title: Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study.
abstract: BACKGROUND
  Exclusive breastfeeding (EBF) during the early months of life reduce infant morbidity and mortality. Current recommendation in Sri Lanka is to continue exclusive breastfeeding up to six months of age. Exclusive breastfeeding rates are generally assessed by the 24 recall method which overestimates the actual rates. The objective of this study was to determine actual exclusive breast feeding rates in a cohort of Sri Lankan children and to determine the reasons that lead to cessation of breastfeeding before six months of age.
  
  
  METHODS
  From a cohort of 2215 babies born in Gampaha district, 500 were randomly selected and invited for the study. They were followed up at two (n = 404), four (n = 395) and six (n = 286) months. An interviewer administered questionnaire asked about feeding history and socio-demographic characteristics. Child health development record was used to assess the growth.
  
  
  RESULTS
  Exclusive breastfeeding rates at two, four and six months were 98.0%, 75.4% and 71.3% respectively. The main reasons to stop exclusive breastfeeding between two to four months was concerns regarding weight gain and between four to six months were mothers starting to work. Majority of the babies that were not exclusively breastfed still continued to have breast milk. Mothers above 30 years had lower exclusive breastfeeding rates compared to younger mothers. Second born babies had higher rates than first borns. There was no significant association between maternal education and exclusive breastfeeding rates.
  
  
  CONCLUSIONS
  Exclusive breastfeeding rates were high among this cohort of children. A decrease in EBF was noted between two and four months. EBF up to six months does not cause growth failure. Mothers starting to work and concerns regarding adequacy of breast milk were the major reasons to cease EBF. The actual exclusive breastfeeding rates up to six months was 65.9%.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, Ragama, Sri Lanka. priyanthaprr@gmail.com.
authors.forename: Priyantha J
authors.initials: PJ
authors.lastname: Perera
authors.forename: Nayomi
authors.initials: N
authors.lastname: Ranathunga
authors.forename: Meranthi P
authors.initials: MP
authors.lastname: Fernando
authors.forename: Wikum
authors.initials: W
authors.lastname: Sampath
authors.forename: Gayni B
authors.initials: GB
authors.lastname: Samaranayake