Infant feeding modalities addressed in two different ways in Eastern Uganda

Abstract

Background: Durations of exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) from two different assessments, among the same mother-infant population, were investigated to determine the degree to which the assessments yielded overlapping results.

Methods: Thirty Ugandan mother-infant pairs were followed up weekly from birth to three months of age with weekly short-time feeding recall: the 24-hour recall asked prior to the 1-week recall. In addition, at week 6 and 12 dietary recalls since-birth were conducted. Variables for the duration of EBF and PBF were created from the short-time feeding recalls and the dietary recalls since-birth, respectively. Mean durations of EBF and PBF from the two assessments were compared with Kaplan Meier analysis at week 6 and 12. Reproducibility of dietary recall instruments was also assessed.

Results: At six weeks postpartum the mean durations of EBF were 0.50 weeks (95% CI: 0, 1.02) according to the weekly short-time recalls and 1.51 weeks (95% CI: 0.66, 2.35) according to the recall since-birth (Mantel-Cox test, p = 0.049). The mean durations of PBF were 4.07 weeks (95% CI: 3.38, 4.77) according to the frequent short-time recalls and 4.50 weeks (95% CI: 3.93, 5.07) according to the recall since-birth, (Mantel-Cox-test, p = 0.82). At twelve weeks the mean durations of EBF were 0.5 weeks (95% CI: 0, 1.1) according to the weekly short-time recalls and 1.4 weeks (95% CI: 0.1, 2.7) according to the recall since-birth (Mantel-Cox-test, p = 0.15). The mean durations of PBF were 5.2 weeks (95% CI: 3.9, 6.5) according to the weekly short-time recalls and 6.6 weeks (95% CI: 5.4, 7.8) according to recall since-birth (Mantel-Cox-test, p = 0.20). Reports of feeding categories and early feeding practices showed high reproducibility.

Conclusion: Comparing duration of EBF and PBF in this group of mother-infant pairs showed overlapping results from the weekly short-time assessment and the recall since-birth at twelve weeks, with the latter yielding slightly longer duration of the respective feeding modalities. The retrospective recall since-birth could be assessed as a cost-reducing tool compared to the frequent follow-up addressing duration of respective infant feeding modalities for evaluation of programmes promoting safer infant feeding practices.

Trial registration: The study was part of formative studies for the ongoing study PROMISE EBF registered at https://ichgcp.net/clinical-trials-registry/NCT00397150" title="See in ClinicalTrials.gov">NCT00397150.

Figures

Figure 1

Comparison of short-time and 'since birth' dietary assessments for introduction of predominant breastfeeding (PBF), 6 weeks. Kaplan-Meier curves illustrating proportion introducing water, water-based drinks, oral rehydration salts or fruit juices to breastfed infants (PBF) according to the frequent short-time recall, 24-hour recall and weekly 1-week recall (red) and recall 'since-birth' (blue) dietary assessments at six weeks.

Figure 2

Comparison of short-time and 'since birth' dietary assessments for introduction of mixed feeding (MF), 6 weeks. Kaplan-Meier curves illustrating proportion introducing milk and semi-solid feeds to breastfed infants (MF) according to the frequent short-time recall, 24-hour recall and weekly 1-week recall (red) and recall 'since-birth' (blue) dietary assessments at six weeks.

Figure 3

Comparison of short-time and 'since birth' dietary assessments for introduction of predominant breastfeeding (PBF), 12 weeks. Kaplan-Meier curves illustrating proportion introducing water, water-based drinks, oral rehydration salts or fruit juices to breastfed infants (PBF) according to the frequent short-time recall, 24-hour recall and weekly 1-week recall (red) and recall 'since-birth' (blue) dietary assessments at twelve weeks.

Figure 4

Comparison of short-time and since birth dietary assessments for introduction of mixed feeding (MF), 12 weeks. Kaplan-Meier curves illustrating proportion introducing milk and semi-solid feeds to breastfed infants (MF) according to the frequent short-time recall, 24-hour recall and weekly 1-week recall (red) and recall 'since-birth' (blue) dietary assessments at twelve weeks.

Figure 5

a-b: Use of items qualifying for predominant breastfeeding (PBF) and mixed feeding (MF) for individuals by weekly assessment. The illustrations represent water-based items, ORS and fruit juices among breastfed infants (qualifying for PBF) (grid pattern, left, 5a) and milk-based and semi-solid items among breastfed infants (qualifying for MF) (line pattern, right, 5b) given to 30 Ugandan infants from the age of 0 to 12 weeks. The information is based on weekly short-time recall (24-hour recall and 1-week recall). Each row represent one infant and each column represent one week in Figure a and b, respectively. The individuals in the two figures are linked with given numbers from 1-30. Gray pattern represents missed visits.