Authors

1 Associate Professor and Head, Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.

2 Head of Comprehensive Health Clinic, Mirza Mohammad Khan Qalacha CHC, Kandahar Directorate of Public Health, Kandahar, Afghanistan.

3 Assistant Professor and Head, Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.

4 Professor and Head, Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.

Abstract

Background
It is recommended for mothers to start breastfeeding their infants within the first hour after birth and exclusively breastfeed them for the first 6 months of their life. Exclusive breastfeeding (EBF) has both short- and long-term benefits for both mother and infant. Main objective of this study was to establish the determinants of EBF practices among mothers in Kandahar, Afghanistan.
Materials and Methods
This was a cross-sectional analytical study conducted in Kandahar, Afghanistan. Researcher-made questionnaire was used to collect the data from 1,028 mothers with children (June–November, 2018). Data was analysed using SPSS software version 22.0
Results
Among 1,028 mothers, 95.9% were uneducated, 53.9% had low socio-economic status, and 94.2% had ante-natal care (ANC) visits. EBF rate was 51.2% (526/1028). During first 6 months of life, 11.1% of the infants were given foods other than milk while 51.4% used pacifier. Weaning was started in nearly half (49.2%) of the infants before 6 months of age. Main barriers to EBF were living in city, male gender, giving sedative syrup (Promethazine) to infant, breastfeeding the infant ≥8 times in 24 hours, and giving expressed milk.
Conclusion
EBF rate in Kandahar is better than many parts of the world, but there are still many barriers that need to be removed. Main barriers of EBF rate in Kandahar needs to be decreased by increasing the health education and overall education status of the mothers.

Keywords

  1. Horta BL, Victora CG. Long-term effects of breastfeeding: A systematic review. World Health Organization. 2013 [cited 2019 Aug 18]. Available from: https://www.who.int/maternal_child_adolescent/documents/breastfeeding_long_term_effects/en/
  2. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.
  3. Rajeshwari K, Bang A, Chaturvedi P, Kumar V, Yadav B, Bharadva K, et al. Infant and young child feeding guidelines: 2010. Indian Pediatr. 2010;47(12):995–1004.
  4. Pakpour A, Alijanzadeh M, Pouresmaeil M, Taherkhani F, Mohammadgholiha R, Jozi N. Predictive Factors Associated with Breastfeeding Initiation and Duration Behaviors of 6-months Postpartum Mothers Referred to Health Centers in the City of Qazvin Based on Theory of Planned Behavior. ranian J Heal Educ Heal Promot. 2016;4(1):20–30.
  5. Debes AK, Kohli A, Walker N, Edmond K, Mullany LC. Time to initiation of breastfeeding and neonatal mortality and morbidity: A systematic review. BMC Public Health. 2013;13(SUPPL.3):S19.
  6. Jamei F, Ostovar A, Javadzade H. Predictors of exclusive breastfeeding among nulliparous Iranian mothers: Application of the theory of planned behavior. Int J Pediatr. 2017;5(3):4457–67.
  7. Jarlenski MP, Bennett WL, Bleich SN, Barry CL, Stuart EA. Effects of breastfeeding on postpartum weight loss among U.S. women. Prev Med (Baltim). 2014;69:146–50.
  8. Babita, Kumar N, Singh M, Malik JS, Kalhan M. Breastfeeding Reduces Breast Cancer Risk: A Case-Control Study in North India. Int J Prev Med. 2014;5(6):791–795.
  9. Assarian F, Moravveji A, Ghaffarian H, Eslamian R, Atoof F. The association of postpartum maternal mental health with breastfeeding status of mothers: A case-control study. Iran Red Crescent Med J. 2014;16(3):e14839.
  10. Esfandiyari R, Moghadam MHB, Khakshour A, Faroughi F, Saeidi M. Study of maternal knowledge and attitude toward exclusive breast milk feeding (BMF) in the first 6 months of infant in yazd-iran. Int J Pediatr. 2014;2(3):175–81.
  11. Noughabi Z, Tehrani G, Foroushani A, Nayeri F, Baheiraei A. Prevalence and factors associated with exclusive breastfeeding at 6 months of life in Tehran: a population-based study. East Mediterr Heal J. 2014;20(1):24–32.
  12. Olang B, Farivar K, Heidarzadeh A, Strandvik B, Yngve A. Breastfeeding in Iran: prevalence, duration and current recommendations. Int Breastfeed J. 2009;4:8.
  13. Central Statistics Organization (CSO), Ministry of Public Health (MoPH), ICF. Demographic and Health Survey 2015. Kabul, Afghanistan: Central Statistics Organization; 2017.
  14. Dashti M, Scott JA, Edwards CA, Al-Sughayer M. Predictors of breastfeeding duration among women in Kuwait: Results of a prospective cohort study. Nutrients. 2014;6(2):711–28.
  15. Velusamy V, Premkumar PS, Kang G. Exclusive breastfeeding practices among mothers in urban slum settlements: Pooled analysis from three prospective birth cohort studies in South India. Int Breastfeed J. 2017;12(35).13.
  16. de Oliveira MM, Camelo JS. Gestational, perinatal, and postnatal factors that interfere with practice of exclusive breastfeeding by six months after birth. Int Breastfeed J. 2017;12(1):42.
  17. Onah S, Osuorah DIC, Ebenebe J, Ezechukwu C, Ekwochi U, Ndukwu I. Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria: A cross-sectional and analytical study. Int Breastfeed J. 2014;9(1).21.
  18. Mundagowa PT, Chadambuka EM, Chimberengwa PT, Mukora-Mutseyekwa F. Determinants of exclusive breastfeeding among mothers of infants aged 6 to 12 months in Gwanda District, Zimbabwe. Int Breastfeed J. 2019;14:30.
  19. Vafaee A, Khabazkhoob M, Moradi A, Najafpoor AA. Prevalence of exclusive breastfeeding during the first six months of life and its determinant factors on the referring children to the health centers in Mashhad, northeast of Iran-2007. J Appl Sci. 2010;10(4):343–8.
  20. Adugna B, Tadele H, Reta F, Berhan Y. Determinants of exclusive breastfeeding in infants less than six months of age in Hawassa, an urban setting, Ethiopia. Int Breastfeed J. 2017;12:45.
  21. Chandrashekhar TS, Joshi HS, Binu V, Shankar PR, Rana MS, Ramachandran U. Breast-feeding initiation and determinants of exclusive breast-feeding - a questionnaire survey in an urban population of western Nepal. Public Health Nutr. 2007;10(2):192–7.
  22. Joshi PC, Angdembe MR, Das SK, Ahmed S, Faruque ASG, Ahmed T. Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh: a cross-sectional study. Int Breastfeed J. 2014;9:7.
  23. Susiloretni KA, Krisnamurni S, Sunarto, Widiyanto SYD, Yazid A, Wilopo SA. The effectiveness of multilevel promotion of exclusive breastfeeding in rural Indonesia. Am J Heal Promot. 2013;28(2):e44-55.
  24. Al-Sahab B, Lanes A, Feldman M, Tamim H. Prevalence and predictors of 6-month exclusive breastfeeding among Canadian women: a national survey. BMC Pediatr. 2010;10:20.
  25. Pries AM, Huffman SL, Mengkheang K, Kroeun H, Champeny M, Roberts M, et al. Pervasive promotion of breastmilk substitutes in Phnom Penh, Cambodia, and high usage by mothers for infant and young child feeding. Matern Child Nutr. 2016;12:38–51.
  26. Haghighi M, Taheri E. Factors associated with breastfeeding in th7e first hour after birth, in baby friendly hospitals, Shiraz-Iran. Int J Pediatr. 2015;3(5):889–96.
  27. Sharma M, Kanani S. Grandmothers’ influence on child care. Indian J Pediatr. 2006;73(4):295–8.
  28. Seid AM, Yesuf ME, Koye DN. Prevalence of Exclusive Breastfeeding Practices and associated factors among mothers in Bahir Dar city, Northwest Ethiopia: a community based cross-sectional study. Int Breastfeed J. 2013;8(1):14.
  29. Matovu A, Kirunda B, Rugamba-Kabagambe G, Tumwesigye NM, Nuwaha F. Factors influencing adherence to exclusive breast feeding among HIV positive mothers in Kabarole district, Uganda. East Afr Med J. 2008;85(4):162–70.
  30. Onah S, Osuorah DIC, Ebenebe J, Ezechukwu C, Ekwochi U, Ndukwu I. Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria: A cross-sectional and analytical study. Int Breastfeed J. 2014;9(1):6.
  31. Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016;16(1):90.
  32. Basu S, Aundhakar C, Galgali A. Gender Discrimination in Relation to Exclusive Breast Feeding Practices amongst Twins in Rural India. Int J Heal Sci Res. 2014;4(5):139–43.
  33. Nagra S, Gilani A. Variations in infant feeding practices in Pakistan with socioeconomic stratification. J Trop Pediatr. 1987;33(2):103–6.
  34. Olang B, Heidarzadeh A, Strandvik B, Yngve A. Reasons given by mothers for discontinuing breastfeeding in Iran. Int Breastfeed J. 2012;7(1):7.
  35. Chandhiok N, Singh KJ, Sahu D, Singh L, Pandey A. Changes in exclusive breastfeeding practices and its determinants in India, 1992-2006: Analysis of national survey data. Int Breastfeed J. 2015;10(34).23.
  36. Amin T, Hablas H, Al Qader AA. Determinants of initiation and exclusivity of breastfeeding in al Hassa, Saudi Arabia. Breastfeed Med. 2011;6(2):59–68.
  37. Yeneabat T, Belachew T, Haile M. Determinants of cessation of exclusive breastfeeding in Ankesha Guagusa Woreda, Awi Zone, Northwest Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth. 2014;14:262.
  38. Khasawneh W, Khasawneh AA. Predictors and barriers to breastfeeding in north of Jordan: could we do better? Int Breastfeed J. 2017 Dec;12(1).13.
  39. Tiwari R, Mahajan PC, Lahariya C. The determinants of exclusive breast feeding in urban slums: a community based study. J Trop Pediatr. 2009;55(1):49–54.
  40. Ogunlesi TA. Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting. Matern Child Health J. 2010;14(3):459–65.
  41. Khanal V, Lee AH, Karkee R, Binns CW. Postpartum Breastfeeding Promotion and Duration of Exclusive Breastfeeding in Western Nepal. Birth. 2015;42(4):329–36.
  42. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: Mothers’ self-reported reasons for stopping during the first year. Pediatrics. 2008;122(SUPPL. 2):S69-76.
  43. Hazir T, Akram D-S, Nisar Y Bin, Kazmi N, Agho KE, Abbasi S, et al. Determinants of suboptimal breast-feeding practices in Pakistan. Public Health Nutr. 2012;16(4):659–72.
  44. Hmone MP, Li M, Agho K, Alam A, Dibley MJ. Factors associated with intention to exclusive breastfeed in central women’s hospital, Yangon, Myanmar. Int Breastfeed J. 2017;12(1):1–12.
  45. Dorgham LS, Hafez SK, Kamhawy HE, Hassan WB, Dorgham LS. Assessment of Initiation of Breastfeeding, Prevalence of Exclusive Breast Feeding and Their Predictors in Taif, KSA. Life Sci J. 2014;11(1):1–9.
  46. Yılmaz E, Yılmaz Z, Isık H, Gultekın IB, Timur H, Kara F, et al. Factors Associated with Breastfeeding Initiation and Exclusive Breastfeeding Rates in Turkish Adolescent Mothers. Breastfeed Med. 2016;11(6):315–20.
  47. Yeneabat et al 2014. Determinants of cessation of exclusive breastfeeding in Ankesha Guagusa Woreda , Awi Zone , Northwest Ethiopia : a cross-sectional study Determinants of cessation of exclusive breastfeeding in Ankesha Guagusa Woreda , Awi Zone , Northwest Ethiopia : a cro. BMC Pregnancyand childbirth. 2014;(August 2016):1–13.
  48. Dun-Dery EJ, Laar AK. Exclusive breastfeeding among city-dwelling professional working mothers in Ghana. Int Breastfeed J. 2016;11(1):23.
  49. Ogbo FA, Eastwood J, Page A, Arora A, McKenzie A, Jalaludin B, et al. Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia. Int Breastfeed J. 2017;12:16.
  50. do Nascimento MBR, Reis MAM, Franco SC, Issler H, Ferraro AA, Grisi SJFE. Exclusive breastfeeding in southern Brazil: prevalence and associated factors. Breastfeed Med. 2010;5(2):79–85.