Infant feeding modalities addressed in two different ways in Eastern Uganda

Ingunn Ms Engebretsen,James K Tumwine,A Elisabeth Sommerfelt,Rebecca Shanmugam,Thorkild Tylleskär

doi:10.1186/1746-4358-5-2

Abstract

BackgroundDurations of exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) from two different assessments, among the same mother-infant population, were investigated to determine the degree to which the assessments yielded overlapping results.MethodsThirty Ugandan mother-infant pairs were followed up weekly from birth to three months of age with weekly short-time feeding recall: the 24-hour recall asked prior to the 1-week recall. In addition, at week 6 and 12 dietary recalls since-birth were conducted. Variables for the duration of EBF and PBF were created from the short-time feeding recalls and the dietary recalls since-birth, respectively. Mean durations of EBF and PBF from the two assessments were compared with Kaplan Meier analysis at week 6 and 12. Reproducibility of dietary recall instruments was also assessed.ResultsAt six weeks postpartum the mean durations of EBF were 0.50 weeks (95% CI: 0, 1.02) according to the weekly short-time recalls and 1.51 weeks (95% CI: 0.66, 2.35) according to the recall since-birth (Mantel-Cox test, p = 0.049). The mean durations of PBF were 4.07 weeks (95% CI: 3.38, 4.77) according to the frequent short-time recalls and 4.50 weeks (95% CI: 3.93, 5.07) according to the recall since-birth, (Mantel-Cox-test, p = 0.82). At twelve weeks the mean durations of EBF were 0.5 weeks (95% CI: 0, 1.1) according to the weekly short-time recalls and 1.4 weeks (95% CI: 0.1, 2.7) according to the recall since-birth (Mantel-Cox-test, p = 0.15). The mean durations of PBF were 5.2 weeks (95% CI: 3.9, 6.5) according to the weekly short-time recalls and 6.6 weeks (95% CI: 5.4, 7.8) according to recall since-birth (Mantel-Cox-test, p = 0.20). Reports of feeding categories and early feeding practices showed high reproducibility.ConclusionComparing duration of EBF and PBF in this group of mother-infant pairs showed overlapping results from the weekly short-time assessment and the recall since-birth at twelve weeks, with the latter yielding slightly longer duration of the respective feeding modalities. The retrospective recall since-birth could be assessed as a cost-reducing tool compared to the frequent follow-up addressing duration of respective infant feeding modalities for evaluation of programmes promoting safer infant feeding practices.Trial registrationThe study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov, NCT00397150.

Highlights

Durations of exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) from two different assessments, among the same mother-infant population, were investigated to determine the degree to which the assessments yielded overlapping results
Half of the mothers had been informed about HIV voluntary counselling and testing (VCT), twelve had received the service, and 10 had been tested
Comparisons of recall assessments The following mean duration of EBF and PBF were seen at week 6 and 12 according to the Kaplan-Meier analysis when comparing the frequent short-time recall with the recall since-birth: At six weeks postpartum the mean time for introducing PBF was 0.50 weeks according to the frequent short-time recalls and 1.51 weeks according to the recall since-birth (Mantel-Cox test, p = 0.049) (Figure 1)

Summary

Introduction

Durations of exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) from two different assessments, among the same mother-infant population, were investigated to determine the degree to which the assessments yielded overlapping results. Breastfeeding is ranked as one of the safest and most children of HIV-positive mothers are on peri- and post exposure prophylaxis during lactation [8]. This resulted in recent changes in the guidelines. The recommendations are difficult to follow for most HIV-positive mothers in resource-poor settings [10], because of the stigma and limited feasibility that results in negligible numbers of both exclusively breastfed and exclusively replacement fed infants in the most highly HIV-burdened areas [11,12]. Even if new treatment regimens with breastfeeding will be recommended at an even higher degree in the years to come for HIV-positive mothers in resource poor settings [13], challenges may remain for mothers regarding feeding issues. EBF promotion needs renewed emphasis in the general population and renewed efforts will benefit all children

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Conclusion