Limitations of maternal recall for measuring exclusive breastfeeding rates in South African mothers

Helen Mulol, Anna Coutsoudis, Helen Mulol, Anna Coutsoudis

Abstract

Background: Maternal 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.

Methods: The 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.

Results: Over 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.

Conclusions: Maternal 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.

Keywords: Deuterium dilution; Exclusive breastfeeding; Maternal recall; Stable isotope.

Conflict of interest statement

Ethical approval for the study was obtained from the Biomedical Research Ethics Administration of the University of KwaZulu-Natal (BE 211/11). All participants signed an informed consent.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison of exclusive breastfeeding rates from our study (DTM method and maternal recall). DTM: dose to mother, NMOI: Non-milk oral intake

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