Spatial modelling of initiation and duration of breastfeeding: analysis of breastfeeding behaviour in Malawi - I.
OBJECTIVE
The benefits of breastfeeding for child health are well recognized. Appropriate health promotion strategies must recognize the interplay between neighbourhood factors and breastfeeding patterns that may lead to spatial clustering in the health outcome. We developed spatial models to study factors associated with breastfeeding behaviour in Malawi by introducing random effects that allowed for unobserved influences on breastfeeding behaviour.


METHODS
Using the 2000 Malawi Demographic and Health Survey, we studied two breastfeeding behaviours: initiation of breastfeeding and duration of breastfeeding. We fitted an ordinal model to estimate the initiation of breastfeeding, and a discrete-time duration model to analyze the duration of breastfeeding. Each model incorporated two spatial random effects at the subdistrict level, one component to capture spatial similarities across neighbouring areas and the other to permit spatial heterogeneity.


RESULTS
Findings indicate a breastfeeding initiation rate of 60% immediately after birth, and a further 37% within 1 hour of birth. Timing of breastfeeding initiation within 1 hour was associated with maternal education; ethnicity; wealth ranking; access to media such as newspapers, radio or TV; and health-sector variables such as place of birth, prenatal care assistance and support at delivery. The mean duration time for breastfeeding was 17.6 months. Again, a range of socio-economic, demographic and health sector factors were identified as influential on breastfeeding duration. The mapped subdistrict-specific effects showed delayed initiation of breastfeeding in the north of the country, while early initiation was displayed in the south-eastern region. Shorter duration of breastfeeding was found in the southern region, whereas protracted breastfeeding was observed in the northern region.


CONCLUSIONS
This study offers important insight on the relative importance of both spatial effects and individual characteristics on breastfeeding behaviour in Malawi. This has potential implications for health policy planning and further research.
Applied Statistics and Epidemiology Research Group, Mathematical Sciences Department, Chancellor College, University of Malawi, Zomba, MALAWI. lkazembe@chanco.unima.mw
Lawrence N
LN
Kazembe
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000453:epidemiology*; D003466:Cultural Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi / Q000453:epidemiology; D008425:Maternal Behavior; D008875:Middle Aged; D008954:Models, Biological; D017062:Small-Area Analysis; D055815:Young Adult