Maternal prenatal attitudes and postnatal breastfeeding behaviors in rural Bangladesh Open Access
Yu, Elaine Ann (2012)
Published
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
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