Factors associated with Exclusive Breastfeeding in Tunisian population

Abstract

Abstract Background Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. WHO recommend the maintaining the exclusive breastfeeding (EB) up to six months. Unfortunately, its prevalence does not exceed 13% in our country at this age. A better understanding of factors associated with short duration of breastfeeding can allow us to identify the strategies that improve it. This study aimed to determine prevalence of EB and predominant breastfeeding (PB) during the first 2 months and identify their associated factors. Methods We conducted an observational prospective study in two centers of maternal and child health of Monastir (Tunisia) during April and May 2019. Data collection was performed after birth using a self-administered questionnaire and at 4th and 8th postpartum week by telephone interviews. We used the BSES-SF scale to identify self-efficacy in BF and the IIFAS-A scale to measure the mother's attitude towards BF. We used Kaplan Meier survival analysis and Cox Proportional Hazard regression to identify independent factors associated with EB and PB. Results During the study, 437 mothers were enrolled. Prevalence at 8th postpartum week was 6.2% with median duration of eight days and 35.6% with median duration of 21 days respectively for EB and PB. Absence of a breastfeeding experience (HR = 1.31 [1.07-1.61], p = 0.008), the first breastfeeding at beyond 12 hours (HR = 1.47 [1.05-2.07], p = 0.023), the intention of mixed breastfeeding (HR = 1.25 [1- 1.55], p = 0.043) were associated with a shorter duration of EB. Absence of breastfeeding experience (HR = 1.47 [1.05-2.07], p = 0.023), the first breastfeeding at beyond 2 hours (HR1 = 1.72 [1.08-2.73]; p = 0.007) and the non-determination of the duration of breastfeeding (HR = 1.54 [1.43-4.51], p = 0.006) were associated with a shorter duration of PB. Conclusions This study allowed us to identify mothers likely to stop BF early. They should be the target of specific promotion interventions. Key messages Breastfeeding is one of the most effective ways to ensure child health and survival. Information about BF, time of first BF, type and duration of planned BF and self-efficacy deserve a particular attention and constitute key axes of effective promotion interventions of EB and PB.