Prevalence and Predictive Factors of Exclusive Breastfeeding in the First Six Months of Life
DOI:
https://doi.org/10.20344/amp.18692Keywords:
Breast Feeding, Infants, Mothers, PortugalAbstract
Introduction: Exclusive breastfeeding (EBF) is currently recommended until six months of age. The Baby-friendly Hospital (BFH) initiative an international program to promote breastfeeding, was launched in Portugal in 1994. The aim of this study was to identify the prevalence and factors influencing breastfeeding in the first six months of life and to compare the results with a study carried out in 1999 including population from the same geographic area.
Material and Methods: A prospective, longitudinal and observational study was carried out in two hospitals in the Lisbon metropolitan area, one BFH and another non-BFH. It consisted of different questionnaires answered by mothers at three distinct moments (zero, three and six months). The first questionnaire was applied between February and June 2019.
Results: A total of 423 infants were included, 324 from the BFH and 99 from the non-BFH. The breastfeeding rate was 94.3% at discharge, 78.2% at three months and 64.4% at six months, whereas EBF rate was 74.2%, 51.8% and 25.6% respectively. All women on EBF at six months, except one, were breastfeeding on demand. The discontinuation of EBF was associated with delayed skin-to-skin contact, Neonatal Intensive Care Unit admission, pacifier and artificial teats use, mother’s return to work earlier and lower education levels. Conversely, factors that promote EBF were older gestational age, adequate birthweight, breastfeeding initiation in the first hour of life, rooming-in practice, shorter hospital stay and absence of infant’s illnesses. Compared with 1999, although there was a significant improvement of breastfeeding rates at three and six months, the EBF rate was similar at six months (23%). Both studies identified the mother’s lower education level and mother’s return to work as contributing factors to breastfeeding discontinuation.
Conclusion: Our results are in agreement with previously reported causes of breastfeeding discontinuation and emphasize the importance of sociocultural factors. Compared with 1999, the breastfeeding rates in this Portuguese population increased significantly at three and six months. However, it is still necessary to improve in order to achieve the World Health Organization global target.
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References
Silva T. Aleitamento materno: prevalência e factores que influenciam a duração da sua modalidade exclusiva nos primeiros seis meses de idade. Acta Pediatr Port. 2013;44:223–8.
Chaves R, Lamounier J, César C. Fatores associados com a duração do aleitamento materno. J Pediatr. 2007;83:241–6. DOI: https://doi.org/10.1590/S0021-75572007000400009
World Health Organization. Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. 2017. [cited 2021 Feb 15]. Available from: https://apps.who.int/iris/handle/10665/259386.
Aguiar H, Silva A. Aleitamento materno: a importância de intervir. Acta Med Port. 2011;24:889–96.
Caldeira T, Moreira P, Pinto E. Aleitamento materno: estudo dos factores relacionados com o seu abandono. Rev Port Clín Geral. 2007;23:685–99. DOI: https://doi.org/10.32385/rpmgf.v23i6.10424
Macenroe T. The baby-friendly hospital initiative. Breastfeed Med. 2010;5:247. DOI: https://doi.org/10.1089/bfm.2010.0035
Kislaya I, Braz P, Dias CM, Loureiro I. Evolução do aleitamento materno em Portugal: dados dos inquéritos nacionais de saúde entre 1995-2014. Instituto Nacional de Saúde. 2014. [cited 2018 Jun 18]. Available from: http://repositorio.insa.pt/handle/10400.18/6110.
Portugal. Decreto-Lei n.º 7/2009. Diário da República, I Série, n.º 30 (2019/02/12).
Lanzaro C, Santos P, Guerra A, Hespanhol A, Esteves MJ. Prevalência do aleitamento materno: comparação entre uma população urbana e uma população rural no norte de Portugal. Acta Pediatr Port. 2015,46:101–8.
Alves A, Lamy S, Henriques G, Virella D, Carreiro H, Lynce N, et al. Aleitamento materno nos concelhos de Cascais, Amadora e Sintra. Saúde Infantil. 1999,21:43–50.
Oliveira M. Aleitamento materno: estudo de prevalência e fatores condicionantes nos primeiros seis meses de vida. Pensar Enfermagem. 2016;20:4–15. DOI: https://doi.org/10.56732/pensarenf.v20i1.111
Piper S, Parks P. Predicting the duration of lactation: evidence from a national survey. Birth. 1996;23:7–12. DOI: https://doi.org/10.1111/j.1523-536X.1996.tb00454.x
Ford K, Labbok M. Who is breast-feeding? implications of associated social and biomedical variables for research on the consequences of method of infant feeding. Am J Clin Nutr. 1990,52:451–6. DOI: https://doi.org/10.1093/ajcn/52.3.451
Arora S, Mcjunkin C, Wehrer J, Kuhn P. Major factors influencing breastfeeding rates: mother’s perception of father’s attitude and milk supply. Pediatrics. 2000;106:67. DOI: https://doi.org/10.1542/peds.106.5.e67
Shiva F. Barriers to breast feeding: a review. Arch Pediatr Infect Dis. 2015;3:1–5. DOI: https://doi.org/10.5812/pedinfect.23516
Oyelana O, Kamanzi J, Richter S. A critical look at exclusive breastfeeding in Africa: through the lens of diffusion of innovation theory. Int J Afr Nurs. 2021;14:1391-2214. DOI: https://doi.org/10.1016/j.ijans.2020.100267
Venancio S, Saldiva S, Mondini L, Levy R, Escuder M. Early interruption of exclusive breastfeeding and associated factors, state of São Paulo, Brazil. J Hum Lact. 2008;24:168–74. DOI: https://doi.org/10.1177/0890334408316073
Cramton R, Zain-Ul-Abideen M, Whalen B. Optimizing successful breastfeeding in the newborn. Curr Opin Pediatr. 2009;21:386–96. DOI: https://doi.org/10.1097/MOP.0b013e32832b325a
Weng D, Hsu CS, Gau ML, Chen CH, Li CY. Analysis of the outcomes at baby-friendly hospitals: appraisal in Taiwan. Kaohsiung J Med Sci. 2003;19:19–27. DOI: https://doi.org/10.1016/S1607-551X(09)70443-7
Setegn T, Belachew T, Gerbaba M. Factors associated with exclusive breastfeeding practices among mothers in Goba district, south east Ethiopia: a cross-sectional study. Int Breastfeed J. 2012;7:1–8. DOI: https://doi.org/10.1186/1746-4358-7-17
Ortiz P, Rolim R, Souza M, Soares P, Vieira T, Vieira G, et al. Comparing breast feeding practices in baby friendly and non-accredited hospitals in Salvador, Bahia. Rev Bras Saude Matern Infant. 2011;11:405–13. DOI: https://doi.org/10.1590/S1519-38292011000400007
Venancio S, Monteiro C. Individual and contextual determinants of exclusive breast-feeding in São Paulo, Brazil: a multilevel analysis. Public Health Nutr. 2006;9:40–6. DOI: https://doi.org/10.1079/PHN2005760
Rebimbas S. Aleitamento materno: análise da situação num meio semi-urbano. Nascer crescer. 2010;19.
Barge S, Carvalho M. Prevalência e fatores condicionantes do aleitamento materno – Estudo ALMAT. Rev Port Clin Geral. 2011;27:518–25. DOI: https://doi.org/10.32385/rpmgf.v27i6.10900
Babakazo P, Donnen P, Akilimali P, Ali N, Okitolonda E. Predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa: a prospective study. Int Breastfeed J. 2015;10:1–9. DOI: https://doi.org/10.1186/s13006-015-0044-7
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