title: Trends and determinants for early initiation of and exclusive breastfeeding under six months in Vietnam: results from the Multiple Indicator Cluster Surveys, 2000-2011.
abstract: BACKGROUND
  There is strong evidence that breastfeeding (BF) significantly benefits mothers and infants in various ways. Yet the proportion of breastfed babies in Vietnam is low and continues to decline. This study fills an important evidence gap in BF practices in Vietnam.
  
  
  OBJECTIVE
  This paper examines the trend of early initiation of BF and exclusive BF from 2000 to 2011 in Vietnam and explores the determinants at individual and contextual levels.
  
  
  METHODS
  Data from three waves of the Multiple Indicator Cluster Survey were combined to estimate crude and adjusted trends over time for two outcomes - early initiation of BF and exclusive BF. Three-level logistic regressions were fitted to examine the impacts of both individual and contextual characteristics on early initiation of BF and exclusive BF in the 2011 data.
  
  
  RESULTS
  Both types of BF showed a decreasing trend over time after controlling for individual-level characteristics but this trend was more evident for early initiation of BF. Apart from child's age, individual-level characteristics were not significant predictors of the BF outcomes, but provincial characteristics had a strong association. When controlling for individual-level characteristics, mothers living in provinces with a higher percentage of mothers with more than three children were more likely to have initiated early BF (odds ratio [OR]: 1.06; confidence interval [CI]: 1.02-1.11) but less likely to exclusively breastfeed their babies (OR: 0.94; CI: 0.88-1.01). Mothers living in areas with a higher poverty rate were more likely to breastfeed exclusively (OR: 1.07; CI: 1.02-1.13), and those who delivered by Caesarean section were less likely to initiate early BF.
  
  
  CONCLUSIONS
  Our results suggest that environmental factors are becoming more important for determining BF practices in Vietnam. Intervention programs should therefore not only consider individual factors, but should also consider the potential impact of contextual factors on BF practices.
authors.affiliation: Department of Epidemiology and Biostatistics, The Hanoi School of Public Health, Hanoi, Vietnam; btq@hsph.edu.vn.
authors.forename: Quyen Thi-Tu
authors.initials: QT
authors.lastname: Bui
authors.affiliation: JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, South Korea; diana0224@gmail.com; diana24@snu.ac.kr.
authors.forename: Hwa-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Epidemiology and Biostatistics, The Hanoi School of Public Health, Hanoi, Vietnam.
authors.forename: Anh Thi-Kim
authors.initials: AT
authors.lastname: Le
authors.affiliation: Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
authors.forename: Do
authors.initials: D
authors.lastname: Van Dung
authors.affiliation: Department of Epidemiology and Biostatistics, The Hanoi School of Public Health, Hanoi, Vietnam.
authors.forename: Lan Thi-Hoang
authors.initials: LT
authors.lastname: Vu
mesh_terms: D001942:Breast Feeding / Q000208:ethnology / Q000706:statistics & numerical data / Q000639:trends*; D004777:Environment; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009035:Mothers / Q000523:psychology; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D012959:Socioeconomic Factors; D014744:Vietnam; D055815:Young Adult
keywords: MICS; Vietnam; breastfeeding; multilevel analysis