Maternal prenatal attitudes and postnatal breastfeeding behaviors in rural Bangladesh Open Access

Abstract

Abstract
Maternal prenatal attitudes and postnatal breastfeeding behaviors in rural Bangladesh

Objective: We assessed the relationships between psychosocial constructs (maternal intention, attitudes, self-efficacy, breastfeeding knowledge) at 7 mo gestation and exclusive or full breastfeeding at 3 mo postpartum.

Design: Prospective longitudinal cohort study with structured home interviews during pregnancy and 3 mo after delivery.

Setting: Two rural sub-districts (Karimganj; Katiadi) of Kishoreganj district, Bangladesh.

Subjects: Mother-infant dyads.

Results: Over 75% of 1470 pregnant women intended to exclusively breastfeed (EBF). Maternal positive attitudes, self-efficacy, and knowledge about breastfeeding were positively associated with intentions to EBF during the 3rd trimester of pregnancy (all p<0.05). All mothers reported initiating breastfeeding, and nearly all children were still breastfed at 3 mo. According to 24-hour dietary recalls, we categorized 639 (43.5%) infants as EBF (47.2% among mothers with intention; 31.0% no intention), and 389 (26.5%) infants as predominantly breastfed (PBF) (25.2% intention; 30.7% no intention) at 3 mo. Prenatal maternal intention to EBF was associated with EBF (aOR 1.35, 95% CI: 1.02-1.80) and full breastfeeding (aOR 1.29, 95% CI: 0.98-1.70) at age 3 mo, adjusting for covariates. EBF and full breastfeeding at age 3 mo were not associated (p>0.05) with any other prenatal maternal psychosocial constructs examined, controlling for covariates.

Conclusions: Despite expressed maternal intentions to exclusively breastfeed during pregnancy and universal breastfeeding initiation, prevalences of both exclusive and full breastfeeding at 3 mo remain lower than WHO recommendations. Our findings indicate associations between EBF intention and postnatal breastfeeding behaviors, suggesting the importance of prenatal intention and psychosocial factors in supporting optimal infant feeding behaviors.

Table of Contents

Table of Contents

Chapter I. Literature Review of Breastfeeding and Psychosocial Risk Factors

Benefits and Consequences of Exclusive Breastfeeding...1

WHO and UNICEF Breastfeeding Definitions

Global Trends in Breastfeeding...3
Breastfeeding in Bangladesh...3
Determinants of Breastfeeding Behaviors...4

Conceptual Framework: Theory of Planned Behavior
Previous Studies on Risk Factors

Sociodemographic
Psychosocial

Next Steps...15
Literature Review References...16

Chapter II. Manuscript Draft

Abstract...22
Introduction...23
Methods...24
Results...28
Discussion...31
Tables and Figures...35
References...40

Chapter III. Implications

Summary, Implications and Future Directions...44

Appendix

Definitions of Breastfeeding...46
Additional Data Tables...47

Descriptive Statistics
Variations of Multivariate Logistic Regressions

Akhoni Shomay Project/Study Timeline...76
Study Participation Flow Charts...77

Cohort 1 Flow Chart
Cohort 2 Flow Chart

Map of Study Locations...79
Ethical Review Approval Letter...80
Project Involvement and Responsibilities...82
Pregnancy Questionnaire...83
3 Month Questionnaire...115
Appendix References...161

Tables & Figures
Chapter I: Literature Review

Table L1: EBF Prevalence in Bangladesh...3
Figure L1: Conceptual Framework: Theory of Planned Behavior...4
Table L2: Attitudes, Subjective Norms, Perceived Control, Intentions, and Other Psychosocial Factors Influencing Breastfeeding Behaviors...10

Chapter II: Manuscript Draft

Table 1: Demographic and Household Characteristics among women during pregnancy in Karimganj and Katiadi...35
Table 2: Breastfeeding of 3 Month Old Infants from 24-Hour and Since-Birth Dietary Recalls...36
Figure 1: EBF Prevalence from Birth to 3 Months Among Women With and Without EBF Intention...37
Table 3: Maternal Intentions to EBF, Attitudes, Self-Efficacy, and Knowledge during Third Pregnancy Trimester...38
Table 4: Multivariate Logistic Regressions for Exclusive and Full Breastfeeding at 3 Months in Karimganj and Katiadi...39

Chapter IV: Appendix

Figure A1: Definitions for Infant Feeding Practices...46
Table A1: Breastfeeding Practices from Birth to 3 Months among Mothers Intending and Not Intending to EBF...47
Table A2: Breastfeeding Practices from Birth to 3 Months in Karimganj and Katiadi...48
Table A3: Twenty-Four Hour Dietary Consumption Recall among Infants at 3 Months in Karimganj and Katiadi...49
Table A4: Liquid Consumption Recall between Birth and 3 Days among Infants in Karimganj and Katiadi...50
Table A5: Intentions versus Mutually-Exclusive Categories of Breastfeeding Practices among 3 Month Infants in Karimganj and Katiadi...51
Table A6: WHO Growth Indicators among Infants at 3 Months in Karimganj and Katiadi...52
Table A7: Anemia at 3 Months among Mothers and Infants in Karimganj and Katiadi...53
Table A8: Diarrhea, ARI, and Fever among Infants at 3 Months...54
Table A9: Household Characteristics of Mother-Infant Dyads...55
Table A10: Delivery Locations of Infants in Karimganj & Katiadi...57
Table A11: Sources of Breastfeeding Information & Support Reported by Mothers at 3 Months...58
Table A12: Counseling during pregnancy from Other NGO Worker...59
Table A13: Bivariate Logistic Regression Results for Exclusively Breastfeeding at 3 Months...60
Table A14: Multivariate Logistic Regression Results for Exclusive Breastfeeding at 3 Months in Karimganj and Katiadi...62
Table A15: Multivariate Logistic Regression Results for Exclusive Breastfeeding at 3 Months in Karimganj and Katiadi (Continuous Maternal Indices)...64
Table A16: Multivariate Logistic Regression Results for Exclusive Breastfeeding at 3 Months in Karimganj and Katiadi (Categorical Maternal Indices - distribution-based cutpoints)...66
Table A17: Bivariate Logistic Regression Results for Full Breastfeeding at 3 Months...68
Table A18: Multivariate Logistic Regression Results for Full Breastfeeding at 3 Months in Karimganj and Katiadi...70
Table A19: Multivariate Logistic Regression Results for Full Breastfeeding at 3 Months in Karimganj and Katiadi (Continuous Maternal Indices)...72
Table A20: Multivariate Logistic Regression Results for Full Breastfeeding at 3 Months in Karimganj and Katiadi (Categorical Maternal Indices by distribution-based cutpoints)...74
Figure A2: Akhoni Shomay Project - Cohort Study Timeline...76
Figure A3: Flow chart of Cohort 1 study subject enrollment and follow-up...77
Figure A4: Flow chart of Cohort 2 study subject enrollment and follow-up...78
Figure A5. Map of Karimganj and Katiadi Upazilas (sub-districts) in Kishoreganj District...79

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Psychosocial Exclusive breastfeeding Bangladesh
Committee Chair / Thesis Advisor	Stein, Aryeh D, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.) University, college or educational institution (other than Emory)

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