title: The Influence of Seasonality and Community-Based Health Worker Provided Counselling on Exclusive Breastfeeding - Findings from a Cross-Sectional Survey in India.
abstract: BACKGROUND
  Exclusive breastfeeding (EBF) during the first six months of life is considered a high impact but low-cost measure for reducing the morbidity and mortality among children. The current study investigated the association of seasonality and frontline worker(FLW) provided counselling with practice of EBF in Bihar, India.
  
  
  METHODS
  We used the 'Lot Quality Assurance Sampling' technique to conduct a multi-stage sampling survey in 8 districts of Bihar. Regarding EBF, mothers of 0-5 (completed) months old children were asked if they had given only breastmilk to their children during the previous day, while mothers of 6-8 (completed) months old children were inquired about the total duration of EBF. We tested for association between EBF during the previous day with season of interview and EBF for full 6 months with nursing season. We also assessed if receiving counselling on EBF and complementary feeding had any association with relevant EBF indicators.
  
  
  RESULTS
  Among the under-6 month old children, 76% received EBF during the previous day, whereas 92% of 6-8 (completed) months old children reportedly received EBF for the recommended duration. Proportion of 0-5 (completed) month old children receiving only breastmilk (during last 24 hours) decreased significantly with increasing age and with change of season from colder to warmer months. Odds of receiving only breastmilk during the previous day was significantly higher during the winter months (Adjusted odds ratio(AOR) = 1.50; 95% CI = 1.37, 1.63) compared to summer. Also, the children nursed primarily during the winter season had higher odds of receiving EBF for 6 months (AOR = 1.90, 95% CI = 1.43, 2.52) than those with non-winter nursing. Receiving FLW-counselling was positively associated with breastfeeding exclusively, even after adjusting for seasonality and other covariates (AOR = 1.82; 95% CI = 1.67, 1.98).
  
  
  CONCLUSIONS
  Seasonality is a significant but non-modifiable risk factor for EBF. However, FLW-counselling was found to increase practice of EBF irrespective of season. Scale-up of FLW-counselling services, with emphasis on summer months and mothers of older infants, can potentially reduce the impact of seasonality on EBF.
authors: CARE India Solutions for Sustainable Development, H No. 14, Patliputra Colony, Patna, Bihar, India.
authors: Aritra
authors: A
authors: Das
authors: CARE India Solutions for Sustainable Development, H No. 14, Patliputra Colony, Patna, Bihar, India.
authors: Rahul
authors: R
authors: Chatterjee
authors: CARE India Solutions for Sustainable Development, H No. 14, Patliputra Colony, Patna, Bihar, India.
authors: Morchan
authors: M
authors: Karthick
authors: Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors: Tanmay
authors: T
authors: Mahapatra
authors: CARE India Solutions for Sustainable Development, H No. 14, Patliputra Colony, Patna, Bihar, India.
authors: Indrajit
authors: I
authors: Chaudhuri
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003150:Community Health Workers; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D055810:Lot Quality Assurance Sampling; D008297:Male; D012621:Seasons; D011795:Surveys and Questionnaires