title: Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya.
abstract: BACKGROUND
  The World Health Organisation (WHO) recommends exclusive breastfeeding during the first six months of life for optimal growth, development and health. Breastfeeding should continue up to two years or more and nutritionally adequate, safe, and appropriately-fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant. Little evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference to WHO recommendations.
  
  
  METHODS
  Data from a longitudinal study conducted in two Nairobi slums are used. The study used information on the first year of life of 4299 children born between September 2006 and January 2010. All women who gave birth during this period were interviewed on breastfeeding and complementary feeding practices at recruitment and this information was updated twice, at four-monthly intervals. Cox proportional hazard analysis was used to determine factors associated with cessation of breastfeeding in infancy and early introduction of complementary foods.
  
  
  RESULTS
  There was universal breastfeeding with almost all children (99%) having ever been breastfed. However, more than a third (37%) were not breastfed in the first hour following delivery, and 40% were given something to drink other than the mothers' breast milk within 3 days after delivery. About 85% of infants were still breastfeeding by the end of the 11th month. Exclusive breastfeeding for the first six months was rare as only about 2% of infants were exclusively breastfed for six months. Factors associated with sub-optimal infant breastfeeding and feeding practices in these settings include child's sex; perceived size at birth; mother's marital status, ethnicity; education level; family planning (pregnancy desirability); health seeking behaviour (place of delivery) and; neighbourhood (slum of residence).
  
  
  CONCLUSIONS
  The study indicates poor adherence to WHO recommendations for breastfeeding and infant feeding practices. Interventions and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education, and family planning.
authors: African Population and Health Research Center, Nairobi, Kenya. lizmurage@gmail.com
authors: Elizabeth W
authors: EW
authors: Kimani-Murage
authors: Nyovani J
authors: NJ
authors: Madise
authors: Jean-Christophe
authors: JC
authors: Fotso
authors: Catherine
authors: C
authors: Kyobutungi
authors: Martin K
authors: MK
authors: Mutua
authors: Tabither M
authors: TM
authors: Gitau
authors: Nelly
authors: N
authors: Yatich
references: J Hum Lact. 1998 Sep;14(3):191-203
references: 10205427
references: J Obstet Gynecol Neonatal Nurs. 2009 May-Jun;38(3):259-68
references: 19538614
references: Lancet. 2000 Nov 11;356(9242):1643-7
references: 11089824
references: Am J Public Health. 2003 Aug;93(8):1277-9
references: 12893612
references: Bull World Health Organ. 1989;67(2):151-61
references: 2743537
references: MCN Am J Matern Child Nurs. 2011 Mar-Apr;36(2):82-8; quiz 89-90
references: 21150474
references: Forum Nutr. 2003;56:236-8
references: 15806879
references: Indian J Community Med. 2009 Oct;34(4):362-3
references: 20165637
references: Int Breastfeed J. 2010 Nov 30;5:21
references: 21118488
references: Matern Child Health J. 2009 Jan;13(1):130-7
references: 18297380
references: Acta Paediatr. 2003;92(2):152-61
references: 12710639
references: Adv Exp Med Biol. 2004;554:63-77
references: 15384567
references: J Trop Pediatr. 2009 Feb;55(1):49-54
references: 18499736
references: Health Place. 2007 Mar;13(1):205-23
references: 16563851
references: Popul Health Metr. 2010 Jul 22;8:22
references: 20649957
references: BMC Med. 2004 Jul 01;2:26
references: 15230974
references: J Urban Health. 2011 Jun;88 Suppl 2:S356-69
references: 20700769
references: BMC Pediatr. 2007 Mar 01;7:10
references: 17331251
references: BMC Public Health. 2011 Jan 04;11(1):6
references: 21205306
references: Food Nutr Bull. 2010 Jun;31(2):295-313
references: 20707235
references: J Am Diet Assoc. 2009 Dec;109(12):2017-28
references: 19942019
references: Soc Sci Med. 1997 Jul;45(1):113-25
references: 9203276
references: Lancet. 2003 Jul 5;362(9377):65-71
references: 12853204
references: Lancet. 2007 Jan 6;369(9555):60-70
references: 17208643
references: J Pediatr (Rio J). 1994 May-Jun;70(3):138-51
references: 14688867
references: J Clin Nurs. 2010 Sep;19(17-18):2434-45
references: 20920071
references: Public Health Nutr. 2010 Dec;13(12):2087-96
references: 20707948
references: Paediatr Perinat Epidemiol. 2003 Jan;17(1):81-90
references: 12562475
references: J Urban Health. 2007 Nov;84(6):829-38
references: 17551841
references: Pediatr Clin North Am. 2001 Feb;48(1):87-104
references: 11236735
references: Lancet. 2008 Jan 26;371(9609):340-57
references: 18206223
references: Pediatrics. 2001 Oct;108(4):E67
references: 11581475
references: Am J Clin Nutr. 2000 Jul;72(1):159-67
references: 10871575
references: World Health Popul. 2010;11(4):5-12
references: 20739835
references: Food Nutr Bull. 2010 Jun;31(2):314-33
references: 20707236
references: Am J Clin Nutr. 1978 Mar;31(3):492-515
references: 343567
references: Rev Lat Am Enfermagem. 2010 May-Jun;18(3):373-80
references: 20721426
references: Breastfeed Rev. 1999 Mar;7(1):5-16
references: 10197366
references: Lancet. 1999 Dec 11;354(9195):2041-5
references: 10636370