title: Factors Associated with Age at Breastfeeding Cessation in Amazonian Infants: Applying a Proximal-Distal Framework.
abstract: Introduction Breastfeeding is an important determinant of child survival and normal growth and development, but breastfeeding prevalence is generally low in Brazil. Factors associated with infant feeding practices there are not well understood. This paper examines factors associated with breastfeeding cessation in a township in the western Brazilian Amazon. Methods A cross-sectional, population-based study was conducted among children younger than 25 months and collected information on maternal and child characteristics. Survival analysis based on a proximal-distal framework examined the association between breastfeeding duration and socioeconomic and maternal/child biological factors. Results The median breastfeeding duration among 101 children who were no longer breastfeeding was 120 days. Almost two-thirds (63 %) of these children stopped breastfeeding before 6 months of age. In the larger sample of 209 children, 74.6 % had previously been bottle-fed. Considering the full proximal-distal model, a child who had ever been bottle-fed was expected to cease breastfeeding about 88 % sooner than one who was never bottle-fed (p < 0.001). Children in the second-poorest wealth quartile stopped breastfeeding sooner than children in the poorest quartile (p < 0.05). Discussion Breastfeeding cessation in the study area occurred much earlier than the recommended 2 years of age. Factors associated with ending breastfeeding early included ever-use of a bottle, having a single mother, and belonging to the second-poorest wealth quartile. Further research is needed to better understand these factors and other barriers women face to continuing breastfeeding.
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. akearns@mail.harvard.edu.
authors.forename: Annie D
authors.initials: AD
authors.lastname: Kearns
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Marcia C
authors.initials: MC
authors.lastname: Castro
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, São Paulo, 01246-904, Brazil.
authors.forename: Bárbara H
authors.initials: BH
authors.lastname: Lourenço
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, São Paulo, 01246-904, Brazil.
authors.forename: Rosângela A
authors.initials: RA
authors.lastname: Augusto
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, São Paulo, 01246-904, Brazil.
authors.forename: Marly A
authors.initials: MA
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D001938:Brazil; D001942:Breast Feeding / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance; D011203:Poverty; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Amazon; Brazil; Breastfeeding; Breastfeeding duration; Infant health