Abstract
We report the infant feeding experiences in the first month of life for 2,053 infants participating in “Malnutrition and Enteric Infections: Consequences for Child Health and Development” (MAL-ED). Eight sites (in Bangladesh, India, Nepal, Pakistan, Brazil, Peru, South Africa, Tanzania), each followed a cohort of children from birth (by day 17), collecting detailed information on infant feeding practices, diet and illness episodes. Mothers were queried twice weekly regarding health status, breastfeeding and the introduction (or no) of non-breast milk liquids and foods. Here, our goal is to describe the early infant feeding practices in the cohort and evaluate factors associated with termination of exclusive breastfeeding in the first month of life. With data from enrollment to a visit at 28-33 days of life, we characterized exclusive, predominant or partial breastfeeding (using a median of 6-9 visits per child across the sites). Only 6 of 2,053 infants were never breastfed. By one month, the prevalences of exclusive breastfeeding were < 60% in 6 of 8 sites, and of partial breastfeeding (or no) were > 20% in 6 of 8 sites. Logistic regression revealed that prelacteal feeding (given to 4-63% of infants) increased the likelihood of partial breastfeeding (Odds Ratio (OR): 1.48 (95% confidence interval (CI): 1.04, 2.10), as did the withholding of colostrum (2-16% of infants) (OR: 1.63:1.01, 2.62), and being a first-time mother (OR: 1.38:1.10, 1.75). Our results reveal diversity across these sites, but an overall trend of early transition away from exclusive breastfeeding in the first month of life. Interventions which introduce or reinforce the WHO/UNICEF Ten Steps for Successful Breastfeeding are needed in these sites to improve breastfeeding initiation, to reinforce exclusive breastfeeding and delay introduction of non-breast milk foods and/or liquids.Electronic supplementary materialThe online version of this article (doi:10.1186/s41043-015-0004-2) contains supplementary material, which is available to authorized users.
Highlights
Overwhelming clinical and epidemiological evidence supports international recommendations for initiation of breastfeeding shortly after birth, avoidance of prelacteal feeding, and exclusive breastfeeding for six months, followed by the timely introduction of safe and nutritionally adequate complementary foods to prevent malnutrition and reduce morbidity in the first five years of life [1,2,3,4]
The importance of breastfeeding initiation is highlighted in epidemiological studies from Ghana, India and Nepal which show a relationship between timing of initiation and risk for neonatal mortality [8,9,10]
The causes of breastfeeding initiation delay were not explored, other research shows that primiparity [12], labor duration [13], maternal overweight [14], and perceptions about breast milk production [15] are factors associated with delays in the initiation of breastfeeding
Summary
Overwhelming clinical and epidemiological evidence supports international recommendations for initiation of breastfeeding shortly after birth, avoidance of prelacteal feeding, and exclusive breastfeeding for six months, followed by the timely introduction of safe and nutritionally adequate complementary foods to prevent malnutrition and reduce morbidity in the first five years of life [1,2,3,4]. The importance of breastfeeding initiation is highlighted in epidemiological studies from Ghana, India and Nepal which show a relationship between timing of initiation and risk for neonatal mortality [8,9,10]. Even after controlling for potential confounding factors, Patil et al Journal of Health, Population and Nutrition (2015) 34:10 late initiation was associated with a 78% increased risk for mortality in India [11]. Cesarean delivery is certainly a lifesaving intervention for a mother, fetus, or both but this surgery negatively affects breastfeeding initiation and continuation [2,16,17,18,19,20]
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