Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
Int Breastfeed J. 2021 Aug 28;16(1):65. doi: 10.1186/s13006-021-00411-2.
The World Health Organization recommends a 24-h recall period to estimate breastfeeding practice of mothers of infants aged younger than six-months. Though 24-h recall was preferred for its low recall bias and for practical reasons, it can overestimate exclusive breastfeeding practice (EBF). Validating this indicator will help account for the deviation from the true estimate. This prospective cohort study measured accuracy of the 24-h recall method and validates a week recall as an alternative approach for use in a small sample population.
The study was conducted from March to April 2018 involving 408 mother-infant pairs living in Butajira Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Participants were prospectively followed for 14 consecutive days; where their breastfeeding practice in the past 24 h was measured daily. Exclusive breastfeeding prevalence estimate obtained using the 24-h recall method and recall periods spanning a varying number of days (short period recalls) was compared against the cumulative of the responses from a prospectively measured repeated 24-h recalls over the course of 14 days. McNemar statistics was used to assess statistical significance of the difference in the EBF prevalence estimates of the single 24-h recall and the reference standard. Sensitivity, specificity, positive predictive value and negative predictive values were calculated to determine the level of accuracy. Receiver Operating Characteristics curve was used to measure the difference in performance between the two methods.
The highest prevalence (71.4%) of exclusive breastfeeding practice was estimated using the single 24-h recall method whereas the lowest breastfeeding practice (47.1%) was obtained from a cumulative of 14 repeated 24-h recalls. A week recall (a recall over 7 days' period), resulted in the smallest discrepancy in estimate (7.1%) as compared to cumulative estimate of 14 repeated 24-h recalls. Comparing against our reference standard, a week recall had 96.7% sensitivity and 83.5% specificity in estimating exclusive breastfeeding practice.
Using single 24-h recall method overestimated exclusive breastfeeding prevalence. However, a week recall gave an estimate close to the estimate from the standard method. A week recall has a potential to balance the tradeoff between the accuracy of EBF estimates and the resource implication of using multiple prospective measurements that have a proven superior accuracy.
世界卫生组织建议使用 24 小时回忆期来估计小于 6 个月大婴儿的母亲的母乳喂养情况。尽管 24 小时回忆期因其低回忆偏差和实际原因而受到青睐，但它可能会高估纯母乳喂养的情况（EBF）。验证这个指标将有助于说明与真实估计值的偏差。本前瞻性队列研究测量了 24 小时回忆法的准确性，并验证了一周回忆期作为一种替代方法在小样本人群中的使用。
该研究于 2018 年 3 月至 4 月在埃塞俄比亚南部布塔吉拉健康和人口监测点（HDSS）进行，涉及 408 对母婴对。参与者被前瞻性地随访了 14 天；在过去的 24 小时内，他们的母乳喂养情况每天都被测量。使用 24 小时回忆法获得的纯母乳喂养流行率估计值与在 14 天的过程中，从前瞻性测量的重复 24 小时回忆中获得的不同天数（短期回忆）的累计值进行了比较。使用 McNemar 统计数据来评估单一 24 小时回忆期和参考标准对 EBF 流行率估计值的差异的统计学意义。计算了灵敏度、特异性、阳性预测值和阴性预测值，以确定准确性的水平。使用接收者操作特征曲线来衡量两种方法之间的性能差异。
使用单一的 24 小时回忆法估计的纯母乳喂养率最高（71.4%），而从 14 次重复 24 小时回忆的累计中获得的最低母乳喂养率（47.1%）。一周回忆期（在 7 天的时间内进行回忆）与累计的 14 次重复 24 小时回忆相比，估计值的差异最小（7.1%）。与我们的参考标准相比，一周回忆期在估计纯母乳喂养方面的灵敏度为 96.7%，特异性为 83.5%。
使用单一的 24 小时回忆法高估了纯母乳喂养的流行率。然而，一周回忆期给出的估计值接近标准方法的估计值。一周回忆期有可能在 EBF 估计值的准确性和使用多次前瞻性测量的资源投入之间取得平衡，而多次前瞻性测量已被证明具有更高的准确性。
