Prevalence of exclusive breastfeeding and its determinants in first 6 months of life: A prospective study

Introduction:

Breastfeeding provides adequate and essential nutrients
for infant’s growth and development, protects infants
against infections and ensures chances of survival. The
benefits of breastfeeding, especially exclusive
breastfeeding are well established^1,2 particularly in poor
environments where early introduction of other milk is
of particular concern because of risk of pathogens
contamination and over dilution of milk leading to
increased risks of morbidity and undernutrition.² Based
on scientific evidence, the World Health Organization
(WHO) recommends the practice of exclusive
breastfeeding the infants for first 6 months after their
birth, in addition to its continuation with supplementary
foods until 2 years or more.³ Till the beginning of this
century, breastfeeding was accepted and practiced as
routine. Data from last few years showed varied
improvement in breastfeeding rates.⁴ Studies have
proved with no doubt that children exclusively breast fed
are less prone to diseases such as diarrhea⁵ and
dehydration.⁶ There is also evidence that early
breastfeeding reduces the rate of hospitalization due to
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pneumonia.

Some studies⁸ reveal factors, positively associated with
exclusive breastfeeding, such as higher maternal
educational level, gestational age greater than 37 weeks,
mothers with previous experience of breastfeeding.
There are also studies that relate factors leading to
interruption of exclusive breastfeeding such as low
family income, low maternal age, primiparity and
mothers returning to work.⁹ Several studies intended to
define determinant variables in the success or failure of
breastfeeding^10,11, which could ease the planning of
promotional strategies. Nevertheless, it is always prudent
to consider that, as an eating habit, breastfeeding is
intrinsically related to social, cultural and traditional
patterns of a given population. This fact justifies need for
regional studies that allows more efficient action in
regard to measures for intervention, based on
knowledge of local reality. The objective of this study
was to evaluate the prevalence of exclusive
breastfeeding during first 6 months of life of babies in
Rajkot, and to identify factors that interfere with
practice.

Methods:

A prospective cohort study included women who gave
birth at maternity unit of Government Medical College &
Hospital, Rajkot and a tertiary care centre for the district.
Tertiary care hospital implies round the clock availability
of specialists like, obstetricians and gynecologists, anes-
thetists, and facilities for blood transfusion & other simil-
ar interventions. The present study was hospital based
and the hospital under study mainly caters people from
lower socio-economic strata. Breastfeeding found a com-
mon practice in these region of India and usually all the
mothers delivering offers breastfeeding to their infants
as soon as after birth. By considering prevalence rate of
exclusive breastfeeding 46% as per National Family
Health Survey (NFHS) -3, present study was planned with
purpose to know the prevalence rate in Rajkot.

Total 492 mothers recruited who delivered from 1s^t
January to 19^th February, 2007. The sample size
calculated was 460 infants, using EPI 6 software with
39.7% children exclusive breastfed upto 6 months⁴,
standard error of 5% and design effect 5. The study was
planned with purposive sampling, in which mothers were
included from the beginning of study period and on
achieving the calculated sample size, data collection was
terminated. By considering 10% lost to follow up, 492
mothers were considered for the study. Informed
consent was obtained from mothers who agreed to
participate in study. To minimize bias, mothers were
informed that the study was on infant feeding practices
rather than breastfeeding practices. Women recruited for
study were from homogenous group and their socio-
demographic variables did not differ from those who did
not participate in the study. Mothers were interviewed
by trained personnel either by home visits or telephone
call at 1, 3 and 6 months after delivery. Study group was
free from contraindications against breastfeeding (e.g.
newborn with severe malformations or mothers
seropositive for HIV). A mother who delivered infant
with congenital malformations was excluded. Among 492
mothers who had given consent to participate, 462
(93.9%) mothers could be interviewed 1 month after
delivery. Among these 462 mothers, 397 (85.9%) mothers
were interviewed by home visits and remaining 65
(14.1%) by telephone calls. Thirty mothers were lost to
follow up. Of these 30, eighteen mothers could not be
traced and 12 lost their interest in study. Successive
interviews were conducted at 3r^d and 6^th month after
delivery among the 462 mothers who were still
breastfeeding at 1 month by home visits (85.9%) and by
telephone calls (14.1%).

The questionnaire included information regarding
demographic profile and socioeconomic status of
mother and her family, obstetric history and infant
feeding practices. Breastfeeding was defined into
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following categories by World Health Organization :
exclusive breastfeeding as when child is fed exclusively
on human milk; predominant breastfeeding when child is
fed on human milk and other liquids like water, tea,
juices; general breastfeeding when all kind of milk, liquid
and semisolid diet is given.

Statistics

EPI 6 and Epi Info version 3.4 were used for data analysis,
adhering to the hierarchical model created previously,
with variables related to demography (baby’s sex,
maternal age) and socioeconomic factors (family income,
parent’s education) at first level, maternal characteristics
(parity, type of delivery, place of delivery, number of

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