Factors Affecting Breastfeeding Practices in Sindh Province, Pakistan: A Secondary Analysis of Cross-Sectional Survey Data

Jin-Won Noh, Young-Mi Kim, Nabeel Akram, Ki-Bong Yoo, Jooyoung Cheon, Lena J Lee, Young Dae Kwon, Jelle Stekelenburg, Jin-Won Noh, Young-Mi Kim, Nabeel Akram, Ki-Bong Yoo, Jooyoung Cheon, Lena J Lee, Young Dae Kwon, Jelle Stekelenburg

Abstract

Breastfeeding practices are critical for child health and growth. This paper investigates demographic factors, socioeconomic status, and information sources that affect breastfeeding practices in Sindh Province, Pakistan. A secondary analysis was performed of data on 10,028 women with a birth in the preceding two years who had participated in the 2013-14 Maternal and Child Health Program Indicator Survey. Multiple logistic regressions were used to test the association between breastfeeding status (ever breastfed and still breastfeeding) and age, number of living children, residence, education, wealth, information sources about breastfeeding, assistance during delivery, and place of delivery. Of the 9955 women included in the analysis, 97.9% had breastfed and 83.9% were still breastfeeding at the time of the survey. Being in the second, third, or fourth wealth quintiles and receiving breastfeeding information from relatives and friends were associated with ever breastfeeding. Women who were 35 years or older, living in a town/small city, higher maternal education, middle wealth quintile, and receiving breastfeeding information from the media were associated with still breastfeeding. The findings suggest the need to develop interventions considering maternal socioeconomic status and peer counseling interventions. Mass media campaigns to promote breastfeeding practices should be accompanied by governmental restrictions on the marketing of infant formula.

Keywords: Pakistan; breastfeeding; maternal and child health; socioeconomic status.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. World Health Organization Maternal, Newborn, Child and Adolescent Health: Breastfeeding. [(accessed on 21 November 2016)]; Available online:
    1. Kramer M.S., Aboud F., Mironova E., Vanilovich I., Platt R.W., Matush L., Igumnov S., Fombonne E., Bogdanovich N., Ducruet T., et al. Breastfeeding and Child Cognitive Development: New Evidence from a Large Randomized Trial. Arch. Gen. Psychiatry. 2008;65:578–584. doi: 10.1001/archpsyc.65.5.578.
    1. Hawkes J.S., Bryan D.L., James M.J., Gibson R.A. Cytokines (IL-1β, IL-6, TNF-α, TGF-β1, and TGF-β2) and Prostaglandin E2 in Human Milk during the First Three Months Postpartum. Pediatr. Res. 1999;46:194–199. doi: 10.1203/00006450-199908000-00012.
    1. Luopajärvi K., Savilahti E., Virtanen S.M., Ilonen J., Knip M., Åkerblom H.K., Vaarala O. Enhanced levels of cow’s milk antibodies in infancy in children who develop type 1 diabetes later in childhood. Pediatr. Diabetes. 2008;9:434–441. doi: 10.1111/j.1399-5448.2008.00413.x.
    1. Rosetta L., Baldi A. On the Role of Breastfeeding in Health Promotion and the Prevention of Allergic Diseases. Adv. Exp. Med. Biol. 2008;606:467–483. doi: 10.1007/978-0-387-74087-4_19.
    1. Horta B.L., Bahl R., Martines J.C., Victora C.G. Evidence on the Long-Term Effects of Breastfeeding: Systematic Review and Meta-Analyses. World Health Organization; Geneva, Switzerland: 2007.
    1. McNally R.J., Alston R.D., Eden T.O., Kelsey A.M., Birch J.M. Further clues concerning the aetiology of childhood central nervous system tumours. Eur. J. Cancer. 2004;40:2766–2772. doi: 10.1016/j.ejca.2004.08.020.
    1. Victora C.G., Bahl R., Barros A.J., França G.V., Horton S., Krasevec J., Murch S., Sankar M.J., Walker N., Rollins N.C., et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–490. doi: 10.1016/S0140-6736(15)01024-7.
    1. United Nations Children’s Fund Tracking Progress for Breastfeeding Policies and Programmes. [(accessed on 31 December 2018)];2017 Available online: .
    1. Lumbiganon P., Martis R., Laopaiboon M., Festin M.R., Ho J.J., Hakimi M. Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database Syst. Rev. 2012;12:CD006425. doi: 10.1002/14651858.CD006425.pub2.
    1. Aidam B.A., Perez-Escamilla R., Lartey A., Aidam J. Factors associated with exclusive breastfeeding in Accra, Ghana. Eur. J. Clin. Nutr. 2005;59:789–796. doi: 10.1038/sj.ejcn.1602144.
    1. Kimani-Murage E.W., Madise N.J., Fotso J.C., Kyobutungi C., Mutua M.K., Gitau T.M., Yatich N. Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya. BMC Public Health. 2011;11:396. doi: 10.1186/1471-2458-11-396.
    1. Ogbo F.A., Agho K.E., Page A. Determinants of suboptimal breastfeeding practices in Nigeria: Evidence from the 2008 demographic and health survey. BMC Public Health. 2015;15:259. doi: 10.1186/s12889-015-1595-7.
    1. Ogunlesi T.A. Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting. Mater. Child Health J. 2010;14:459–465. doi: 10.1007/s10995-008-0440-3.
    1. Shifraw T., Worku A., Berhane Y. Factors associated exclusive breastfeeding practices of urban women in Addis Ababa public health centers, Ethiopia: A cross sectional study. Int. Breastfeed. J. 2015;10:22. doi: 10.1186/s13006-015-0047-4.
    1. Tan K.L. Factors associated with exclusive breastfeeding among infants under six months of age in peninsular Malaysia. Int. Breastfeed. J. 2011;6:2. doi: 10.1186/1746-4358-6-2.
    1. Vieira T.O., Vieira G.O., de Oliveira N.F., Mendes C.M., Giugliani E.R.J., Silva L.R. Duration of exclusive breastfeeding in a Brazilian population: New determinants in a cohort study. BMC Pregnancy Childbirth. 2014;14:175. doi: 10.1186/1471-2393-14-175.
    1. Foss K.A., Southwell B.G. Infant feeding and the media: The relationship between Parents’ Magazine content and breastfeeding, 1972–2000. Int. Breastfeed. J. 2006;1:10. doi: 10.1186/1746-4358-1-10.
    1. Oakley L., Baker C.P., Addanki S., Gupta V., Walia G.K., Aggarwal A., Bhogadi S., Kulkarni B., Wilson R.T., Prabhakaran D., et al. Is increasing urbanicity associated with changes in breastfeeding duration in rural India? An analysis of cross-sectional household data from the Andhra Pradesh children and parent study. BMJ Open. 2018;7:e016331. doi: 10.1136/bmjopen-2017-016331.
    1. Ogbo F.A., Page A., Idoko J., Agho K.E. Population attributable risk of key modifiable risk factors associaed with non-exclusive breastfeeding in Nigeria. BMC Public Health. 2018;18:247. doi: 10.1186/s12889-018-5145-y.
    1. UNICEF Media Centre Breastfeeding: A Key to Sustainable Development. [(accessed on 31 October 2018)];2016 Available online: .
    1. Agha S., Williams E. Maternal and Child Health Program Indicator Survey 2013, Sindh Province. Jhpiego; Karachi, Pakistan: 2013. MNCH Services Component, USAID/Pakistan MCH Program.
    1. Balogun O.O., Dagvadorj A., Anigo K.M., Ota E., Sasaki S. Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: A quantitative and qualitative systematic review. Mater. Child Nutr. 2015;11:433–451. doi: 10.1111/mcn.12180.
    1. National Institute of Population Studies (NIPS) [Pakistan] and ICF International . Pakistan Demographic and Health Survey 2012–2013. NIPS and ICF International; Islamabad, Pakistan: Calverton, MD, USA: 2013.
    1. Ali S., Ali S.F., Imam A.M., Ayub S., Billoo A.G. Perception and practices of breastfeeding of infants 0–6 months in an urban and a semi-urban community in Pakistan: A cross-sectional study. J. Pak. Med. Assoc. 2011;61:99–104.
    1. Noh J.W., Kim Y.M., Akram N., Yoo K.B., Cheon J., Lee L.J., Kwon Y.D., Stekelenburg J. Impact of socio-economic factors and health information sources on place of birth in Sindh Province, Pakistan: A secondary analysis of cross-sectional survey data. Int. J. Environ. Res. Public Health. 2019;16:932. doi: 10.3390/ijerph16060932.
    1. Ogbo F.A., Eastwood J., Page A., Efe-Aluta O., Anago-Amanze C., Kadiri E.A., Ifegwu I.K., Woolfenden S., Agho K.E. The impact of sociodemographic and health-service factors on breast-feeding in sub-Saharan African countries with high diarrhoea mortality. Public Health Nutr. 2017;20:3109–3119. doi: 10.1017/S1368980017002567.
    1. Asare B.Y., Preko J.V., Baafi D., Dwumfour-Asare B. Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana. Int. Breastfeed. J. 2018;13:12. doi: 10.1186/s13006-018-0156-y.
    1. Khan G.N., Ariff S., Khan U., Habib A., Umer M., Suhag Z., Hussain I., Bhatti Z., Ullah A., Turab A., et al. Determinants of infant and young child feeding practices by mothers in two rural districts of Sindh, Pakistan: A cross-sectional survey. Int. Breastfeed. J. 2017;12:40. doi: 10.1186/s13006-017-0131-z.
    1. Asim M., Mahmood B., Sohail M.M. Infant health care; pratices in Pakitan: A sytematic review. Prof. Med. J. 2015;22:978–988.
    1. Zakar R., Zakar M.Z., Zaheer L., Fischer F. Exploring parental perceptions and knowledge regarding breastfeeding practices in Rajanpur, Punjab Province, Pakistan. Int. Breastfeed. J. 2018;13:24. doi: 10.1186/s13006-018-0171-z.
    1. Safari J.G., Kimambo S.C., Lwelamira J.E. Feeding practices and nutritional status of infants in Morogoro Municipality, Tanzania. Tanzan. J. Health Res. 2013;15:1–10. doi: 10.4314/thrb.v15i3.5.
    1. Kim Y.M., Haq Z.U., Soomro J., Sultana Z., Faizunnisa A., Agha S. Case study: Effects of a media campaign on breastfeeding behaviours in Sindh Province, Pakistan. World Health Popul. 2015;16:39–45. doi: 10.12927/whp.2016.24494.
    1. Piwoz E.G., Huffman S.L. The impact of marketing of breast-milk substitutes on WHO-recommended breastfeeding practices. Food Nutr. Bull. 2015;36:373–386. doi: 10.1177/0379572115602174.
    1. Shen Y. Monitoring the International Code of Marketing of Breast-Milk Substitutes: A Comparative Analysis of Past Study Efforts. [(accessed on 11 November 2018)]; Available online: .
    1. World Health Organization . International Code of Marketing of Breastmilk Substitutes. World Health Organization; Geneva, Switzerland: 1981.
    1. Salasibew M., Kiani A., Faragher B., Garner P. Awareness and reported violations of the WHO International Code and Pakistan’s national breastfeeding legislation; a descriptive cross-sectional survey. Int. Breastfeed. J. 2008;3:24. doi: 10.1186/1746-4358-3-24.
    1. Ara G., Khanam M., Papri N., Nahar B., Haque M.A., Kabir I., Dibley M.J. Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh. Mater. Child. Nutr. 2018;14:e12605. doi: 10.1111/mcn.12605.

Source: PubMed

3
Tilaa