Discontinuation Of Exclusive Breastfeeding Research Articles

Determinants of early cessation of exclusive breastfeeding practices among rural mothers from Jaffna District of Sri Lanka

BackgroundSri Lanka is an upper-middle-income country with excellent health statistics. However, 2016 Demographic and Health Survey data have shown 82% and 64% of mothers exclusively breastfed infants aged 0–6 months and 4–5 months, respectively. The short duration of exclusive breastfeeding (EBF) has an impact on the growth and development of babies. Since no studies have been reported on EBF practices of the rural mothers in Jaffna District, an administrative district among 25 districts of Sri Lanka, this study aimed to assess the factors influencing the early cessation of EBF.MethodsFor this community-based cross-sectional study, 338 mother–child pairs were selected from 2013–14. EBF was defined as children not receiving any food or drink, including complementary foods, formula milk or milk products except for medicines and vitamins or mineral drops, other than breast milk since birth. Socio-economic and demographic factors, the influence of the mode of delivery, and knowledge on EBF were obtained using an interviewer-administered questionnaire. The details of EBF and reasons for the cessation of breastfeeding before six months were obtained from a subgroup of mothers (n = 208). Multivariate analysis was performed to explore the correlates of breastfeeding.ResultsIn this study, 71.2% (95% CI 64.5, 77.2) had practiced EBF for six months. Early discontinuation of EBF was practiced by employed mothers (AOR 4.3; 95% CI 1.3, 13.9), mothers of low birth weight babies (AOR 3.6; 95% CI 1.6, 8.2) and those who experienced Cesarean section birth (AOR 2.9; 95% CI 1.2, 6.9). The EBF practiced by mothers of rural Jaffna was not associated with the gender of the babies, type of family, number of children in a family, religion of the household, knowledge on EBF, or family income.ConclusionThe prevalence of EBF up to six months was low in rural Jaffna, and it was influenced by employment, birthweight of the babies, and the mode of delivery. To enhance EBF, the Regional Directorate of Health Service, Jaffna, should take necessary action with policymakers to increase maternity leave for at least six months, reduce the Cesarean section rate, and provide nutritional support to pregnant mothers.

Breastfeeding by Working Mothers: Global Challenges

A mother’s full-time employment is a determinant factor in abandoning exclusive breastfeeding before 6 months. White-collar workers have a better knowledge, attitude, and practice toward breastfeeding than blue-collar workers. The discontinuation of exclusive breastfeeding is associated with delayed skin-to-skin contact, Neonatal Intensive Care Unit admission, pacifier and artificial teats use, mother’s return to work earlier and lower education levels. Racial and ethnic disparities in paid and unpaid workloads of mothers, and the relationship between components of job quality and duration of mother’s own milk provision. However, returning to work, insufficient breast milk, misconceptions about breastfeeding, and interference with social life were the barriers for mothers to breastfeed continuously. Several aspects must be considered to increase the chances of a beneficial effect of interventions: type of intervention, target audience, timing of intervention, actors that can implement it, strategies and methods of intervention, and intensity of intervention. Intervention efforts should focus on behavior change to educate and equip mothers to overcome the barriers that are within their control. Such interventions should further focus on family-centered education and strengthening the proficiency of healthcare workers on advising breastfeeding mothers. Findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Women’s experiences reveal a daily life with difficulties in reconciling the desire to breastfeed and the work scenario. Support network and adaptation to children’s food routine are strategies adopted to minimize risks of weaning. The results show the need to consolidate policies to encourage continued breastfeeding in the labor market. Effort is needed to sustain breastfeeding after maternal return to work. A breastfeeding-friendly policy with clear operating guidelines in the workplace is critical to sustaining breastfeeding. Learning from others who have had a positive experience will ensure that all breastfeeding women are better supported in the workplace in future. When ‘breastfeeding only’ support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For ‘breastfeeding plus’ interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale. Governments should make it obligatory for employers to offer a breastfeeding support program and a dedicated breastfeeding facility at the workplace as these simple measures significantly increase exclusive breastfeeding. Knowledge improvement related to breastfeeding benefits and supports to working mothers are a key priority, however advocacy to employers, managers, and supervisors in providing breastfeeding facilitation and program support are also critical to successful breastfeeding practice among workers. Policies, regulations, and laws supporting the promotion of exclusive breastfeeding practices until 6 months in mothers as recommended by the WHO should be reinforced.

Assessment of Mothers' Knowledge, Practice and Attitude Regarding Prevention of Exclusive Breastfeeding Discontinuation

Assessment of Mothers' Knowledge, Practice and Attitude Regarding Prevention of Exclusive Breastfeeding Discontinuation

Factors That Influence Posthospital Infant Feeding Practices Among Women Who Deliver at a Baby Friendly Hospital in Southern United States.

Introduction: The Baby Friendly Hospital Initiative has had a positive impact on breastfeeding initiation; however, little is known about posthospital infant feeding practices among women who deliver at baby friendly hospitals. Therefore we sought to evaluate posthospital breastfeeding outcomes among women who deliver at a baby friendly hospital (BFH) by (1) estimating exclusive breastfeeding rates at the postpartum visit (PPV), (2) quantifying the exclusive breastfeeding discontinuation rate, and (3) identifying which factors are associated with breastfeeding discontinuation. Methods: This was a prospective cohort study of women aged 14 and over, who delivered at the University of Alabama at Birmingham. The primary outcome was mode of infant feeding categorized as exclusive breastfeeding (EBF), combination breastfeeding and formula feeding (CF), and exclusive formula feeding (EFF) at the PPV. Secondary outcome was EBF discontinuation rate. Patients who initiated formula and/or who stopped breastfeeding were asked what influenced their decision. Results: At hospital discharge, 71.1% of the participants were EBF, 21.7% were CF, and 7.2% were EFF. At the PPV, the frequency of the primary outcome of EBF was 31.6% (95% confidence interval: 25.2-38.8); 34.6% (28.0-41.9) were CF, and 33.8% (27.3-41.1) were EFF. Therefore, the EBF absolute and relative discontinuation rates were 39.5% and 55.6%, respectively. No demographic factors, delivery characteristics, or maternal medical morbidities were associated with EBF in the multivariable logistic regression. However, women in the EBF group were more likely to report a workplace environment conducive to breastfeeding and partner and friend support. Conclusion: Significant breastfeeding discontinuation rates occur even among women who deliver at a BFH. Our findings suggest that multifactorial interventions, including a focus on the prevention of formula introduction, are needed in the early postpartum period to achieve higher EBF rates at the PPV.

Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan

BackgroundWhile breastfeeding provides benefits for infants and the mother, many women either do not breastfeed or terminate breastfeeding earlier than recommended. The aim of this analysis was to identify factors associated with early discontinuation of breastfeeding in Japanese women.MethodsThis study used data from medical records of women delivering a singleton live birth between March 2017 and August 2019 in Iwase General Hospital, Fukushima Prefecture, Japan to assess cessation of breastfeeding by the 1-month postpartum appointment. Demographic (age at birth, and employment status), medical (parity, and physical and mental condition of the mother; and infant medical factors, such as sex, Apgar score, and jaundice, among other), and family factors (husband/partner, family members living at the same house, among others) in 734 women who had initiated breastfeeding during their delivery hospital stay were examined, and multiple logistic regression was used to determine significant predictors of early cessation of exclusive breastfeeding.ResultsBivariate analysis revealed that women who were primipara, unmarried, exposed to secondhand smoke, and employed; those who smoked before pregnancy; and those who had asthma were more likely to discontinue exclusive breastfeeding than other women. Infant factors associated with discontinuation were lower birthweight, earlier gestational age, neonatal intensive care unit admission, treatment for jaundice, or lower weight gain. Multivariable analysis revealed that primiparity, passive smoking before pregnancy, maternal employment, and neonatal jaundice therapy were associated with discontinuation of breastfeeding.ConclusionsIn particular, women whose partners smoked before pregnancy may need to be targeted for additional support for breastfeeding.

Factors Associated with Discontinuing Exclusive Breastfeeding among Mothers of Infants Aged 0-6 Months

IntroductionKnowing breastfeeding is one of the easiest and cost-effective ways to maintain a good childhealth, majority infants are not exclusively breastfed for the recommended 6 months of age.Thus, the aim of the study was to find out the factors associated with discontinuing exclusivebreastfeeding (EBF) among mothers of infants’ aged 0-6 months. MethodsA analytical study design was used to find out the factors associated with discontinuing EBFamong mothers of infants’ aged 0-6 months in Nepal. A total of 380 mothers of infants whosechild were 0-6 months old were selected using non-probability purposive sampling techniquethrough online survey as people are advised to stay at home during the Covid-19 outbreak. Datawas collected using structured questionnaire with interview technique. ResultsStudy findings revealed that half (50.5%) of the mothers exclusive breastfed their infants withmother’s mean age being 27.39 ± 3.64 years. Discontinuation of EBF varied with mothers age,ethnicity, mother’s educational level, initiation of breastfeeding and sources of informationregarding EBF as newspaper/articles and relatives/friends/neighbors (p=<0.005). The factorsrelated to mother that are associated with discontinuation of EBF were found to be perceivedinsufficient milk, cesarean section delivery, jobholder mother (p= <0.001) respectively. ConclusionsOnly half of respondents exclusively breastfed their infants for the recommended age in whichonly factors related to mother were significant with discontinuation of EBF rather than infants’.Findings of the study emphasizes on counselling the mothers regarding the benefits of EBF toboth child and mother during hospital visits. Keywords: exclusive breastfeeding; factors; under 6 months; EBF.

Exclusive breastfeeding continuation and associated factors among employed women in North Ethiopia: A cross-sectional study.

Exclusive Breastfeeding (EBF) can prevent up to 13% of under-five mortality in developing countries. In Sub-Saharan Africa the rate of EBF at six months remains very low at 36%. Different types of factors such as maternal, family and work-related factors are responsible for the low rate of EBF among employed women. This study aimed to assess the prevalence of EBF continuation and associated factors among employed women in North Ethiopia. A community-based, cross-sectional study was conducted in two towns of Tigray region, North Ethiopia. Employed women who had children between six months and two years were surveyed using multistage, convenience sampling. Women filled in a paper based validated questionnaire adopted from the Breastfeeding and Employment Study toolkit (BESt). The questions were grouped into four parts of sociodemographic characteristics, maternal characteristics, family support and work-related factors. Factors associated with EBF continuation as a binary outcome (yes/no) were determined using multivariable logistic regression. Four-hundred and forty-nine women participated in this study with a mean (SD) age 30.4 (4.2) years. Two hundred and fifty-four (56.4%) participants exclusively breastfed their children for six months or more. The main reason for discontinuation of EBF was the requirement of women to return to paid employment (31.5%). Four-hundred and forty (98.2%) participants believed that breastfeeding has benefits either to the infant or to the mother. Three hundred and seventy-one (82.8%) of the participants received support from their family at home to assist with EBF, most commonly from their husbands and mothers. Having family support (adjusted odds ratio [AOR] = 2.1, 95%, CI 1.2-3.6; P = 0.005), having frequent breaks at work (AOR = 2.6, 95% CI, 1.4-4.8; P = 0.002) and the possibility of buying or borrowing required equipment for expressing breast milk (AOR = 1.7, 95% CI, 1.0-3.0; P = 0.033) were statistically associated with an increased chance of EBF. Although returning to work was reported by the study participants as the main reason for discontinuation of EBF, families and managers' support play significant roles in EBF continuation, which in the absence of six-month's maternity leave for employed women in Ethiopia would be of benefit to both mothers and children.

The Impact of Formula Industry Marketing on Breastfeeding Rates in Native and Migrant Mothers.

Introduction: Lifelong benefits of breastfeeding are far-reaching. However, optimal breastfeeding practices may be negatively affected by the marketing of different forms of breast milk substitutes. In addition, whether market factors have a different impact on migrants' breastfeeding practices when compared to natives has been poorly investigated. Objectives: Our study's aims are (1) to assess the effect of market factors on breastfeeding discontinuation (any and exclusive), (2) comparing migrant and native women. Methods: A longitudinal study was conducted within baMBINO, a nationwide project on perinatal health among migrant women in Portugal. Our final sample included 1,251 migrants and 1,150 natives recruited between April 2017 and March 2019 in 32 public maternities. Cox regression analysis was performed, adjusting for important confounders, and interactions were tested. Results: Market factors were associated with any and exclusive breastfeeding discontinuation. Participants receiving free formula samples from a health professional were more likely to stop exclusive breastfeeding (adjusted hazard ratios [aHR] = 1.37, 95% confidence intervals [95% CI] = 1.13-1.66, p = 0.002). Reporting exposure to formula discounts was associated with discontinuation of exclusive (aHR = 1.22, 95% CI = 1.09-1.38, p = 0.001) and any breastfeeding (aHR = 1.21, 95% CI = 1.00-1.46, p = 0.046). No interactions were found between being migrant and exposure to market factors. Conclusions: Market factors influence discontinuation of any and exclusive breastfeeding. The impact of marketing does not differ between native and migrant women.

Effect of Nursing Intervention on Prevention of Exclusive Breastfeeding Discontinuation

Introduction: Planned nursing intervention and health education regarding exclusive breastfeeding (EBF)improved knowledge, practice and attitude of mothers and contributed to prevention of EBF discontinuationwhich can consequently reduce the worldwide infants’ morbidity and mortality rates. Aim of theStudy: The present study aimed to investigate the effect of nursing intervention on prevention of EBFdiscontinuation. Study Design: A quasi-experimental design was utilized. Setting: Obstetric OutpatientClinic, Breast Feeding Room in NICU of Children’s Hospital affiliated to Ain Shams University hospitalsand MCH center in Abassia sector/Cairo/Egypt. Subject: A purposive sample of 100 mothers of infantsaged from birth up to 6 months. Tools of the Study: Predesigned questionnaire to assess: mothers andinfants characteristics, knowledge regarding factors affecting EBF discontinuation and its prevention,Iowa Infant Feeding Attitude Scale and observational checklists to assess mothers? breastfeeding practice.Results: It was clear that the majority of the studied mothers had good knowledge, positive attitude towardsprevention of EBF discontinuation and improved practice of breastfeeding post implementation of nursingintervention. There was statistical significant difference between total knowledge of the studied mothersregarding factors affecting EBF discontinuation and its preventionand total practice of breastfeeding pre/post nursing intervention. Conclusion: Nursing intervention had a positive effect on prevention of EBFdiscontinuation. Recommendation: Developing initiatives,pre and postnatal health education programs forprotecting, promoting and supporting breastfeeding which aid in the prevention of EBF discontinuation.

Determinants of exclusive breast-feeding discontinuation in southeastern Brazil, 2008-2013: a pooled data analysis.

To analyse the determinants of exclusive breast-feeding (EBF) discontinuation in southeastern Brazil between 2008 and 2013. Secondary cross-sectional data were analysed from three waves of child feeding surveys conducted in the city of Marília, São Paulo, Brazil, in 2008, 2011 and 2013 (n 1645 children under 6 months). Multivariable Poisson regression models were used to test the association between EBF discontinuation and socio-economic, demographic and biomedical factors in a pooled sample and within each survey wave. Regionally representative cross-sectional survey from Brazil. The analytical sample included 1645 infants under 6 months old. In the pooled sample, 40·7 % of the infants were exclusively breastfed. Between 2008 and 2013, there was a significant increase in C-section (35·1-42·7 %) and pacifier use (41·4-48·8 %). The determinants of EBF discontinuation in the pooled analysis were mothers working outside the home (adjusted prevalence ratio (APR) = 1·10; 95 % CI 1·00, 1·21), first-time mothers (APR = 1·10; 95 % CI 1·01, 1·20), pacifier use (APR = 1·48; 95 % CI 1·36, 1·61) and low birth weight (APR = 1·17; 95 % CI 1·05, 1·32). Mothers working outside the home, first-time moms, pacifier use and low birth weight were the factors associated with EBF discontinuation. Evidence-based counselling strategies during antenatal and early postpartum care in primary healthcare are needed to address the modifiable determinants of EBF discontinuation and ultimately to improve its rates in southeastern Brazil.

Assessing the impact of professional lactation support frequency, duration and delivery form on exclusive breastfeeding in Lebanese mothers.

The optimal frequency, duration, and form of professional lactation support needed to continue exclusive breastfeeding (EBF) for six months have not yet been specifically identified. This study investigates the association between six-month EBF and the frequency, duration, and form (face-to-face vs. telephone contact) of professional lactation support in a cohort of Lebanese mothers, and explores barriers to EBF during the first six months postpartum. An observational study was nested in a breastfeeding support randomized controlled trial. Secondary analysis of data from 159 trial participants who received professional lactation support was conducted. (1) Six-month EBF with professional lactation support frequency, duration, and form was investigated using bivariate and multivariate regression analyses. (2) Barriers to breastfeeding were explored using content analysis of narrative data collected about breastfeeding mothers by the lactation experts. Six-month EBF was achieved by 57/159 (35.8%) participants. Professional lactation support was received by more mothers continuing six months of EBF (100% vs. 83.3%, p = 0.001). In crude analysis, those mothers had a higher number of overall contacts with lactation experts (mean ± SD of 9.5 ± 2.9 vs. 7.0 ± 4.4, p = 0.001), and longer duration of face-to-face contacts (mean ± SD of 261.9 ± 209.1 vs. 201.0 ± 117.4 minutes, p = 0.035). In adjusted analysis, frequencies of overall and of telephone contacts with the lactation experts were positively associated with six-month EBF (OR = 1.15; 95% CI: 1.04 to 1.27, p = 0.007; OR = 1.12; 95% CI: 1.00 to 1.26, p = 0.05; respectively). Participants discontinuing EBF early were described as inexperienced, lacking breastfeeding knowledge, concerned about milk insufficiency, and showing negative attitudes towards night feeds. Need-based telephone contact augmenting face-to-face professional lactation support may positively influence six-month EBF. Early identification of mothers at risk for early discontinuation of EBF can help tailor interventions specific to their concerns.

Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa

BackgroundDespite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32 %. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3–14 days, 4–8 weeks, 10–14 weeks and 20–24 weeks.MethodsThis community-based mixed-methods study collected data within a prospective cohort study on sociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6–8 weeks with infant feeding data collected at 4–8, 10–14 and 20–24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6–24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.ResultsThe majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks. Mixed feeding with infant formula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier, Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions, benefits of breastfeeding, support in the home, access to information and services from health professionals and baby’s health were strong enabling factors.ConclusionsLow EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.

Assessment of Knowledge, Attitude and Practices Regarding Breastfeeding among Primiparas Mothers in Kanchipuram District, Tamilnadu

Background: Breastfeeding is the fundamental component of the child-survival strategy.Lack of breast feeding – especially exclusive breast feeding during first few months of life is important as it reduces the risk factors for the infant mortality and the morbidity rate. Limited studies have attempted to understand the knowledge on benefits of breastfeeding among mothers which affect breastfeeding pattern in urban areas. Objective: To find out the association of socio demographic factors and breastfeeding knowledge among Primiparas.To understand the current practices of breastfeeding among Primiparas. Method: A quantitative, institutional based cross sectional study was conducted in a PG Medical college. Convenient Sampling was used to collect data from 216 Primiparas in the age group of 18-49 years having a child up to 12 months of age for a period of one month. Their knowledge and practice with regard to prelacteal feeds, initiation of breastfeeding, feeding colostrum, and exclusive breastfeeding were assessed. Results: Various demographic factors like the Maternal age, Maternal age at marriage, Maternal education, type of delivery, and religion had a direct association on Breastfeeding knowledge. Statistically significant difference was also found in the prevalence of knowledge about advantages of breast feeding with respect to education trend (p<0.005). The main reason cited for incorrect practices was shortage of breastmilk which led to mixed feed and discontinuation of Exclusive breastfeeding. Conclusion: Increased Involvement of the Heath care personnel’s in imparting knowledge on breastfeeding benefits to both mother and the baby would encourage and counsel the mothers for proper breastfeeding practices.

Exclusive breastfeeding changes in Brazil attributable to pacifier use.

BackgroundIdentifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown.Research aimQuantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time.MethodsSecondary data analyses of two nationally representative cross-sectional surveys conducted in States’ capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis.ResultsFrom 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points’ exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points.ConclusionsAbout one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.

Following the World Health Organization's Recommendation of Exclusive Breastfeeding to 6 Months of Age Does Not Impact the Growth of Rural Gambian Infants

BackgroundThe WHO recommends exclusive breastfeeding (EBF) for the first 6 mo of life. ObjectiveThe objective of this study was to assess the benefit of EBF to age 6 mo on growth in a large sample of rural Gambian infants at high risk of undernutrition. MethodsInfants with growth monitoring from birth to 2 y of age (n = 756) from the ENID (Early Nutrition and Immune Development) trial were categorized as exclusively breastfed if only breast milk and no other liquids or foods were given. EBF status was entered into confounder-adjusted multilevel models to test associations with growth trajectories by using >11,000 weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z score observations. ResultsThirty-two percent of infants were exclusively breastfed to age 6 mo. The mean age of discontinuation of EBF was 5.2 mo, and growth faltering started at ∼3.5 mo of age. Some evidence for a difference in WAZ and WHZ was found between infants who were exclusively breastfed to age 6 mo (EBF-6) and those who were not (nEBF-6), at 6 and 12 mo of age, with EBF-6 children having a higher mean z score. The differences in z scores between the 2 groups were small in magnitude (at 6 mo of age: 0.147 WAZ; 95% CI: −0.001, 0.293 WAZ; 0.189 WHZ; 95% CI: 0.038, 0.341 WHZ). No evidence for a difference between EBF-6 and nEBF-6 infants was observed for LAZ at any time point (6, 12, and 24 mo of age). Furthermore, a higher mean WLZ at 3 mo of age was associated with a subsequent higher mean age at discontinuation of EBF, which implied reverse causality in this setting (coefficient: 0.060; 95% CI: 0.008, 0.120). ConclusionsThis study suggests that EBF to age 6 mo has limited benefit to the growth of rural Gambian infants. This trial was registered at http://www.isrctn.com as ISRCTN49285450.

Predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa: a prospective study.

BackgroundAlthough breastfeeding is common in Democratic Republic of the Congo, the proportion of women who exclusively breastfeed their babies up to 6 months remains low. This study aimed at identifying predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa.MethodsA prospective study was carried out from October 2012 to July 2013 among 422 mother-child pairs recruited shortly after discharge from twelve maternities in Kinshasa and followed up to six months. Interviews were conducted at each woman’s house during the first week after birth, and at one, two, three, four, five and six months. Collected data included history of child’s feeding and mother’s socio-demographic and psychosocial characteristics. The Cox Proportional Model was used to identify predictors of discontinuing exclusive breastfeeding before six months.ResultsThe median duration of exclusive breastfeeding was 10.9 weeks (Inter Quartile Range 4.3 to 14.9). At six months, 2.8 % of infants were exclusively breastfed. The factors independently associated with the discontinuation of exclusive breastfeeding before six months were: not confident in the ability to breastfeed [Adjusted hazard ratio (AHR) = 3.90; 95 % CI 1.66, 9.16)], no plan on the duration of EBF (AHR = 2.86; 95 % CI 1.91, 4.28), breastfeeding problems during the first week (AHR = 1.54; 95 % CI 1.13, 2.11), low level of breastfeeding knowledge (AHR = 1.52; 95 % CI 1.08, 2.15), and experienced less than five Baby-friendly practices during the maternity stay (AHR = 1.47; 95 % CI 1.05, 2.06).ConclusionsConfidence in the ability to breastfeed and intention to exclusively breastfeed were the most important predictors of discontinuing exclusive breastfeeding before six months. To have a greater impact on the duration of exclusive breastfeeding, interventions should focus on these factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s13006-015-0044-7) contains supplementary material, which is available to authorized users.

Duration of exclusive breastfeeding in a Brazilian population: new determinants in a cohort study

BackgroundDeterminants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. The present study aimed to identify factors associated with discontinuation of EBF in a municipality in northeastern Brazil, including variables that have received little or no attention in previous literature.MethodsThis cohort study involved 1,344 mother-child pairs selected from maternity hospitals in Feira de Santana, Bahia, Brazil. Subjects were followed up for 6 months through monthly home visits, and discontinuation of EBF was recorded. Possible determinants were tested using Cox’s four-level hierarchical survival model, taking into consideration the temporal proximity of the predisposing factors to interruption of EBF. Median duration of EBF was estimated using Kaplan-Meier’s survival curve.ResultsMedian duration of EBF was 89 days. Out of the 19 variables tested, 9 showed an association with EBF cessation; of these, two had never been evaluated in Brazilian studies, namely, mother partner’s appreciation for breastfeeding (hazard ratio [HR] 0.62; 95% confidence interval [95% CI] 0.48-0.79) and limiting the number of nighttime feeds at the breast (HR 1.58; 95% CI 1.11-2.23). Another two variables that had been previously evaluated, but had never been described as determinants of discontinuation of EBF showed association: presence of cracked nipples (HR 2.54; 95% CI 2.06-3.13) and prenatal care provided by public services (HR 1.34; 95% CI 1.17-1.55). Other variables showing associations with the outcome were: guidance on breastfeeding received at the hospital (HR 0.80; 95% CI 0.68-0.92), birth in a Baby-Friendly Hospital (HR 0.85; 95% CI 0.73-0.99), less than or equal to 8 years of maternal schooling (HR 1.34, 95% CI 1.17-1.53), mother working outside the home (HR 1.73; 95% CI 1.53-1.95), and use of a pacifier (HR 1.40; 95% CI 1.14-1.71).ConclusionsThe study confirmed that the factors associated with EBF duration are multiple, variable, and dependent on the population being evaluated. Characteristics that had never been previously evaluated or described, at least in Brazilian studies, behaved as determinants of EBF in the present study, and thus allow to expand the existing list of factors determining this practice.

Do population-based interventions widen or narrow socioeconomic inequalities? The case of breastfeeding promotion.

Despite numerous population-based randomized intervention trials, the impact of such interventions on socioeconomic inequalities has rarely been examined. We used data from a large cluster-randomized trial to assess the impact of a breastfeeding promotion intervention on socioeconomic inequalities in breastfeeding (exclusivity and duration) and in child cognitive ability at early school age. The Promotion of Breastfeeding Intervention Trial (PROBIT) randomized 31 Belarusian maternity hospitals and their affiliated polyclinics either to receive a breastfeeding promotion intervention modelled on the WHO/UNICEF Baby-Friendly Hospital Initiative or to continue the standard practices in effect at the time of randomization. We estimated and compared inequalities in discontinuation of exclusive breastfeeding before 3 months and of any breastfeeding before 12 months and in child verbal IQ at age 6.5 years, across maternal education strata between the two intervention arms. Socioeconomic inequalities in discontinuing exclusive breastfeeding before 3 months were negligible in the control group. However, graded inequalities by maternal education emerged in the intervention group {relative risk [RR] = 1.12 [95% confidence interval (CI): 1.04, 1.20] for partial university and RR = 1.20 [95% CI: 1.11, 1.31] for secondary education or less vs complete university; risk difference [RD] = 0.06 [95% CI: 0.03, 0.09] and 0.10 [95% CI: 0.06, 0.14], respectively}. For discontinuing any breastfeeding before 12 months, small socioeconomic gradients in the control group were widened in the intervention group (RR = 1.04 and 1.16, respectively, for mothers with secondary education or less). Despite these differential effects on breastfeeding, however, we observed a small, nonsignificant reduction in socioeconomic inequalities in child verbal IQ at age 6.5 years. A population-based intervention to promote breastfeeding slightly widened socioeconomic inequalities in breastfeeding but not those in child cognitive ability.

Commentary

Commentary

Breastfeeding and Infant Size: Evidence of Reverse Causality

Infants who receive prolonged and exclusive breastfeeding grow more slowly during the first year of life than those who do not. However, infant feeding and growth are dynamic processes in which feeding may affect growth, and prior growth and size may also influence subsequent feeding decisions. The authors carried out an observational analysis of 17,046 Belarusian infants who were recruited between June 1996 and December 1997 and who participated in a cluster-randomized trial of a breastfeeding promotion intervention. To assess the effects of infant size on subsequent feeding, the authors restricted the analysis to infants breastfed (or exclusively breastfed) at the beginning of each follow-up interval and examined associations between weight or length at the beginning of the interval and weaning or discontinuation of exclusive breastfeeding by the end of the interval. Smaller size (especially weight for age) was strongly and statistically significantly associated with increased risks of subsequent weaning and of discontinuing exclusive breastfeeding (adjusted odds ratios = 1.2-1.6), especially between 2 and 6 months, even after adjusment for potential confounding factors and clustered measurement. The authors speculate that similar dynamic processes involving infant crying, other signs of hunger, and supplementation/weaning undermine causal inferences about the "effect" of prolonged and exclusive breastfeeding on slower infant growth.