title: Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study.
abstract: We report the infant feeding experiences in the first month of life for 2,053 infants participating in "Malnutrition and Enteric Infections: Consequences for Child Health and Development" (MAL-ED). Eight sites (in Bangladesh, India, Nepal, Pakistan, Brazil, Peru, South Africa, Tanzania), each followed a cohort of children from birth (by day 17), collecting detailed information on infant feeding practices, diet and illness episodes. Mothers were queried twice weekly regarding health status, breastfeeding and the introduction (or no) of non-breast milk liquids and foods. Here, our goal is to describe the early infant feeding practices in the cohort and evaluate factors associated with termination of exclusive breastfeeding in the first month of life. With data from enrollment to a visit at 28-33 days of life, we characterized exclusive, predominant or partial breastfeeding (using a median of 6-9 visits per child across the sites). Only 6 of 2,053 infants were never breastfed. By one month, the prevalences of exclusive breastfeeding were < 60% in 6 of 8 sites, and of partial breastfeeding (or no) were > 20% in 6 of 8 sites. Logistic regression revealed that prelacteal feeding (given to 4-63% of infants) increased the likelihood of partial breastfeeding (Odds Ratio (OR): 1.48 (95% confidence interval (CI): 1.04, 2.10), as did the withholding of colostrum (2-16% of infants) (OR: 1.63:1.01, 2.62), and being a first-time mother (OR: 1.38:1.10, 1.75). Our results reveal diversity across these sites, but an overall trend of early transition away from exclusive breastfeeding in the first month of life. Interventions which introduce or reinforce the WHO/UNICEF Ten Steps for Successful Breastfeeding are needed in these sites to improve breastfeeding initiation, to reinforce exclusive breastfeeding and delay introduction of non-breast milk foods and/or liquids.
authors.affiliation: Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA. cpatil@uic.edu.
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Patil
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. turab.ali@aku.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Turab
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, MD, USA. Ram.Chandyo@cih.uib.no.
authors.forename: Ramya
authors.initials: R
authors.lastname: Ambikapathi
authors.affiliation: Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, Limpopo Province, South Africa. cebisa.nesamvuni@univen.ac.za.
authors.forename: Cebisa
authors.initials: C
authors.lastname: Nesamvuni
authors.affiliation: Centre for International Health, University of Bergen, Norway and Department of Child Health and Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. lcaulfie@jhsph.edu.
authors.forename: Ram Krishna
authors.initials: RK
authors.lastname: Chandyo
authors.affiliation: Christian Medical College, Vellore, India. abose@cmcvellore.ac.in.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Bose
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. mislam@icddrb.org.
authors.forename: M Munirul
authors.initials: MM
authors.lastname: Islam
authors.affiliation: Biomedical Investigations Unit AB PRISMA, Iquitos, Peru. mustafa@icddrb.org.
authors.forename: A M Shamsir
authors.initials: AM
authors.lastname: Ahmed
authors.affiliation: Department of Nutrition, State University of Ceará, Fortaleza, Ceará, Brazil. mparedeso@prisma.org.pe.
authors.forename: Maribel Paredes
authors.initials: MP
authors.lastname: Olortegui
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, W2041, Baltimore, MD, USA, 21205. milena_mila2003@yahoo.com.br.
authors.forename: Milena Lima
authors.initials: ML
authors.lastname: de Moraes
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, W2041, Baltimore, MD, USA, 21205. lcaulfie@jhsph.edu.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Caulfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000208:ethnology; D015331:Cohort Studies; D019049:Developed Countries; D005260:Female; D006801:Humans; D007225:Infant Food / Q000009:adverse effects; D007231:Infant, Newborn; D017053:Infection Control; D007239:Infections / Q000453:epidemiology / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D018673:Nutrition Policy; D009749:Nutrition Surveys; D010298:Parity; D010349:Patient Compliance / Q000208:ethnology; D011446:Prospective Studies; D014480:United Nations; D014944:World Health Organization; D055815:Young Adult
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