Attitude, self-efficacy, knowledge and intention to exclusively breastfeed among pregnant women in rural Bangladesh Público

Abstract

Attitude, self-efficacy, knowledge and intention to exclusively breastfeed among
pregnant women in rural Bangladesh
By Joan Sara Thomas
Background: Malnutrition is responsible for 60 percent of the 10.9 million deaths that
occur annually among children. Over two thirds of these deaths are directly associated
with inappropriate feeding practices and occur during the first year of life. Although
breastfeeding is almost universal in Bangladesh, exclusive breastfeeding is less
consistently practiced with a stagnant national prevalence of 42-46 percent for twelve
years. Intention to exclusively breastfeed is influenced by socioeconomic status, maternal
self-efficacy, knowledge and empowerment issues. Identifying those factors in a mother's
life that would influence her to engage in appropriate infant feeding practices is important
information for program development.
Objective: This thesis examines the associations among knowledge, attitudes, self-
efficacy and exclusive breastfeeding intention among pregnant women in rural
Bangladesh, using the Theory of Planned Behavior as a framework.
Methods: Data were analyzed on rural Bangladeshi women who were interviewed in
their third trimester of pregnancy, as part of CARE's Window of Opportunity project. A
cohort of 800 women was interviewed between 12 January 2011 and 4 February 2011.
Indices of maternal attitudes, self-efficacy and knowledge were created by using principal
components analysis. The association between intention to exclusively breastfeed and the
three indices was assessed using logistic regression.
Results: High levels of positive attitude (OR: 2.30; 95% CI 1.14 - 4.66) and self-efficacy
(OR: 3.91; 95% CI 1.91 - 8.00) towards exclusive breastfeeding were associated with
intent to exclusively breastfeed. However, in a multiple regression model, higher level of
knowledge was only modestly associated with intent to exclusively breastfeed (OR: 1.12;
95% CI 0.74-1.71).
Discussion: In this cohort, positive attitudes and self-efficacy were strongly associated
with intent to exclusively breastfeed, while a higher level of knowledge was only
modestly associated with intent to exclusively breastfeed. These findings contribute to the
limited existing literature on determinants of exclusive breastfeeding in Bangladesh. This
analysis reaffirms the need for further population-specific research to identify modifiable
causes of intent to exclusively breastfeed. The results of this analysis will be used to
inform the Window of Opportunity program.

Attitude, self-efficacy, knowledge and intention to exclusively breastfeed among
pregnant women in rural Bangladesh
By
Joan Sara Thomas
B.A
McGill University
2006
Thesis Committee Chair: Dr. Aryeh Stein, BSc, MPH, PhD
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Public Health
in the Hubert Department of Global Health
2011

Table of Contents

Table of Contents

1. Background 1.1 Introduction .. 1.2 Rationale and Public Health Significance 1.3 Purpose Statement 1.3.1 Main Objectives 1.4 Study Setting: The People's Republic of Bangladesh 1.5 Study Sites: Karimganj and Katiadi, two sub-districts in the district of Kishoreganj 2. Review of the Literature 2.1 Breastfeeding .. 2.2 Breastfeeding as a Basic Human Right 2.3 A Global Movement towards Breastfeeding Protection 2.4 The International Code of Marketing of Breast Milk Substitutes 2.5 Breastfeeding and maternal and infant health 2.5.1 Breastfeeding and Maternal Health 2.5.2 Breastfeeding and infant health 2.6 National Initiatives for Exclusive Breastfeeding in Bangladesh 2.6.1 Dhaka Declaration 2.6.2 Bangladesh Breastfeeding Foundation 2.6.3 Comprehensive nutrition programs 2.6.4 National IYCF Strategy 2.7 Breastfeeding in Bangladesh 2.8 Exclusive breastfeeding Intentions and Behavioral Health Models 2.8.1 Theory of Reasoned Action and the Theory of Planned Behavior 2.8.2 Theory of Reasoned Action 2.8.3 Theory of Planned Behavior 3. Manuscript contribution of student . Abstract. Introduction .. Methodology The Window of Opportunity Project Study Population Data Collection Multivariable logistic regression modeling strategy Results Descriptive Analysis Multivariable Logistic Models Discussion Strengths and Weaknesses 4. Conclusion, Final comments and Reflections Window Cohort: Questionnaire development, data collection and analysis Public Health and Policy Implications List of Manuscript Figures and Tables Figures . Tables Appendix 1 Flowchart of variable: exclusively breastfed last child .. Appendix 2 final deciles of risk for Hosmer-Lemeshow goodness-of-fit test for the final model Appendix 3 stratified analysis by sub-district .

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 Health Sciences, Public Health
Palavra-chave	Breastfeeding Exclusive Breastfeeding Bangladesh Self-efficacy Intention Attitude Knowledge
Committee Chair / Thesis Advisor	Stein, Aryeh D, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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