showed association: presence of cracked nipples (HR 2.54; 95% CI 2.06-3.13) and prenatal care provided by public services (HR 1.34; 95% CI 1.17-1.55). Other variables showing associations with the outcome were: guidance on breastfeeding received at the hospital (HR 0.80; 95% CI 0.68-0.92), birth in a Baby-Friendly Hospital (HR 0.85; 95% CI 0.73-0.99), less than or equal to 8 years of maternal schooling (HR 1.34, 95% CI 1.17-1.53), mother working outside the home (HR 1.73; 95% CI 1.53-1.95), and use of a pacifier (HR 1.40; 95% CI 1.14-1.71).ConclusionsThe study confirmed that the factors associated with EBF duration are multiple, variable, and dependent on the population being evaluated. Characteristics that had never been previously evaluated or described, at least in Brazilian studies, behaved as determinants of EBF in the present study, and thus allow to expand the existing list of factors determining this practice.
Highlights
Determinants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations
Considering that the determinants of EBF differ among populations and that it is important to improve our knowledge of these determinants in order to plan actions aimed at increasing the duration of EBF, the objective of the present study was to identify factors associated with early EBF cessation in a city located in northeastern Brazil, including variables that have received little or no attention in previous literature
Mother partner’s appreciation for breastfeeding, mother working outside the home, mother’s limiting nighttime feeds at the breast, presence of cracked nipples, and use of a pacifier were the variables selected from model 4
Summary
Determinants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. Despite the scientific evidence recommending exclusive breastfeeding (EBF) for the first 6 months of life [2], this practice has low prevalence worldwide [3,4,5,6,7], including in Brazil [8,9]. There is great variability in the duration of EBF in the 27 Brazilian capitals: results range from 0.7 day in a capital of the central-western region to 88.8 days in one of the northern region [8]. This variation probably reflects the multifactorial nature of breastfeeding, regulated by biological, psychological, socioeconomic, ethical, and cultural factors. There is a need to improve our knowledge of the factors with the greatest influence on the prevalence of breastfeeding in different localities
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