Across-country comparisons of selected infant and young child feeding indicators and associated factors in four South Asian countries.
BACKGROUND
Information on infant and young child feeding is widely available in Demographic and Health Surveys and National Family Health Surveys for countries in South Asia; however, infant and young child feeding indicators from these surveys have not been compared between countries in the region.


OBJECTIVE
To compare the key indicators of breastfeeding and complementary feeding and their determinants in children under 24 months of age between four South Asian countries.


METHODS
We selected data sets from the Bangladesh Demographic and Health Survey 2004, the India National Family Health Survey (NFHS-03) 2005-06, the Nepal Demographic and Health Survey 2006, and the Sri Lanka 2000 Demographic and Health Survey. Infant feeding indicators were estimated according to the key World Health Organization indicators.


RESULTS
Exclusive breastfeeding rates were 42.5% in Bangladesh, 46.4% in India, and 53.1% in Nepal. The rate of full breastfeeding ranged between 60.6% and 73.9%. There were no factors consistently associated with the rate of no exclusive breastfeeding across countries. Utilization of health services (more antenatal clinic visits) was associated with higher rates of exclusive breastfeeding in India but lower rates in Nepal. Delivery at a health facility was a negative determinant of exclusive breastfeeding in India. Postnatal contacts by Public Health Midwives were a positive factor in Sri Lanka. A considerable proportion of infants under 6 months of age had been given plain water, juices, or other nonmilk liquids. The rate of timely first suckling ranged from 23.5% in India to 56.3% in Sri Lanka. Delivery by cesarean section was found to be a consistent negative factor that delayed initiation of breastfeeding. Nepal reported the lowest bottle-feeding rate of 3.5%. Socioeconomically privileged mothers were found to have higher bottlefeeding rates in most countries.


CONCLUSIONS
Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality. The countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life.
Dibley
Michael J
MJ
Sydney School of Public Health, University of Sydney, NSW, Australia. mdibley@health.usyd.edu.au
Roy
S K
SK
Senarath
Upul
U
Patel
Archana
A
Tiwari
Kalpana
K
Agho
Kingsley E
KE
Mihrshahi
Seema
S
D000375:Aging; D000553:Ambulatory Care; D001211:Asia, Western; D001903:Bottle Feeding / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods; D005247:Feeding Behavior; D006293:Health Promotion / Q000379:methods; D006306:Health Surveys; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000517:prevention & control; D007231:Infant, Newborn; D008880:Midwifery; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D012959:Socioeconomic Factors; D014944:World Health Organization