title: Predictors of suboptimal breastfeeding: an opportunity for public health interventions.
abstract: BACKGROUND
  Sub-optimum breastfeeding significantly contributes to the global burden of disease. Our aim was to identify risk factors associated with suboptimal breastfeeding in Southern Croatia.
  
  
  METHODS
  Between February 2008 and August 2009, 773 mother-infant pairs were recruited from University Hospital of Split Maternity Unit. Mothers were interviewed at birth, 3, 6, 12 and 24 months.
  
  
  RESULTS
  Ninety-nine percent of mothers initiated breastfeeding but only 2.2% of them exclusively breastfed whilst in hospital. At 24 months, 4.1% of mothers were breastfeeding. Exclusive and any breastfeeding at 3 months was negatively associated with maternal education of 12 years or less, smoking during pregnancy, intention to use a pacifier and in-hospital formula supplementation. In addition, exclusive breastfeeding at 3 months was negatively associated with primiparity, antenatal course non-attendance and not receiving assistance with breastfeeding from hospital staff. Antenatal course non-attendance and discussing infant feeding with a health professional during pregnancy lowered the odds for any breastfeeding at 6 months. At 12 and 24 months, a lower level of education, antenatal course non-attendance and not receiving advice in hospital on feeding frequency was significantly associated with lower odds of breastfeeding. Additionally, intention to use a pacifier was found to be a negative predictor of breastfeeding at 12 months.
  
  
  CONCLUSIONS
  Important modifiable risk factors found to be significantly associated with suboptimal breastfeeding include smoking during pregnancy, intention to use a pacifier, in-hospital formula supplementation, not receiving advice from hospital staff on normal feeding patterns, not receiving assistance with breastfeeding in hospital and antenatal course non-attendance.
authors.affiliation: 1 Department of Family Medicine, University of Split School of Medicine, Šoltanska 2, Split 21000, Croatia irena.zakarija-grkovic@mefst.hr.
authors.forename: Irena
authors.initials: I
authors.lastname: Zakarija-Grković
authors.affiliation: 2 Health Centre "Dr.A.Franulović" Vela Luka, Kale 1, Vela Luka 20270, Croatia.
authors.forename: Olga
authors.initials: O
authors.lastname: Šegvić
authors.affiliation: 3 Health Centre of Split and Dalmatia County, Kavanjinova 2, Split 21 000, Croatia.
authors.forename: Ana
authors.initials: A
authors.lastname: Vučković Vukušić
authors.affiliation: 4 Department of Anaesthetics, University Hospital of Split, Spinčićeva 1, Split 21000, Croatia.
authors.forename: Toni
authors.initials: T
authors.lastname: Lozančić
authors.affiliation: 5 Department of Respiratory Diseases, University Hospital of Split, Spinčićeva 1, Split 21000, Croatia.
authors.forename: Toni
authors.initials: T
authors.lastname: Božinović
authors.affiliation: 6 Health Centre of Split and Dalmatia County, Kavanjinova 2, Split 21000, Croatia.
authors.forename: Anamarija
authors.initials: A
authors.lastname: Ćuže
authors.affiliation: 7 Department of Molecular Medicine, Public Health Section, University of Padova, Italy.
authors.forename: Tea
authors.initials: T
authors.lastname: Burmaz
mesh_terms: D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data*; D017523:Croatia; D006785:Hospitals, University; D006801:Humans; D041943:Infant Formula / Q000706:statistics & numerical data; D033182:Intention; D009035:Mothers / Q000193:education / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011634:Public Health; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013997:Time Factors