Low adherence to exclusive breastfeeding in Eastern Uganda: a community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

Ingunn Marie S Engebretsen, Henry Wamani, Charles Karamagi, Nulu Semiyaga, James Tumwine, Thorkild Tylleskär, Ingunn Marie S Engebretsen, Henry Wamani, Charles Karamagi, Nulu Semiyaga, James Tumwine, Thorkild Tylleskär

Abstract

Background: Exclusive 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.

Methods: A 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.

Results: Breastfeeding 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).

Conclusion: Even 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.

Figures

Figure 1
Figure 1
The proportion being exclusively breastfed (EBF), predominantly breastfed (PBF), complementary fed (CF) and replacement fed (RF) according to the recall since birth.
Figure 2
Figure 2
The proportion being exclusively breastfed (EBF), predominantly breastfed (PBF), complementary fed (CF) and replacement fed (RF) according to the 24-hour recall.
Figure 3
Figure 3
Introduction of the different food items for food items given to more than 20% of the infants, cumulative percentage. Median and range given.

References

    1. Bryce J, Terreri N, Victora CG, Mason E, Daelmans B, Bhutta ZA, Bustreo F, Songane F, Salama P, Wardlaw T. Countdown to 2015: tracking intervention coverage for child survival. Lancet. 2006;368:1067–1076. doi: 10.1016/S0140-6736(06)69339-2.
    1. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol. 2004;554:63–77.
    1. León-Cava N, Lutter C, Ross J, Martin L. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, USA, The Food and Nutrition Program (HPN), Pan American Health Organization (PAHO), The Linkages Project; 2002.
    1. Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet. 2003;361:1418–1423. doi: 10.1016/S0140-6736(03)13134-0.
    1. Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108:E67. doi: 10.1542/peds.108.4.e67.
    1. HIV and Infant Feeding Framework for Priority Action
    1. Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, Humphrey JH. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. Aids. 2005;19:699–708. doi: 10.1097/01.aids.0000166093.16446.c9.
    1. Kuhn L, Stein Z, Susser M. Preventing mother-to-child HIV transmission in the new millennium: the challenge of breast feeding. Paediatr Perinat Epidemiol. 2004;18:10–16. doi: 10.1111/j.1365-3016.2003.00528.x.
    1. Wamani H, Astrom AN, Peterson S, Tylleskar T, Tumwine JK. Infant and young child feeding in western Uganda: knowledge, practices and socio-economic correlates. J Trop Pediatr. 2005;51:356–361. doi: 10.1093/tropej/fmi048.
    1. Pool R, Nyanzi S, Whitworth JA. Breastfeeding practices and attitudes relevant to the vertical transmission of HIV in rural south-west Uganda. Ann Trop Paediatr. 2001;21:119–125.
    1. Watkins K. Human Developement report. New York, USA, United Nations Development Programme (UNDP); 2005.
    1. Musinguzi J. Kirungi W. Opio A. Madraa E. Biryahwaho B. Mulumba N . STD/HIV/AIDS Surveillance Report, June 2003. Kampala, Uganda, STD/AIDS Control Programme. Ministry of Health Uganda; 2003.
    1. Uganda Population and Housing Census 2002. Uganda Bureau of Statistics (UBOS)
    1. Cochran WG. Sampling Techniques. 3rd. New York, USA, John Wiley and Sons; 1977.
    1. Bennett S, Woods T, Liyanage WM, Smith DL. A simplified general method for cluster-sample surveys of health in developing countries. World Health Statistics Q. 1991;44:98–106.
    1. Piwoz E. Breastfeeding and replacement feeding practices in the context of mother-to-child transmission of HIV. An assessment tool for research. WHO/RHR/01.12, WHO/CAH/01.21. Geneva, Switzerland, World Health Organization, Department of Reproductive Health and Research (RHR), Department of Child and Adolescent Health and Development (CAH); 2001.
    1. Dewey KG. WHO Global Consultation on Complementary Feeding. , Pan American Health Organization (PAHO), World Health Organization (WHO); 2001. Guiding principles for complementary feeding of the breastfed child.
    1. Shirima R, Greiner T, Kylberg E, Gebre-Medhin M. Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania. Public Health Nutr. 2001;4:147–154.
    1. Baby Friendly Hospital Initiative (BFHI).
    1. Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 2006;117:e380–6. doi: 10.1542/peds.2005-1496.
    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365:891–900. doi: 10.1016/S0140-6736(05)71048-5.
    1. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005;365:977–988. doi: 10.1016/S0140-6736(05)71088-6.
    1. Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics. 2005;115:519–617.
    1. Bahl R, Frost C, Kirkwood BR, Edmond K, Martines J, Bhandari N, Arthur P. Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bulletin of the World Health Organization. 2005;83:418–426.
    1. Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. Jama. 2001;285:413–420. doi: 10.1001/jama.285.4.413.
    1. Demographic and Health Surveys
    1. Greiner T. Research on HIV and breastfeeding: definitions can make all the difference. Acta Paediatr. 2002;91:615–616. doi: 10.1080/080352502760068981.
    1. Ssenyonga R, Muwonge R, Nankya I. Towards a better understanding of exclusive breastfeeding in the era of HIV/AIDS: a study of prevalence and factors associated with exclusive breastfeeding from birth, in Rakai,Uganda. J Trop Pediatr. 2004;50:348–353. doi: 10.1093/tropej/50.6.348.
    1. Uganda Demographic and Health Survey 2000-2001. Calverton, Maryland, USA, Uganda Bureau of Statistics Entebbe (UBOS) and ORC Macro; 2001.
    1. Lauer JA, Betran AP, Victora CG, De Onis M, Barros AJ. Breastfeeding patterns and exposure to suboptimal breastfeeding among children in developing countries: review and analysis of nationally representative surveys. BMC Med. 2004;2:26. doi: 10.1186/1741-7015-2-26.
    1. Bland RM, Rollins NC, Coutsoudis A, Coovadia HM. Breastfeeding practices in an area of high HIV prevalence in rural South Africa. Acta Paediatr. 2002;91:704–711. doi: 10.1080/080352502760069151.
    1. Aarts C, Kylberg E, Hornell A, Hofvander Y, Gebre-Medhin M, Greiner T. How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data. Int J Epidemiol. 2000;29:1041–1046. doi: 10.1093/ije/29.6.1041.
    1. Piwoz EG, Creed de Kanashiro H, Lopez de Romana G, Black RE, Brown KH. Potential for misclassification of infants' usual feeding practices using 24-hour dietary assessment methods. J Nutr. 1995;125:57–65.
    1. Vähätalo L, Bärlund S, Hannila ML, Uusitalo U, Pigg HM, Salonen M, Nucci A, Krischer JP, Knip M, Akerblom HK, Virtanen SM. Relative validity of a dietary interview for assessing infant diet and compliance in a dietary intervention trial. Maternal & child nutrition. 2006;2:181–187. doi: 10.1111/j.1740-8709.2006.00063.x.
    1. Agnarsson I, Mpello A, Gunnlaugsson G, Hofvander Y, Greiner T, Shirima R, Kylberg E, Gebre-Medhin M. Infant feeding practices during the first six months of life in a rural area in Tanzania. Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania. East Afr Med J. 2001;78:9–13.
    1. Zhao Y, Niu AM, Xu GF, Garrett MJ, Greiner T. Early infant feeding practices in Jinan City, Shandong Province, China. Asia Pac J Clin Nutr. 2003;12:104–108.
    1. Waruru AK, Nduati R, Tylleskär T. Audio computer-assisted self-interviewing (ACASI) may avert socially desirable responses about infant feeding in the context of HIV. BMC medical informatics and decision making. 2005;5:24. doi: 10.1186/1472-6947-5-24.

Source: PubMed

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