Examination of key determinants of successful breastfeedingpractices in Bihar, India Open Access

Abstract

Introduction: Scaling breastfeeding practices up globally could prevent over 823,000 annual deaths in children younger than 5 years. Care India's Integrated Family Health Initiative (IFHI) focuses efforts on maternal and child health issues related to child nutrition including delivering services to encourage successful breastfeeding practices in Bihar, India.

Objective: The objectives were to 1) examine current early initiation of breastfeeding and exclusive breastfeeding practices in Bihar, India among 0-5 month infants; 2) identify key determinants of successful early initiation of breastfeeding and exclusive breastfeeding practices; 3) identify gaps, barriers and opportunities to desired breastfeeding practices within rural communities to improve IYCF programming in the future.

Methods: This study is a cross-sectional, secondary data analysis of existing CARE India monitoring data (n=31, 374) to analyze the key determinants of successful breastfeeding practices among in Bihar.

Results: Early initiation of breastfeeding was 53% among 0-2 months and exclusive breastfeeding was 66% and 46% for 0-2 months and 3-5 months, respectively. Key sociodemographic factors including maternal age, caste, SES, and education were associated with the success of breastfeeding. Early initiation of breastfeeding was strongly associated with exclusive breastfeeding among 0-2 month olds [OR=1.56, 95% CI (1.45, 1.69)]. Furthermore, mothers who were visited by a frontline worker (FLW) postpartum and were given breastfeeding advice were more likely to exclusively breastfeed.

Discussion: Breastfeeding counseling from community FLWs can increase early initiation and exclusive breastfeeding for women in a large scale program in Bihar. However, the success of this program is limited by the reach of FLWs and underlying sociodemographic factors.

Table of Contents

INTRODUCTION ...........................................................................................1

Ananya Program: CARE India's Integrated Family Health Initiative...................1

Research Question.........................................................................................3

Thesis Objectives ..........................................................................................3

BACKGROUND..............................................................................................4

Global burden of malnutrition........................................................................4

India.............................................................................................................6

Bihar.............................................................................................................7

Around the globe ...........................................................................................8

Purpose of Study...........................................................................................10

METHODS ...................................................................................................11

Study Design................................................................................................11

Lot Quality Assurance Sampling (LQAS+)........................................................11

Study Population & Sample Size....................................................................12

Outcome variables........................................................................................13

Sociodemographic factors.............................................................................14

Program operational factors..........................................................................14

Data Analysis...............................................................................................16

RESULTS......................................................................................................18

DISCUSSION................................................................................................39

Key Findings.................................................................................................40

Research Limitations ....................................................................................43

Research Strengths........................................................................................44

Program Gaps...............................................................................................45

Barriers........................................................................................................46

Opportunities...............................................................................................46

Program Recommendations...........................................................................47

Future Research............................................................................................49

CONCLUSION...............................................................................................52

REFERENCES................................................................................................53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition
Keyword	Breastfeeding India
Committee Chair / Thesis Advisor	Young, Melissa Fox, Emory University

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