Prevalence and predictive factors for breastfeeding in the first 6 months among mothers attending Primary Healthcare Centers in Cairo, Egypt

Abstract

reastfeeding is the ideal feeding type suitable for the physiological and psychological requirements of infants, not only because breast milk has great nutritional values, but also it is clean and rich in antibodies that protect the infant against many famous childhood illnesses, beside that it is always at the suitable temperature, cheap and almost every mother has more than sufficient of such good quality nutrition for her infant. Breastfeeding for at least one year is the international recommendations of most organizations due to its well-known valuable effects. The prevalence of breastfeeding in many developing countries is quite low, the Egyptian DHS (2014) reported a prevalence of exclusive breastfeeding at 4-5 months to be 13%, the current prevalence of breastfeeding and predictive factors for its discontinuation are not well-known. Both AAF and The U.S. Preventive Services Task Force recommend primary care interventions to support breastfeeding and improve breastfeeding duration and rates, as family Physicians understand the advantages of family-centered care and are well positioned to provide breastfeeding support in that context as they provide comprehensive care to the whole family, family physicians have an opportunity to provide breastfeeding education and support throughout the course of life to all family members. To identify prevalence and predictive factors affecting breastfeeding in Egypt, a cross sectional study included mothers attended first six months immunization sessions in PHC centres in Cairo, Egypt is conducted. Three Primary Healthcare Centres were selected via convenient sample, and systematic random sample is used to select the participants from each center. Data collection took the period from April to August 2019. Infants with specific health problems who needed special feeding programs were excluded. Infants with any obvious congenital anomalies or features of genetic diseases or if they had a medical history of any metabolic errors or physical problems were also excluded. The estimated sample size was 174 infants with their mothers (approximated to 180), thus60 were the needed from every center, as exclusive breastfeeding prevalence rate is 13% in the first 4-5 months according to EDHS 2014. The official records of Cairo governorate showed that the catchment areas of the three selected PHC have yearly 25,000 newborns according to City Population 2019. Sample size was calculated with precision 5% and 95% confidence interval specified limits. Sample size was calculated using EpiDat 4.2 program. Data collection done via questionnaire, which was adopted from questionnaire for monitoring breastfeeding mothers in baby friendly hospitals, it was translated into Arabic, and pre-tested before using it. It comprises 51 main questions with some subsidiary questions investigating personal and medical characteristics of the mothers and their infants, in addition to mother's knowledge, health education and breastfeeding practice. This was conducted in the form of interview questionnaire. Standard of living was calculate and classified to high, medium and low according to Fahmy and El-Sherbini (1983) modified by Awad et al. (2014). Comparison between participants in the three centers was done according to previously mentioned variables was done in addition to comparison between exclusive and non-exclusive breastfeeding participant mothers according to possible risk factors, statistical analysis was done via using Chi-square test; Independent t-test; Mann-Whitney test, with level of significance has been set at P-value > 0.05: Non-significant; P-value < 0.05: Significant; P-value < 0.01: Highly significant. The adjusted predictive factors for Exclusive Breastfeeding were obtained by logistic regression analysis. The dependent variable was the presence or absence of Exclusive Breastfeeding in all the participants. All variables described previously were considered as possible candidates for the final model. The initial multivariable model construction consisted of the preliminary selection of variables using a manual purposeful selection method and a relatively high significance level (alpha approximately 0.10). Subsequently, the resulting model was reduced using a likelihood ratio test with a significance level of 0.05. Before accepting a final model, the interactions as well as confounding factors were evaluated. The calibration of the final model was assessed using the Hosmer and Lemeshow goodness-of-fit test, and its discrimination was assessed by the area under the receiver operator characteristic (ROC) curve. Shows discrimination (area under the receiver operating characteristics curve): 0.57.Ethical considerations included administrative approval of the Primary Healthcare Centers where data collection took place, ethical approval was obtained from research Ethics Committee of faculty of medicine Ain Shams University and verbal informed consent from study participants was obtained before answering the questionnaire and the questionnaire was anonymous. The study reviled that, the frequency of breastfeeding among the participants was (90.6%), and the total (0-6 months) exclusive breastfeeding frequency was (39.4%). Our logistic regression model showed that exclusive breastfeeding decreases with progressive increase in infant’s age with OR 0.74, mothers with good knowledge about proper practice of breastfeeding (e.g. infant’s chin should be immersed in mother's breast and most nipple halo in the infant lower lip) adhered more to exclusive breastfeeding with OR 2.51. Our multivariate analysis showed that during working hours, mothers who fed their infants other than breast milk adhered less to exclusive breastfeeding with OR 0.19,and it is very obvious In this study, although there is high frequency of breastfeeding among our sample , the frequency of exclusive breastfeeding is dropping and this could be referred to certain predictive factors which are clearly evidenced in our study such as improper breastfeeding practice, which could be due to insufficient health education and lactation consultations about feeding breast milk which supposed to be given to the mothers during their all attended medical visits starting from perinatal visits, frequent infant vaccine visits even in any health visit, the percentage of participants awareness about advantages of breastmilk is high but for breastfeeding practice is low , as most of the mothers replied that they are aware that successful breastfeeding is painless but they are not aware about prevention and early management of it if it happened, not only that but also they are not practicing the part of theoretical health education which was given to them as more than 30% of them received health education about breast milk expression and storage but no one of the employee mothers practicing these important information. The most catastrophic thing that they are not oriented about their actual gap of knowledge and its drawbacks on their breastfeeding practice, as all of the non-exclusively breastfeeding mothers denied that the reason to be due to lack of knowledge about breastfeeding, unclearly, they refer the reason to unknown causes need to be investigated, also not all of them are aware about early initiation of breastfeeding and most of them started breastfeeding late, beside their poor level of perception about proper assessment of breastfeeding sufficiency and baby positioning and latching, all of these are vital practical steps for successful breastfeeding techniques that is supposed not to be missed, added to that low awareness rate about dealing with common breastfeeding problems especially among mothers for the first time example painful breastfeeding, only (11.7%) know that they need to correct the position of the child and his attachment to the breast, depressively only (13.5%) of them aware about need to reduce breastfeeding from painful breast, in addition to low percentage of practical consultations about feeding breast milk after child delivery, unfortunately, the mothers are not aware about their lack of knowledge about important steps in clinical practice of breastfeeding and all these are very crucial obstacles against successful breastfeeding. Conclusively, the prevalence of exclusive breastfeeding is 39.4, the predictive factors for exclusive breastfeeding are, younger infant’s age, good knowledge of the mothers about proper practice of breastfeeding, mothers insisting breastfeeding during working hours.