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BMC Pediatrics

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Open Access 01-12-2016 | Research article

The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal

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

Published in: BMC Pediatrics | Issue 1/2016

Abstract

Background

While the initiation of breastfeeding is universal in Nepal, little has been reported on formula feeding practices. This study aimed to report the prevalence of, and factors associated with, the use of infant formula as supplementary feeds in the Western region of Nepal.

Methods

A community-based cohort study was conducted to collect infant feeding information among 735 postpartum mothers using structured questionnaires. Complete formula feeding data were collected from 711 women in the first, fourth and sixth month postpartum. Factors independently associated with formula feeding were investigated using multiple logistic regression.

Results

All mothers were breastfeeding their infants at the time of recruitment. The prevalence of formula feeding was 7.5 % in the first month and 17 % in the sixth month. About a quarter of mothers (23.8 %) reported providing infant formula at least once during the first six months of life. Infant formula was used commonly as top-up food. Stepwise logistic regression showed that infants born to families residing in urban areas (adjusted odds ratio (aOR): 2.14; 95 % confidence interval (CI): 1.37 to 3.33), mothers with higher education (aOR: 2.08; 95 % CI: 1.14 to 3.80), and infants born by caesarean section (aOR: 1.96; 95 % CI: 1.21 to 3.18) were at greater risk of formula feeding.

Conclusion

The current findings indicate that health workers should support mothers to initiate and continue exclusive breastfeeding particularly after caesarean deliveries. Furthermore, urban health programs in Nepal should incorporate breastfeeding programs which discourage the unnecessary use of formula feeding. The marketing of formula milk should be monitored more vigilantly especially in the aftermath of the April 2015 earthquakes or other natural disasters.

Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71.CrossRefPubMed

Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.CrossRefPubMed

Brady JP. Marketing breast milk substitutes: problems and perils throughout the world. Arch Dis Child. 2012;97:529–32.CrossRefPubMedPubMedCentral

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.CrossRefPubMed

Hipgrave DB, Assefa F, Winoto A, Sukotjo S. Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java. Public Health Nutr. 2012;15(02):307–15.CrossRefPubMed

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

Goldman AS. Modulation of the Gastrointestinal Tract of Infants by Human Milk. Interfaces and Interactions. An Evolutionary Perspective. J Nutr. 2000;130(2):426.

Binns CW, Lee MK, Tang L, Yu C, Hokama T, Lee A. Ethical Issues in Infant Feeding After Disasters. Asia Pac J Public Health. 2012;24(4):672–80.CrossRefPubMed

Karkee R, Lee AH, Khanal V, Binns CW. Infant feeding information, attitudes and practices: a longitudinal survey in central Nepal. Int Breastfeed J. 2014;9(1):14.CrossRefPubMedPubMedCentral

10.

Ministry of Health and Population (MOHP) [Nepal], New ERA, ICF International Inc. Nepal Demographic and Health Survey 2011. Kathmandu; Calverton: Ministry of Health and Population; New ERA, and ICF International; 2012.

11.

Ministry of Health and Population: Annual Report. In. Kathmandu; 2013.

12.

Government of Nepal. In: Population MoHa, editor. Substitute for the Breast Milk (Sale, Distribution and Control) Act 2049. Kathamndu, Nepal: Government of Nepal; 1992.

13.

Price JI, Bohara AK. Maternal health care amid political unrest: the effect of armed conflict on antenatal care utilization in Nepal. Health Policy Plan. 2013;28(3):309–19.CrossRefPubMed

14.

Rice, lactogen distributed at Laprak uneatable [http://www.ekantipur.com/2015/06/25/top-story/rice-lactogen-distributed-at-laprak-uneatable/407046.html]. Accessed 26 June 2015.

15.

Joshi N, Agho KE, Dibley MJ, Senarath U, Tiwari K. Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary data analysis of Demographic and Health Survey 2006. Matern Child Nutr. 2012;8(s1):45–59.CrossRefPubMed

16.

Khanal V. Factors Associated With Low Birth Weight and Infant and Young Child Feeding Practices From the Deomgraphic and Health Survey in Nepal. Perth: Curtin University; 2012.

17.

District Public Health Office Rupandehi. Annual Repport. Bhairahawa, Nepal: DPHO, Rupandehi; 2010.

18.

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

19.

Karkee R, Lee A, Khanal V, Binns C. A community-based prospective cohort study of exclusive breastfeeding in central Nepal. BMC Public Health. 2014;14(1):927.CrossRefPubMedPubMedCentral

20.

Karkee R, Lee AH, Khanal V, Binns CW. Initiation of Breastfeeding and Factors Associated with Prelacteal Feeds in Central Nepal. J Hum Lact. 2014;30:353–7.CrossRefPubMed

21.

Khanal V, Lee A, Karkee R, Binns C: Postpartum breastfeeding promotion and duration of exclusive breastfeeding western Nepal. Birth 2015, Online first. 42:329–6.

22.

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.CrossRefPubMedPubMedCentral

23.

Child Health Division. Assessment of the Community Based Newborn Care Package. Kathmandu, Nepal: Child Health Division, Ministry of Health and Population, Nepal; 2012.

24.

Sethi M, Mishra D. Display of feeding bottles in advertising renditions. Indian J Pediatr. 2006;73(1):104–5.CrossRefPubMed

25.

Rosenberg KD, Eastham CA, Kasehagen LJ, Sandoval AP. Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. Am J Public Health. 2008;98(2):290.CrossRefPubMedPubMedCentral

26.

District Public Health Office Rupandehi. Annual Repport. Bhairahawa, Nepal: DPHO, Rupandehi; 2014.

27.

Statistics [http://www.unicef.org/infobycountry/nepal_nepal_statistics.html]. Accessed 3 Mar 2016.

28.

Ministry of Health and Population. Community Based Newborn Care Program (CB-NCP): Training Package for Health Facility Staff. Kathmandu, Nepal: Ministry of Health and Population, and Child Health Division; 2010.

29.

Zanardo V, Svegliado G, Cavallin F, Giustardi A, Cosmi E, Litta P, Trevisanuto D. Elective Cesarean Delivery: Does It Have a Negative Effect on Breastfeeding? Birth. 2010;37(4):275–9.CrossRefPubMed

30.

Khanal V, Lee AH, da Cruz J, Karkee R. Prelacteal Feeding of Newborns in Post-Conflict Timor-Leste. J Pediatr Gastroenterol Nutr. 2014;59:162–6.CrossRefPubMed

31.

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. 2015;105:24–30.

32.

Patel RR, Liebling RE, Murphy DJ. Effect of Operative Delivery in the Second Stage of Labor on Breastfeeding Success. Birth. 2003;30(4):255–60.CrossRefPubMed

33.

WHO. How to Prepare Formula for Bottle-Feeding at Home. Ireland: WHO and FAO; 2007.

34.

Khanal V, da Cruz JLNB, 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

35.

Smith JP, McIntyre E, Craig L, Javanparast S, Strazdins L, Mortensen K. Workplace support, breastfeeding and health. 2013.

36.

Khanal V, Khanal P, Lee AH. Sustaining progress in maternal and child health in Nepal. Lancet. 2015;385:2573.

37.

Lawrence RA. Disasters at home and abroad. Breastfeed Med. 2011;6(2):53–4.CrossRefPubMed

38.

Bai Y, Middlestadt SE, Peng C-YJ, Fly AD. Predictors of Continuation of Exclusive Breastfeeding for the First Six Months of Life. J Hum Lact. 2009;26:26–34.

39.

Binns C, Scott JA. Breastfeeding: reasons for starting, reasons for stopping and problems along the way. Breastfeed Rev. 2002;10(2):13–9.

40.

Dubois L, Girard M. Social determinants of initiation, duration and exclusivity of breastfeeding at the population level - The results of the Longitudinal Study of Child Development in Quebic (ELDEQ 1998-2002). Can J Public Health. 2003;94(4):300–5.PubMed

41.

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(6):1041–6.CrossRefPubMed

Title: The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal
Authors: Vishnu Khanal
Jane A. Scott
Andy H. Lee
Rajendra Karkee
Colin W. Binns
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2016
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-016-0602-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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