印度全国及城乡地区母乳喂养早开始率及其决定因素。
National and rural-urban prevalence and determinants of early initiation of breastfeeding in India.
机构信息
Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.
Medical Education Unit, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia.
出版信息
BMC Public Health. 2019 Jul 8;19(1):896. doi: 10.1186/s12889-019-7246-7.
BACKGROUND
Early initiation of breastfeeding (EIBF) reduces the risk of neonatal mortality. Previous studies from India have documented some factors associated with EIBF. However, those studies used data with limited sample size that potentially affect the application of the evidence. Additionally, the effectiveness of national breastfeeding programmes requires up-to-date analysis of new and robust EIBF data. The present study aimed to investigate the prevalence and determinants of EIBF in India and determine to what extent these factors differ by a mother's residence in the rural or urban area.
METHODS
This study used information from a total weighted sample of 94,401 mothers from the 2015-2016 India National Family Health Survey. Multivariate logistic regression was used to investigate the association between the study factors and EIBF in India and rural-urban populations, after adjusting for confounders and sampling weight.
RESULTS
Our analysis indicated that 41.5% (95% confidence interval (CI): 40.9-42.5, P < 0.001) of Indian mothers initiated breastfeeding within 1-h post-birth, with similar but significant different proportions estimated for those who resided in rural (41.0, 95% CI: 40.3-41.6, P < 0.001) and urban (42.9, 95% CI: 41.7-44.2, P < 0.001) areas. Mothers who had frequent health service contacts and those with higher educational attainment reported higher EIBF practice. Multivariate analyses revealed that higher educational achievement, frequent antenatal care visits and birthing in a health facility were associated with EIBF in India and rural populations (only health facility birthing for urban mothers). Similarly, residing in the North-Eastern, Southern, Eastern and Western regions were also associated with EIBF. Birthing through caesarean, receiving delivery assistance from non-health professionals and residing in rural areas of the Central region were associated with delayed EIBF in all populations.
CONCLUSION
We estimated that more than half of Indian mothers delayed breastfeeding initiation, with different rural-urban prevalence. Key modifiable factors (higher maternal education and frequent health service contacts) were associated with EIBF in India, with notable difference in rural-urban populations. Our study suggests that targeted and well-coordinated infant feeding policies and interventions will improve EIBF for all Indian mothers.
背景
早期启动母乳喂养（EIBF）可降低新生儿死亡率。印度之前的研究记录了一些与 EIBF 相关的因素。然而，这些研究使用的样本量有限，可能会影响证据的应用。此外，国家母乳喂养计划的有效性需要对新的和强有力的 EIBF 数据进行最新分析。本研究旨在调查印度 EIBF 的流行率和决定因素，并确定这些因素在多大程度上因母亲居住在农村或城市地区而有所不同。
方法
本研究使用了 2015-2016 年印度全国家庭健康调查中总计加权 94401 名母亲的信息。采用多变量逻辑回归分析方法，在调整混杂因素和抽样权重后，调查了研究因素与印度和城乡地区 EIBF 之间的关系。
结果
我们的分析表明，41.5%（95%置信区间（CI）：40.9-42.5，P<0.001）的印度母亲在分娩后 1 小时内开始母乳喂养，农村地区（41.0，95%CI：40.3-41.6，P<0.001）和城市地区（42.9，95%CI：41.7-44.2，P<0.001）的比例相似但差异显著。经常接触卫生服务和受教育程度较高的母亲报告 EIBF 实践率更高。多变量分析显示，较高的教育程度、频繁的产前保健就诊和在医疗机构分娩与印度和农村地区的 EIBF 相关（仅城市母亲与医疗机构分娩相关）。同样，居住在东北地区、南部地区、东部地区和西部地区也与 EIBF 相关。通过剖宫产分娩、接受非卫生专业人员的分娩协助以及居住在中部地区农村地区与所有人群中 EIBF 的延迟相关。
结论
我们估计，超过一半的印度母亲延迟了母乳喂养的开始，农村和城市地区的流行率不同。关键的可改变因素（较高的母亲教育程度和经常接触卫生服务）与印度的 EIBF 相关，农村和城市地区的差异显著。我们的研究表明，针对所有印度母亲的有针对性和协调一致的婴儿喂养政策和干预措施将改善 EIBF。
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