Susiloretni Kun A, Hadi Hamam, Blakstad Mia M, Smith Emily R, Shankar Anuraj H
Department of Nutrition, Department of Applied Midwifery, Semarang Health Polytechnic, Ministry of Health of the Republic of Indonesia, Poltekkes Kemenkes Semarang, Jl. Wolter Monginsidi 115 Semarang 52192, Indonesia.
Alma Ata Center for Healthy Life and Food (ACHEAF), Alma Ata University, Yogyakarta, Indonesia.
Midwifery. 2019 Feb;69:163-171. doi: 10.1016/j.midw.2018.11.008. Epub 2018 Nov 19.
Suboptimal breastfeeding contributes to morbidity and mortality in children. Studies in high-income countries (HICs) show that exclusive-breastfeeding (EBF) is associated with longer breastfeeding duration. The aim of this study was to determine whether maternal reports of EBF at six months are associated with longer duration of breastfeeding during the first two years of life in a low and middle-income country (LMIC) setting, and to identify determinants of breastfeeding duration.
This prospective cohort includes data from an EBF promotion program in Demak District, Central Java Province, Indonesia, with a non-randomized pretest-posttest control group. Mothers and infants were followed through 26 months postnatal age. Data were analyzed using Cox proportional hazard regression with time to cessation of EBF as the outcome.
A total of 147 families were included in the study. Longer EBF duration was not associated with prolonged duration of breastfeeding. Longer breastfeeding duration was associated with mothers who disagreed with a statement of being ashamed to breastfeed (HR 0.035, 95%CI 0.003,0.44). Risk factors for shorter breastfeeding duration included mothers' plan to breastfeed for less than 24 months (HR 4.28 95%CI 1.91,9.60), mothers' belief that breastfeeding less than 24 months was the norm (HR 2.98 95%CI 1.31,6.77) and exposure to EBF promotion (HR:4.09 95%CI 2.14,7.82).
In a LMIC community where long breastfeeding duration is common, EBF is not associated with breastfeeding duration. However, modifiable behavioral factors were significant predictors of breastfeeding duration. We therefore recommend that prolonged breastfeeding duration can be achieved through programs that improve breastfeeding behavior.
母乳喂养不充分会导致儿童发病和死亡。高收入国家（HICs）的研究表明，纯母乳喂养（EBF）与更长的母乳喂养持续时间相关。本研究的目的是确定在低收入和中等收入国家（LMIC）环境中，母亲报告的6个月时纯母乳喂养情况是否与生命最初两年更长的母乳喂养持续时间相关，并确定母乳喂养持续时间的决定因素。
这项前瞻性队列研究纳入了印度尼西亚中爪哇省德马克区一项纯母乳喂养促进项目的数据，采用非随机的前测-后测对照组。对母亲和婴儿进行了26个月的产后随访。以纯母乳喂养停止时间为结局，使用Cox比例风险回归分析数据。
共有147个家庭纳入研究。纯母乳喂养持续时间较长与母乳喂养持续时间延长无关。母乳喂养持续时间较长与不同意因母乳喂养感到羞耻这一说法的母亲有关（风险比0.035，95%置信区间0.003，0.44）。母乳喂养持续时间较短的风险因素包括母亲计划母乳喂养少于24个月（风险比4.28，95%置信区间1.91，9.60）、母亲认为母乳喂养少于24个月是正常现象（风险比2.98，95%置信区间1.31，6.77）以及接触纯母乳喂养促进活动（风险比4.09，95%置信区间2.14，7.82）。
在母乳喂养持续时间较长很常见的低收入和中等收入国家社区中，纯母乳喂养与母乳喂养持续时间无关。然而，可改变的行为因素是母乳喂养持续时间的重要预测因素。因此，我们建议通过改善母乳喂养行为的项目来实现延长母乳喂养持续时间。
