The Influence of Seasonality and Community-Based Health Worker Provided Counselling on Exclusive Breastfeeding - Findings from a Cross-Sectional Survey in India.
The Influence of Seasonality and Community-Based Health Worker Provided Counselling on Exclusive Breastfeeding - Findings from a Cross-Sectional Survey in India.
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DOI：
10.1371/journal.pone.0161186
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Chaudhuri I
中科院分区：
文献类型：
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作者：
Das A;Chatterjee R;Karthick M;Mahapatra T;Chaudhuri I
生命前六个月的纯母乳喂养（EBF）被认为是降低儿童发病率和死亡率的一项影响大但成本低的措施。目前的研究调查的季节性和一线工人（FLW）提供咨询与EBF在印度比哈尔邦的做法。我们使用“批次质量保证抽样”技术在比哈尔邦的8个地区进行了多阶段抽样调查。关于EBF，询问0-5个月（已满）婴儿的母亲前一天是否只给孩子喂母乳，而询问6-8个月（已满）婴儿的母亲EBF的总持续时间。我们测试了前一天的EBF与面试季节和EBF与护理季节的关系。我们还评估了接受有关EBF和补充喂养的咨询是否与相关EBF指标有任何关联。在6个月以下的儿童中，76%在前一天接受了EBF，而据报道，92%的6-8个月（完成）的儿童接受了EBF的建议时间。0-5个月（已满）的婴儿（在过去24小时内）只接受母乳喂养的比例随着年龄的增长和季节从寒冷月份到温暖月份的变化而显著下降。与夏季相比，冬季月份仅在前一天接受母乳的几率显著较高（调整后的比值比（AOR）= 1.50; 95% CI = 1.37，1.63）。此外，主要在冬季护理的儿童接受EBF 6个月（AOR = 1.90，95%CI = 1.43，2.52）的几率高于非冬季护理的儿童。接受FFW咨询与纯母乳喂养呈正相关，即使在调整季节性和其他协变量后也是如此（AOR = 1.82; 95%CI = 1.67，1.98）。季节性是EBF的一个重要但不可改变的风险因素。然而，FLW咨询被发现增加EBF的做法，无论季节。扩大FLW咨询服务的规模，重点放在夏季月份和较大婴儿的母亲，可能会减少季节性对EBF的影响。
Exclusive breastfeeding (EBF) during the first six months of life is considered a high impact but low-cost measure for reducing the morbidity and mortality among children. The current study investigated the association of seasonality and frontline worker(FLW) provided counselling with practice of EBF in Bihar, India. We used the ‘Lot Quality Assurance Sampling’ technique to conduct a multi-stage sampling survey in 8 districts of Bihar. Regarding EBF, mothers of 0–5 (completed) months old children were asked if they had given only breastmilk to their children during the previous day, while mothers of 6–8 (completed) months old children were inquired about the total duration of EBF. We tested for association between EBF during the previous day with season of interview and EBF for full 6 months with nursing season. We also assessed if receiving counselling on EBF and complementary feeding had any association with relevant EBF indicators. Among the under-6 month old children, 76% received EBF during the previous day, whereas 92% of 6–8 (completed) months old children reportedly received EBF for the recommended duration. Proportion of 0–5 (completed) month old children receiving only breastmilk (during last 24 hours) decreased significantly with increasing age and with change of season from colder to warmer months. Odds of receiving only breastmilk during the previous day was significantly higher during the winter months (Adjusted odds ratio(AOR) = 1.50; 95% CI = 1.37, 1.63) compared to summer. Also, the children nursed primarily during the winter season had higher odds of receiving EBF for 6 months (AOR = 1.90, 95% CI = 1.43, 2.52) than those with non-winter nursing. Receiving FLW-counselling was positively associated with breastfeeding exclusively, even after adjusting for seasonality and other covariates (AOR = 1.82; 95% CI = 1.67, 1.98). Seasonality is a significant but non-modifiable risk factor for EBF. However, FLW-counselling was found to increase practice of EBF irrespective of season. Scale-up of FLW-counselling services, with emphasis on summer months and mothers of older infants, can potentially reduce the impact of seasonality on EBF.