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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study

Authors: Vishnu Khanal, Andy H. Lee, Jane A. Scott, Rajendra Karkee, Colin W. Binns

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Correct measurement and continuous monitoring of exclusive breastfeeding are essential to promote exclusive breastfeeding. Measuring exclusive breastfeeding is a complex issue as rates can vary according to the definition, measurement period, questions asked, and infant’s age. This article reviewed the methodology of reporting exclusive breastfeeding in Nepal, and compared exclusive breastfeeding rates using data from a cohort study undertaken in western Nepal.

Methods

A literature review was first conducted on studies published during 2000–2014. In our cohort study, 735 mother-infant pairs were recruited within the first month postpartum and followed up during the fourth and sixth months.

Results

The majority of studies in Nepal, including national surveys, used the World Health Organization (WHO) recommended definition (only breastmilk with the exception of medicine and vitamin syrup), and the most common measurement period was a 24-h recall. Our data demonstrated that the exclusive breastfeeding rate during the sixth month was 8.9% using the recall-since-birth method but was 18.7% using the 24-h recall method. Substantial differences in rates were also found during the first (66.3% vs 83.9%) and fourth months (39.2% vs 61.1%).

Conclusion

We found that recent studies reporting exclusive breastfeeding in Nepal varied considerably in methodology. The most commonly used measurement, the 24-h recall, leads to over-estimation of the prevalence of exclusive breastfeeding when compared to the recall-since-birth method. A common standard of reporting exclusive breastfeeding is clearly needed for evidence-based decision making.
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Literature
1.
Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the agency for healthcare research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(S1):S-17-S-30.CrossRef
2.
Horta B, Bahl R, Martines JC, Victora C. Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses. Geneva, Switzerland: WHO; 2007.
3.
Horta BL, Loret de Mola C, Victora CG. Breastfeeding and intelligence: A systematic review and meta-analysis. Acta Paediatr. 2015;104(S467):14–9.CrossRefPubMed
4.
Thompson AL, Monteagudo-Mera A, Cadenas MB, Lampl ML, Azcarate-Peril MA. Milk-and solid-feeding practices and daycare attendance are associated with differences in bacterial diversity, predominant communities, and metabolic and immune function of the infant gut microbiome. Front Cell Infect Microbiol. 2015;5.
5.
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. Bull World Health Organ. 2005;83(6):418–26.PubMedPubMedCentral
6.
Mobbs EJ, Mobbs GA, Mobbs AE. Imprinting, latchment and displacement: a mini review of early instinctual behaviour in newborn infants influencing breastfeeding success. Acta Paediatr. 2016;105(1):24–30.CrossRefPubMed
7.
Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R. Optimal breastfeeding practices and infant and child mortality– A systematic review and meta-analysis. Acta Paediatr. 2015;104:3–13.CrossRefPubMed
8.
Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 2016;387(10017):475–90.CrossRef
9.
World Health Organization. Comprehensive implementation plan on maternal, infant and young child nutrition. Geneva: WHO; 2014.
10.
11.
12.
13.
WHO. Indicators for Assessing Breastfeeding Practices. Geneva: WHO; 1991.
14.
WHO. Indicators for assessing infant and young child feeding practices : conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C., USA. Washington DC, USA: WHO; 2008.
15.
Binns CW, Fraser ML, Lee AH, Scott J. Defining exclusive breastfeeding in Australia. J Paediatr Child Health. 2009;45(4):174–80.CrossRefPubMed
16.
Khanal V, Adhikari M, Sauer K, Zhao Y. Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal demographic and health survey 2011. Int Breastfeed J. 2013;8:9.CrossRefPubMedPubMedCentral
17.
Patel A, Banerjee A, Kaletwad A. Factors Associated with Prelacteal Feeding and Timely Initiation of Breastfeeding in Hospital-Delivered Infants in India. J Hum Lact. 2013;29:572–8.CrossRefPubMed
18.
19.
Aarts C, Kylberg E, Hörnell 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;29:1041–6.CrossRefPubMed
20.
Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev. 2005;63(4):103–10.CrossRefPubMed
21.
Win NN, Binns CW, Zhao Y, Scott JA, Oddy WH. Breastfeeding duration in mothers who express breast milk: a cohort study. Int Breastfeed J. 2006;1(28):1–5.
22.
Binns C, Lee A, Sauer K, Hewitt K. Reported breastfeeding rates in the Asia-pacific region. Curr Pediatr Rev. 2012;8(4):339–45.CrossRef
23.
Agampodi SB, Agampodi TC, De Silva A. Exclusive breastfeeding in Sri Lanka: problems of interpretation of reported rates. Int Breastfeed J. 2009;4(14):4358–4.
24.
Department of Health Services, Ministry of Health and Population. Annual Report 2013/2014. Kathmandu: Department of Health Services, Ministry of Health and Population; 2014.
25.
Ministry of Health and Population (MOHP) [Nepal], New ERA, ICF International Inc. Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland: Ministry of Health and Population (MOHP) [Nepal], New ERA, & ICF International Inc; 2012.
26.
Ministry of Health and Population (MOHP) [Nepal], New ERA, Inc II. Nepal Demographic and Health Survey 2001. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland; 2002; 2002.
27.
Ministry of Health and Population (MOHP) [Nepal], New ERA, Macro International Inc. Nepal Demographic and Health Survey 2006. Kathmandu [Nepal]: Ministry of Health and Population (MOHP) [Nepal],New ERA,and Macro International Inc.; 2007.
28.
Karkee R, Lee AH, Khanal V, Binns CW. A community-based prospective cohort study of exclusive breastfeeding in central Nepal. BMC Public Health. 2014;14.
29.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and ElaborationPRISMA: Explanation and Elaboration. Ann Intern Med. 2009;151(4):W-65.CrossRef
30.
Central Bureau of Statistics, UNICEF. Nepal Multiple Indicator Cluster Survey 2010-Mid and Far western regions. Kathmandu, Nepal: Central Bureau of Statistics, UNICEF,& MICS; 2012.
31.
Khanal V, Scott JA, Lee AH, Karkee R, Binns CW. Factors associated with Early Initiation of Breastfeeding in Western Nepal. Int J Environ Res Public Health. 2015;12(8):9562–74.CrossRefPubMedPubMedCentral
32.
Khanal V, Lee A, Karkee R, Binns C. Postpartum breastfeeding promotion and duration of exclusive breastfeeding western Nepal. Birth. 2015;42(4):329-36.
33.
USAID, FANTA, AED, UC DAVIS, IFPRI. Indicators for assessing infant and young child feeding practices part 2: measurement. Geneva: The World Health Organization; 2010.
34.
Dibley MJ, Roy SK, Senarath U, Patel A, Tiwari K, Agho KE, Mihrshahi S, South Asia Infant Feeding Research N. Across-country comparisons of selected infant and young child feeding indicators and associated factors in four South Asian countries. Food Nutr Bull. 2010;31(2):366–75.CrossRefPubMed
35.
Pandey S, Tiwari K, Senarath U, Agho K, Dibley MJ. Determinants of Infant Feeding Practices in Nepal: Analyses of 2006 Demographic and Health Survey Data. Ann Nutr Metab. 2006;2009(55):233–3.
36.
Khanal V, Sauer K, Zhao Y: Exclusive breastfeeding practices in relation to social and health determinants: a comparison of the 2006 and. Nepal Demographic and Health Surveys. BMC Public Health. 2011;2013:13.
37.
Subedi N, Paudel S, Rana T, Poudyal AK. Infant and young child feeding practices in Chepang communities. JNHRC. 2012;10(21):141–6.
38.
Ulak M, Chandyo RK, Mellander L, Shrestha PS, Strand TA. Infant feeding practices in Bhaktapur, Nepal: a cross-sectional, health facility based survey. Int Breastfeed J. 2012;7(1):1.CrossRefPubMedPubMedCentral
39.
Chandrashekhar TS, Joshi HS, Binu V, Shankar PR, Rana MS, Ramachandran U. Breast-feeding initiation and determinants of exclusive breast-feeding - a questionnaire survey in an urban population of western Nepal. Public Health Nutr. 2007;10(2):192–7.CrossRefPubMed
40.
Subba SH, Chandrashekhar TS, Binu VS, Joshi HS, Rana MS, Dixit SB. Infant feeding practices of mothers in an urban area in Nepal. KUMJ. 2007;5(1):42–7.PubMed
41.
Locks LM, Pandey PR, Osei AK, Spiro DS, Adhikari DP, Haselow NJ, Quinn VJ, Nielsen JN. Using formative research to design a context-specific behaviour change strategy to improve infant and young child feeding practices and nutrition in Nepal. Matern Child Nutr. 2013;11(4):882-96.
42.
Khanal V, da Cruz JL, Karkee R, Lee AH. Factors associated with exclusive breastfeeding in Timor-Leste: findings from Demographic and Health Survey 2009-2010. Nutrients. 2014;6(4):1691–700.CrossRefPubMedPubMedCentral
43.
Karkee R, Lee AH, Khanal V, Binns CW. Infant feeding information, attitudes and practices: a longitudinal survey in central Nepal. International breastfeeding journal. 2014;9(1):14.CrossRefPubMedPubMedCentral
44.
Debes AK, Kohli A, Walker N, Edmond K, Mullany LC. Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review. BMC Public Health. 2013;13 Suppl 3:S19.CrossRefPubMedPubMedCentral
45.
Inoue M, Binns CW, Otsuka K, Jimba M, Matsubara M. Infant feeding practices and breastfeeding duration in Japan: A review. Int Breastfeed J. 2012;7(1):15.CrossRefPubMedPubMedCentral
46.
Senarath U, Dibley MJ, Agho KE. Factors associated with nonexclusive breastfeeding in five east and Southeast Asian countries: a multilevel analysis. J Hum Lact. 2010;26:248–57.CrossRefPubMed
Metadata
Title
Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study
Authors
Vishnu Khanal
Andy H. Lee
Jane A. Scott
Rajendra Karkee
Colin W. Binns
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1180-9

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