title: Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh: a cross-sectional study.
abstract: BACKGROUND
  Exclusive breastfeeding (EBF) means that the infant receives only breast milk for the first six months of life after birth. In Bangladesh, the prevalence of EBF remained largely unchanged for nearly two decades and was 43% in 2007. However, in 2011, a prevalence of 64% was reported, an increase by 21 percentage points. The reasons for this large change remain speculative at this point. Thus to investigate the issue further, this study was conducted. The objective was to assess the prevalence of EBF and associated factors among mothers having children aged 0-6 months in rural Bangladesh.
  
  
  METHODS
  A cross-sectional study was conducted in Mirzapur Upazilla (sub district) among 121 mothers of infants aged 0-6 months. Eligible mothers were identified and randomly selected using the demographic surveillance system's computerized database that is updated weekly. A semi-structured questionnaire was used for interviews that inquired information on socio-demographic characteristics, obstetric, health service, breastfeeding related factors (initiation of breastfeeding, prelacteal feeding and colostrum feeding) and economic factors. EBF prevalence was calculated using 24 hour recall method. In multivariate analysis, a logistic regression model was developed using stepwise modeling to analyze the factors associated with EBF.
  
  
  RESULTS
  The prevalence of EBF in the last 24 hours preceding the survey was 36%. Bivariate and multivariate analysis revealed no significant association between EBF and its possible predictors at 0.05 level of alpha. However, there was some evidence of an association between EBF and having a caesarean delivery (OR = 0.47, 95% CI: 0.21, 1.06). In multivariate analysis, type of delivery: caesarean (AOR = 0.45, 95% CI: 0.19, 1.03) and wealth quintile: richer (AOR = 2.40, 95% CI: 0.94, 6.16) also showed some evidence of an association with EBF.
  
  
  CONCLUSIONS
  The prevalence of EBF in Mirzapur (36%) is lower than the national figure (64%). Prelacteal feeding was not uncommon. These findings suggest that there is a need for breastfeeding support provided by health services. Hence, promotion of EBF during the first six months of life needs to be addressed and future breastfeeding promotion programmes should give special attention to those women who are not practicing EBF.
authors.affiliation: Department of Public Health, Central Institute of Science and Technology, Pokhara University, Kathmandu, Nepal.|James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
authors.forename: Prakash Chandra
authors.initials: PC
authors.lastname: Joshi
authors.affiliation: Department of Public Health, Central Institute of Science and Technology, Pokhara University, Kathmandu, Nepal.|James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
authors.forename: Mirak Raj
authors.initials: MR
authors.lastname: Angdembe
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
authors.forename: Sumon Kumar
authors.initials: SK
authors.lastname: Das
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
authors.forename: Shahnawaz
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
authors.forename: Abu Syed Golam
authors.initials: ASG
authors.lastname: Faruque
authors.affiliation: James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.|Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
keywords: Bangladesh; Exclusive breastfeeding; Factors; Predictors; Prevalence