Abstract
BackgroundExclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall.MethodsA cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed.ResultsBreastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively).ConclusionEven if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda.
Highlights
Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity
The feeding patterns seen in our study were not influenced by socio-demographic characteristics, which is consistent with earlier findings from Uganda and Tanzania [9,18]
exclusively breastfed (EBF) has been emphasized in sub-Saharan Africa for two reasons: 1) it has a superior protective effect against both morbidity and mortality in the whole infant population, and 2) it generates a potentially lower postnatal HIV-1 transmission among children born to HIV-1positive mothers
Summary
Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. The MDGs were recently evaluated, and exclusive breastfeeding for six months was considered one of the most effective interventions to achieve MDG-4 [1]. Exclusive breastfeeding, giving breast milk only and no other liquids, except drops or syrups with vitamins, mineral supplements or medicines, is superior to non-exclusive breastfeeding with a protective effect against both morbidity and mortality [2,3]. The spillover effect would imply that mothers change breastfeeding behaviour, meaning that they do not breastfeed, stop breastfeeding earlier or increasingly practice mixed feeding, in other words giving complementary foods in addition to breast milk. World Health Organization (WHO) has emphasized that there should be an effort to ensure positive perceptions of and attitudes towards breastfeeding within the general population [6]
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