Middlesex University, London, UK.
IZA Institute of Labor Economics, Bonn, Germany.
BMC Public Health. 2024 Aug 31;24(1):2366. doi: 10.1186/s12889-024-19821-y.
This study aims to investigate the measurement of breastfeeding prevalence indicators using Demographic and Health Surveys (DHS) data, focusing on early initiation, exclusive breastfeeding, and continued breastfeeding indicators as reported by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and on the discrepancies arising from small changes in their definition.
Two hundred sixty DHS samples from 78 countries were analyzed to re-calculate usual indicators reported by WHO and UNICEF: early initiation of breastfeeding (EIB), exclusive breastfeeding under 6 months (EBF), and continued breastfeeding between 1 and 2 years (CBF12 and CBF24). Additionally, alternative estimates of the same indicators, slightly changing their definition, were calculated to test their robustness.
The WHO and UNICEF indicators for early initiation (EIB) primarily capture cases where breastfeeding is initiated "immediately" after birth, omitting those initiated within 0 or 1 hour. This discrepancy leads to substantial underestimation of levels in some regions, particularly South Asia, and in trends. Furthermore, sizable discrepancies between exclusive breastfeeding (EBF) indicators arise from the inclusion or exclusion of plain water in the definition, with significant variations across regions, especially in West and Middle Africa. However, continued breastfeeding indicators showed consistency across definitions, proving them robust for international comparisons and time trend estimations.
This study highlights the importance of understanding how breastfeeding indicators are defined and calculated using DHS data. Researchers should be cautious when using WHO and UNICEF indicators for early initiation and exclusive breastfeeding, as they may underestimate prevalence due to their narrow definition. Continued breastfeeding indicators, on the other hand, are less affected by small changes in definitions and provide reliable measures for cross-country comparisons and trend analyses. These findings underscore the need for standardized robust definitions and transparent reporting of breastfeeding indicators in global health assessments.
本研究旨在探讨使用人口与健康调查（DHS）数据衡量母乳喂养流行率指标，重点关注世界卫生组织（WHO）和联合国儿童基金会（UNICEF）报告的早期启动、纯母乳喂养和持续母乳喂养指标，以及其定义微小变化所导致的差异。
分析了来自 78 个国家的 260 个 DHS 样本，重新计算了 WHO 和 UNICEF 报告的常规指标：早期母乳喂养启动（EIB）、6 个月以下的纯母乳喂养（EBF）和 1 至 2 岁的持续母乳喂养（CBF12 和 CBF24）。此外，还计算了略有改变其定义的相同指标的替代估计值，以测试其稳健性。
WHO 和 UNICEF 的早期启动（EIB）指标主要捕捉在出生后“立即”开始母乳喂养的情况，忽略了在 0 或 1 小时内开始的情况。这种差异导致在某些地区，特别是南亚，以及在趋势上，母乳喂养水平的大幅低估。此外，由于在定义中包括或排除了白开水，纯母乳喂养（EBF）指标之间存在很大差异，尤其是在西非和中非地区。然而，持续母乳喂养指标在不同定义下表现出一致性，证明它们在国际比较和时间趋势估计方面具有稳健性。
本研究强调了在使用 DHS 数据时理解母乳喂养指标的定义和计算方法的重要性。研究人员在使用 WHO 和 UNICEF 的早期启动和纯母乳喂养指标时应谨慎，因为它们可能会由于定义狭窄而低估流行率。另一方面，持续母乳喂养指标受定义微小变化的影响较小，为跨国比较和趋势分析提供了可靠的衡量标准。这些发现突显了在全球健康评估中需要标准化稳健的定义和透明报告母乳喂养指标的必要性。
