Abstract
BackgroundMaternal recall is most commonly used to determine exclusive breastfeeding rates. A gold standard stable isotope method is available which can determine intake of breast milk versus water from sources other than breast milk and thus objectively determine exclusive breastfeeding. The objectives of this study were to determine exclusive breastfeeding rates by both maternal recall and the objective stable isotope method and discuss the limitations and usefulness of the two methods.MethodsThe study involved 100 mother-infant pairs in a peri-urban area in Durban, South Africa and study visits took place from July 2012 to September 2014. Maternal recall of exclusive breastfeeding was carried out using the World Health Organization’s 24 hour recall of infant feeding and this was compared to the objective measurement of exclusive breastfeeding using the stable isotope technique at three time points: six weeks, three and 5.5 months. The objective measurements were carried out using two different cut off values for exclusive breastfeeding. Kappa analysis was used to quantify the relationship between maternal recall and results from the stable isotope technique for each mother-infant pair.ResultsOver reporting of exclusive breastfeeding was common at the three different time points regardless of the cut off value used to assess exclusive breastfeeding by the stable isotope technique. Kappa analysis also revealed only slight or fair agreement (K < 0.24) between reported and measured exclusive breastfeeding at all time points.ConclusionsMaternal recall of exclusive breastfeeding is limited in accuracy and should be restricted to large scale epidemiological surveys. The more objective gold standard stable isotope method for measuring intake volumes of breast milk should be used to evaluate interventions with smaller representative samples.
Highlights
Maternal recall is most commonly used to determine exclusive breastfeeding rates
No side effects have been noted at enrichment levels less than 0.2% and in this Dose to mother (DTM) method the deuterium enrichment level in the mother reaches a maximum of 0.1% in the body and less than half of that amount in the infant [19]
Saliva samples are taken from the mother and infant over a period of 14 days and the deuterium enrichment is measured in each sample using a Fourier Transform Infrared Spectrometer (FTIR) compared to their pre-dose saliva sample
Summary
Maternal recall is most commonly used to determine exclusive breastfeeding rates. The objectives of this study were to determine exclusive breastfeeding rates by both maternal recall and the objective stable isotope method and discuss the limitations and usefulness of the two methods. The 2003 South African Demographic and Health Survey (SADHS) carried out by the Department of Health showed low rates of EBF at time points up to six months In view of the importance of breastfeeding to improve child survival and given the historically very low EBF rates, the South African government called a Breastfeeding Consultative Forum in 2011 and committed itself to increase efforts to protect, promote and support breastfeeding [3]. The KwaZulu-Natal province (KZN) in particular was very active and in 2014 the KwaZulu-Natal Initiative for Breastfeeding Support (KIBS) was established as a three year programme, which aimed to improve exclusive breastfeeding rates in the KwaZulu-Natal
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