title: The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal.
abstract: While the initiation of breastfeeding is universal in Nepal, little has been reported on formula feeding practices. This study aimed to report the prevalence of, and factors associated with, the use of infant formula as supplementary feeds in the Western region of Nepal.
  
  
  
  A community-based cohort study was conducted to collect infant feeding information among 735 postpartum mothers using structured questionnaires. Complete formula feeding data were collected from 711 women in the first, fourth and sixth month postpartum. Factors independently associated with formula feeding were investigated using multiple logistic regression.
  
  
  
  All mothers were breastfeeding their infants at the time of recruitment. The prevalence of formula feeding was 7.5 % in the first month and 17 % in the sixth month. About a quarter of mothers (23.8 %) reported providing infant formula at least once during the first six months of life. Infant formula was used commonly as top-up food. Stepwise logistic regression showed that infants born to families residing in urban areas (adjusted odds ratio (aOR): 2.14; 95 % confidence interval (CI): 1.37 to 3.33), mothers with higher education (aOR: 2.08; 95 % CI: 1.14 to 3.80), and infants born by caesarean section (aOR: 1.96; 95 % CI: 1.21 to 3.18) were at greater risk of formula feeding.
  
  
  
  The current findings indicate that health workers should support mothers to initiate and continue exclusive breastfeeding particularly after caesarean deliveries. Furthermore, urban health programs in Nepal should incorporate breastfeeding programs which discourage the unnecessary use of formula feeding. The marketing of formula milk should be monitored more vigilantly especially in the aftermath of the April 2015 earthquakes or other natural disasters.
authors.affiliation: Nepal Development Society, Bharatpur, Chitwan, Nepal. khanal.vishnu@gmail.com.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Khanal
authors.affiliation: School of Public Health, Curtin University, Perth, Australia.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Scott
authors.affiliation: School of Public Health, Curtin University, Perth, Australia.
authors.forename: Andy H
authors.initials: AH
authors.lastname: Lee
authors.affiliation: School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Karkee
authors.affiliation: School of Public Health, Curtin University, Perth, Australia.
authors.forename: Colin W
authors.initials: CW
authors.lastname: Binns
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D041943:Infant Formula / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008425:Maternal Behavior; D008875:Middle Aged; D009390:Nepal; D055815:Young Adult
keywords: Baby formula; Breastfeeding; Cohort studies; Infant Formula; Infant food; Nepal; Urban Health