title: Determinants of suboptimal breast-feeding practices in Pakistan.
abstract: OBJECTIVE
  Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan.
  
  
  METHODS
  A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006-2007.
  
  
  METHODS
  A nationally representative sample of households.
  
  
  METHODS
  Last-born alive children aged 0-23 months (total weighted sample size 3103).
  
  
  RESULTS
  The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0-23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0-5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P < 0·001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P < 0·001).
  
  
  CONCLUSIONS
  The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.
authors.affiliation: ARI Research Cell, Children's Hospital, Pakistan Institute of Medical Sciences, Sector: G-8/3, Islamabad 44000, Pakistan. tabishhazir@hotmail.com
authors.forename: Tabish
authors.initials: T
authors.lastname: Hazir
authors.forename: Dure-Samin
authors.initials: DS
authors.lastname: Akram
authors.forename: Yasir Bin
authors.initials: YB
authors.lastname: Nisar
authors.forename: Narjis
authors.initials: N
authors.lastname: Kazmi
authors.forename: Kingsley E
authors.initials: KE
authors.lastname: Agho
authors.forename: Saleem
authors.initials: S
authors.lastname: Abbasi
authors.forename: Amira M
authors.initials: AM
authors.lastname: Khan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
mesh_terms: D000328:Adult; D001903:Bottle Feeding / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008880:Midwifery; D015999:Multivariate Analysis; D009752:Nutritional Status; D010154:Pakistan; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult