Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, NV, USA.
Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.
Int Breastfeed J. 2023 Jul 13;18(1):34. doi: 10.1186/s13006-023-00567-z.
In rural China, exclusive breastfeeding (EBF) prevalence is low and hospitals often fail to attain baby-friendly feeding objectives, such as ≥ 75% of newborns exclusively breastfed from birth to discharge. Empirical evidence for the impact of increased hospital compliance with recommended feeding guidelines on continued EBF in rural China is lacking. We sought to measure and model the association of newborns' in-hospital feeding experiences with EBF practice in infancy to inform policies for EBF promotion.
Data were cross-sectional from 785 caregivers of infants < 6 months of age, collected from November to December 2019 in four underdeveloped counties/districts in Sichuan Province. In-hospital feeding practices were determined, and prevalence of current infant feeding practices was calculated from 24-h recall and categorized according to WHO/UNICEF Infant and Young Child Feeding categories as EBF, breastfed with non-milk liquids, mixed feeding, breastfed with solids, and not breastfed. Relative risk ratios were estimated using adjusted multinomial logistic regression to examine risk factors for non-EBF practices compared to EBF, including in-hospital feeding experiences. The regression model was used to investigate change in EBF prevalence under alternative in-hospital experiences.
Only 38.1% of under-six-month-old infants were being exclusively breastfed when data were collected; 61.8% and 77.6% had been fed water and infant formula, respectively, in the hospital. Infants who were fed water or formula before discharge were estimated as 2-3 times as likely to be non-EBF than EBF up to age six months. According to our model, EBF prevalence would have increased to 53.7% (95% confidence interval (CI) 46.1, 61.2) had ≥ 75% of infants been exclusively breastfed and water-based feeds eliminated in-hospital.
Given the importance of infants' first feeding experiences in the establishment and continuation of EBF, it is imperative that rural Chinese hospitals actively seek to limit infant formula feeds to medically indicated situations and eliminate water-based feeds.
在中国农村，纯母乳喂养（EBF）的比例较低，医院往往未能实现婴儿喂养友好目标，例如，从出生到出院，≥75%的新生儿完全母乳喂养。缺乏增加医院对推荐喂养指南的依从性对农村地区持续 EBF 的影响的实证证据。我们旨在测量和建模新生儿住院期间的喂养经历与婴儿期 EBF 实践的关系，为 EBF 促进政策提供信息。
数据来自 2019 年 11 月至 12 月在四川省四个欠发达县/区收集的 785 名婴儿<6 个月的照顾者的横断面数据。确定住院期间的喂养实践，并根据世界卫生组织/联合国儿童基金会婴儿和幼儿喂养类别，从 24 小时回忆中计算当前婴儿喂养实践的流行率，并分为纯母乳喂养、母乳喂养加非奶液体、混合喂养、母乳喂养加固体和未母乳喂养。使用调整后的多变量逻辑回归估计相对风险比，以检查与 EBF 相比，非 EBF 实践的风险因素，包括住院期间的喂养经历。该回归模型用于研究在替代住院经历下 EBF 流行率的变化。
数据收集时，只有 38.1%的 6 个月以下婴儿完全母乳喂养；分别有 61.8%和 77.6%的婴儿在医院中喝过水和婴儿配方奶粉。在出院前喂过水或配方奶的婴儿，估计在 6 个月内非 EBF 的可能性是 EBF 的 2-3 倍。根据我们的模型，如果≥75%的婴儿完全母乳喂养且医院中消除了水基喂养，那么 EBF 的流行率将增加到 53.7%（95%置信区间（CI）为 46.1%，61.2%）。
鉴于婴儿首次喂养经历对 EBF 的建立和持续的重要性，农村中国医院必须积极寻求将婴儿配方奶粉喂养限制在医学指征的情况下，并消除水基喂养。
