title: Breastfeeding Practices among Poor Women in Mesoamerica.
abstract: BACKGROUND
  Breastfeeding is an effective intervention to reduce pediatric morbidity and mortality. The prevalence of practices and predictors of breastfeeding among the poor in Mesoamerica has not been well described.
  
  
  OBJECTIVE
  We estimated the prevalence of ever breastfeeding, early initiation of breastfeeding, exclusive breastfeeding, and breastfeeding between 6 mo and 2 y of age using household survey data for the poorest quintile of families living in 6 Mesoamerican countries. We also assessed the predictors of breastfeeding behaviors to identify factors amenable to policy interventions.
  
  
  METHODS
  We analyzed data from 12,529 children in Guatemala, Honduras, Mexico (Chiapas State), Nicaragua, Panama, and El Salvador using baseline survey data from the Salud Mesoamérica 2015 Initiative. We created multivariable Poisson regression models with robust variance estimates to calculate adjusted risk ratios (aRRs) and 95% CIs for breastfeeding outcomes and to control for sociodemographic and healthcare-related factors.
  
  
  RESULTS
  Approximately 97% of women in all countries breastfed their child at least once, and 65.1% (Nicaragua) to 79.0% (Panama) continued to do so between 6 mo and 2 y of age. Breastfeeding in the first hour of life varied by country (P < 0.001), with the highest proportion reported in Panama (89.8%) and the lowest in El Salvador (65.6%). Exclusive breastfeeding also varied by country (P = 0.037), ranging from 44.5% in Panama to 76.8% in Guatemala. For every 20% increase in the proportion of peers who exclusively breastfed, there was an 11% (aRR: 1.11, 95% CI: 1.04, 1.18) increase in the likelihood of exclusive breastfeeding.
  
  
  CONCLUSIONS
  Our study revealed significant variation in the prevalence of breastfeeding practices by poor women across countries surveyed by the Salud Mesoamérica 2015 initiative. Future interventions to promote exclusive breastfeeding should consider ways to leverage the role of the community in supporting individual women.
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and dvc2@uw.edu.
authors.forename: Danny V
authors.identifier: http://orcid.org/0000-0002-5237-1300
authors.initials: DV
authors.lastname: Colombara
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hernández
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Marielle C
authors.initials: MC
authors.lastname: Gagnier
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Casey
authors.initials: C
authors.lastname: Johanns
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Sima S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Annie
authors.initials: A
authors.lastname: Haakenstad
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Claire R
authors.initials: CR
authors.lastname: McNellan
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Palmisano
authors.affiliation: Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama.
authors.forename: Diego
authors.initials: D
authors.lastname: Ríos-Zertuche
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama.
authors.forename: Paola
authors.initials: P
authors.lastname: Zúñiga-Brenes
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zyznieuski
authors.affiliation: Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama.
authors.forename: Emma
authors.initials: E
authors.lastname: Iriarte
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA; and.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002489:Central America; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D008429:Maternal Welfare; D008800:Mexico; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Central America; breastfeeding; duration; exclusivity; initiation; predictors