Abstract
BackgroundExclusive breastfeeding (EBF) during the first six months of life is considered a high impact but low-cost measure for reducing the morbidity and mortality among children. The current study investigated the association of seasonality and frontline worker(FLW) provided counselling with practice of EBF in Bihar, India.MethodsWe used the ‘Lot Quality Assurance Sampling’ technique to conduct a multi-stage sampling survey in 8 districts of Bihar. Regarding EBF, mothers of 0–5 (completed) months old children were asked if they had given only breastmilk to their children during the previous day, while mothers of 6–8 (completed) months old children were inquired about the total duration of EBF. We tested for association between EBF during the previous day with season of interview and EBF for full 6 months with nursing season. We also assessed if receiving counselling on EBF and complementary feeding had any association with relevant EBF indicators.ResultsAmong the under-6 month old children, 76% received EBF during the previous day, whereas 92% of 6–8 (completed) months old children reportedly received EBF for the recommended duration. Proportion of 0–5 (completed) month old children receiving only breastmilk (during last 24 hours) decreased significantly with increasing age and with change of season from colder to warmer months. Odds of receiving only breastmilk during the previous day was significantly higher during the winter months (Adjusted odds ratio(AOR) = 1.50; 95% CI = 1.37, 1.63) compared to summer. Also, the children nursed primarily during the winter season had higher odds of receiving EBF for 6 months (AOR = 1.90, 95% CI = 1.43, 2.52) than those with non-winter nursing. Receiving FLW-counselling was positively associated with breastfeeding exclusively, even after adjusting for seasonality and other covariates (AOR = 1.82; 95% CI = 1.67, 1.98).ConclusionsSeasonality is a significant but non-modifiable risk factor for EBF. However, FLW-counselling was found to increase practice of EBF irrespective of season. Scale-up of FLW-counselling services, with emphasis on summer months and mothers of older infants, can potentially reduce the impact of seasonality on EBF.
Highlights
Adequate nutrition, especially of the newborns, is a fundamental requirement for ensuring that the children realize their potential of developing into healthy adults
We assessed if receiving counselling on Exclusive breastfeeding (EBF) and complementary feeding had any association with relevant EBF indicators
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
Especially of the newborns, is a fundamental requirement for ensuring that the children realize their potential of developing into healthy adults. About 35% under-five mortalities are attributed to malnutrition.[1] A number of global and region-specific health interventions—such as universalizing early initiation of breastfeeding, breastfeeding exclusively during the first six months of life and age-appropriate frequency and quantity of complementary feeding from sixth month onwards—have focused on improving the nutritional status of children.[2, 3] In India, one of the key objectives of the ‘Integrated Child Development Services (ICDS)’ scheme has been to improve the nutritional status of children up to 6 years of age.[4] in spite of such efforts, childhood nutritional indicators in India remained poor—with stunted, wasted and underweight children, respectively, accounting for about 48%, 20% and 43% of the total under-five year old population.[5] Amidst this grim premise, identification of the causes of childhood undernutrition and implementation of targeted measures to lessen its burden need to be prioritized. The current study investigated the association of seasonality and frontline worker(FLW) provided counselling with practice of EBF in Bihar, India
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