Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
Int Breastfeed J. 2023 Aug 28;18(1):46. doi: 10.1186/s13006-023-00584-y.
Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality.
We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO's Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported.
An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child.
The highest attention should be placed in Bangladesh to attain the WHO's 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations.
有证据表明，基于教育、财富状况、居住地和地理位置的不平等现象严重影响了关键的母乳喂养指标，包括早期母乳喂养的启动。本研究旨在应用绝对和相对不平等衡量标准，估计 2004 年至 2017 年期间孟加拉国早期母乳喂养实践中不平等现象的趋势和程度。
我们使用了来自 2004 年至 2017 年最近五次孟加拉国人口与健康调查（BDHS）的数据，使用世界卫生组织的卫生公平评估工具包（HEAT）软件衡量早期母乳喂养实践中的不平等。采用以下总结衡量不平等的指标：人群归因风险（PAR）、人群归因分数（PAF）、差异（D）和比例（R），其中公平维度包括财富状况、教育程度、儿童性别、居住地和次国家区域（行政区）。对于每个衡量标准，报告了点估计值和 95%置信区间（CI）。
发现早期母乳喂养启动率呈上升趋势，2004 年至 2017 年期间，早期母乳喂养启动率从 24.9%增加到 59.0%。我们发现，在每个调查波次中，财富状况都存在显著的母乳喂养实践启动不平等现象，有利于最贫穷的财富五分位数（2017 年，D-10.5；95%CI-16.6 至-4.3）。我们还发现了早期母乳喂养实践中的地理差异（2017 年，PAF11.1；95%CI2.2 至 19.9），有利于朗布尔（65.5%）和锡尔赫特（65.3%）行政区。仅在 2004 年观察到与教育相关的差异，但在以后的调查年份中没有，这是由于接受中等或高等教育的人遵守率较低所致。在早期母乳喂养启动方面，没有发现基于城市与农村居住地和儿童性别的显著差异。
孟加拉国应高度重视实现世界卫生组织 100%及时启动母乳喂养的建议。本研究强调解决现有的社会经济和地理不平等问题。应通过政府和非政府组织的共同努力，规划和实施针对富裕亚群和较低流行率行政区的母亲的提高认识外联方案。
