Keywords
Exclusive Breastfeeding, Knowledge and Practice, Composite Index, Chi-square Test, Binary Logistic Regression.
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Mat Min R and Hossain MM. Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.12688/f1000research.20148.1)
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Research Article
Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study
[version 1; peer review: 2 approved with reservations, 1 not approved]
PUBLISHED 11 Nov 2019
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Abstract
Corresponding author:
Md Mosharaf Hossain
Competing interests:
No competing interests were disclosed.
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The author(s) declared that no grants were involved in supporting this work.
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© 2019 Mat Min R and Hossain MM.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Mat Min R and Hossain MM. Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.12688/f1000research.20148.1)
First published: 11 Nov 2019, 8:1903 (https://doi.org/10.12688/f1000research.20148.1)
Latest published: 11 Nov 2019, 8:1903 (https://doi.org/10.12688/f1000research.20148.1)
Introduction
Exclusive breastfeeding (EBF) is one of the best nutrition practices for child health, growth and nutrition and is an optimal strategy for feeding newborn and young infants1. According to WHO and UNICEF, EBF should start within less than one hour of delivery and should continue for up to 6 months of infants’ age as it is the only diet and source of fluids for babies at that age2.
Children, especially new born babies, are in high danger of malnutrition during the first six months of life when breast milk alone is necessary to meet all nutritious supplies and breastfeeding needs to continue during this time3. Good practice of EBF can prevent 13.8% and 11.6% of all deaths among infants aged <2 years and those under 5-years, respectively4; however, a report estimated that in 2012 only 35% of infants were exclusively breastfed globally5. EBF, due to its various recognized health welfare for babies, children and their mothers, is a crucial plan to improve public health6. Low breastfeeding rates have been found in Canada, as well as other industrialized countries7, and EBF for at least 6 months is not a general practice in developed nations, and is even less in developing nations8. Usually infant development is measured by nutritional level9.
Nearly all Bangladeshi children are breastfed to some extent in the first year of life and many mothers continue to breastfeed up to the second year of a baby’s life (91%)10. Bangladesh has the highest prevalence of malnourishment in South East Asia with a high percentage of children aged 59 months being underweight10. To determine knowledge and practices of newborn nourishment is imperative11.
Several studies have been performed to assess the knowledge, perception and practices of breastfeeding among women and to assess the global trends of EBF12,13. For instance, previous studies have been conducted in Nigeria about knowledge, attitude and techniques of breastfeeding mothers of under five children14,15. In Ethiopia, special concern has been paid to the association between schoolgirls’ perception and knowledge about breastfeeding, and knowledge and practice of mothers towards EBF16.
Only a few studies have been carried out on EBF, and most of these studies were carried out in developing countries17,18. Furthermore, methodological concerns associated with the measurement of knowledge and practices about EBF have not been adequately addressed in earlier studies. The difficulty of judging knowledge lies in its multidimensional aspects; most of studies have been focused on a few indicators. To the best of our knowledge, in Bangladesh this type of study has not been conducted. Therefore, the aim of the present study was to assess the knowledge and practices of EBF among mothers who have at least one child aged 6–12 months in Rajshahi District, Bangladesh.
Methods
Study design
A village hospital based study was conducted in the rural area of Rajshahi district, Bangladesh. There are several reasons why we selected mothers who have at least one child aged 6–12 months from different village hospitals in Rajshahi district. Firstly, to the best of our knowledge in this area no studies have been conducted on EBF; secondly, this area is situated in the remote areas of Rajshahi19. Most of the sample population included all participants that were living near different village hospitals in Rajshahi district, Bangladesh.
Simple size determination
The following formula has been used for calculating sample size: n= N/ (1+Nd2), where n = required sample size, N= population size (5,123), d = marginal error (0.05)20. The formula provided that the minimum sample size was estimated to be 366 for this study. For a better result, we collected data from 513 participants.
Participants
Before sampling, lists of children aged 6–12 months were gathered from the Charghat upazila (sub-district) Health Complex, Rajshahi, from lists used in expanded programmes on immunization. A two-stage purposive sampling approach was chosen to enrol mothers that have at least one child aged 6–12 months from Rajshahi district. In the first stage, out of nine upazila of Rajshahi District, one upazila was purposively selected. In the second stage, purposive sampling was used for the selected sample size. The inclusion criteria of the participants was mothers who have at one child aged 6–12 months and those with no psychological disorders. Exclusion criteria was male parents. The participants asked to be interviewed during routine check-ups. The interviews took place at the participants homes.
Data collection
From September to December 2015, we collected the following data from the mothers for the study: (i) socio-demographic characteristics and (ii) knowledge about EBF using a semi-structured questionnaire by face-to-face interviews from the villages in Rajshahi District. The survey questionnaires were drafted in Bangla, the national and mother tongue of Bangladesh and was then for research purpose translated into English (Extended data). Five fully trained and experienced enumerators conducted the interviews.
Outcomes variables
The dependent variable in our study is the level of good knowledge about EBF, which was calculated through nine different questions, namely: i) Do you know what is meant by EBF?; ii) Do you know when EBF should be started?; iii) Do you know when supplementary feeding is needed?; iv) Do you know if water is allowed in the EBF period?; v) Do you know if honey is allowed in EBF period?; vi) Do you know what the appropriate duration of EBF is?; vii) Do you know what the benefits of EBF are?; viii) Do you know what happens if EBF is not done?; ix) Do you know if any additional feed is essential during the EBF period?
Other outcome variables in this study were good practices about EBF, which was measured through two different questions, namely: i) Did you feed anything else to your last baby during EBF?; ii) What type of feed did you allow during your EBF period for your last baby?
The respondent’s knowledge and practice were scored using a system adopted from earlier studies. A correct reply was given 1 point, while incorrect replies received 0 points [34].
Independent variables
Socio-economic and demographic factors were included as independent variables. Age was classified into two groups: ≤ 30 years and ≥ 31years. Place of delivery was divided into two groups (hospital and home) and occupation was classified into two groups (housewife and service holder). Education was classified based on the formal learning system in Bangladesh: Illiterate and literate. Size of family was categorized as joint (both parents) or single family. Respondent’s monthly income was categorized as yes or no to the question: do you earn ≤6,999 Bangladeshi Taka (BDT)? – (≤6,999 BDT = yes; ≥7,000 BDT = no).
Statistical analyses
Statistical Package for Social Science (SPSS) version 22 IBM was used to analyse the data. Descriptive analyses were conducted to ascertain the socio-economic and demographic variables, and the good knowledge and practice scores. Demographic differences regarding good knowledge and practices of EBF were assessed by χ2 analysis significance, and all analyses was set at p<0.05. Completely adjusted models were used to analyse each binary outcome variable. All variables were inputted into binary logistics regression models. The adjusted odds ratio (AOR) was observed to assess the strength of the associations, and 95% confidence intervals (Cis) for significance test were used.
The knowledge index was calculated through the sums of binary input variables, where the highest and lowest values were selected for each underlying pointer. To determine the knowledge pertaining to breastfeeding, ten questions about the knowledge of breastfeeding were provided. The question was answered CORRECT or INCORRECT. A score of 1 was given for a correct answer and 0 for the incorrect answer. The scores varied from 0–9 points and were classified into two levels, as follows: Bloom’s cut off point, 60%-80%. The items were all assessed using a zero-one indicator (dummy variables). These variables were given a value of zero (low knowledge less than 6 points) for ‘No’ (Bloom’s cut off point less than 59%), and a value of one (high knowledge more than or equal to 6 points) for ‘Yes’ (Bloom’s cut off point 60% – 80% or high). The enactment of individually pointer was articulated using a unit-free index between 0 and 1 in accordance with the structure technique of the Human Development Index21.
Knowledge index = (Actual value - Minimum value) / (Maximum value - Minimum value)
The scores were categorized as the following groups [35, 36]: knowledge - poor = 0-2, moderate = 3-4, and good = 5-9; practice - poor = 0-<1, and good = ≥1.
Results
A total of 513 mothers were involved in this study. From the total sample population, approximately 61% were ≤30 years of age, 60% of deliveries were at hospital and 61% respondents were housewives. Regarding education, 27.5% were illiterate, 19.1% were primary educated and the remaining 53.4% had secondary or higher level of education. A total of 79.5% were from a joint family, and a major portion of respondent’s (59.8 %) had a monthly family income <6,999 BDT.
There was a good level of knowledge and practice of EBF among the mothers that participated in this study. Table 1 and Table 2 show the socio-economic and demographic factors associated with good knowledge and practice. From the total sample population, 32% mothers had a good level of knowledge and 27.9% mothers had a good level of practice about EBF, which was statistically significant (p<0.05) for all variables apart from education.
Table 1. Socio-economic and demographic variables associated with knowledge of exclusive breastfeeding among mothers in Bangladesh with at least one child aged 6–12 months.
Table 2. Socio-economic and demographic variables associated with practice of exclusive breastfeeding among mothers in Bangladesh with at least one child aged 6–12 months.
Regression analysis of the factors associated with good knowledge and practices among mothers on EBF showed (Table 3) that mothers aged ≤30 years (adjusted odds ratio (AOR) = 0.040; 95% CI: 0.021-0.079), gave birth in a hospital (AOR = 0.039; 95% CI: 0.017-0.095) and had a ≤6,999 BDT monthly family income (AOR = 0.197; 95% CI: 0.088-0.442) were less likely to have good knowledge of EBF compared to their counterparts (p<0.05). Mothers that were housewives (AOR = 21.352; 95% CI: 5.170-88.174) and had joint families (AOR = 27.445;95% CI: 11.494-65.537) were more likely to have good knowledge of EBF compared to their counterparts (p<0.05).
Table 3. Effects of socio-economic and demographic variables associated with knowledge of exclusive breastfeeding among mothers in Bangladesh with at least one child aged 6–12 months.
| Explanatory variables | Adjusted odds ratio (AOR) | 95% CI for AOR | P-value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Age (years) | ||||
| ≤30R | ||||
| ≥31 | 0.040 | 0.021 | 0.079 | 0.001 |
| Education IlliterateR Literate | 1.356 | 1.036 | 1.635 | 0.001 |
| Occupation | ||||
| HousewifeR | ||||
| Service holder | 21.352 | 5.170 | 88.174 | 0.001 |
| Place of delivery | ||||
| HospitalR | ||||
| Home | 0.039 | 0.017 | 0.095 | 0.001 |
| Type of family | ||||
| JointR | ||||
| Single | 27.445 | 11.494 | 65.537 | 0.001 |
| Monthly family income (BDT) | ||||
| ≤6,699R | ||||
| ≥7,000 | 0.197 | 0.088 | 0.442 | 0.001 |
| Model summary: Model chi-square = 233.492 (p-value = 0.001) Nagelkerke R2 = 0.512 | ||||
In Table 4, Mothers aged ≤30 years (AOR = 0.084; 95% CI: 0.050-0.143), gave birth at home (AOR = 0.208; 95% CI: 0.111-0.389), had a ≤6,999 BDT monthly family income (AOR = 0.092; 95% CI: 0.050-0.168), and had a joint family (AOR = 0.024; 95% CI: 0.010-0.057) were less likely to have good practice of EBF compared to their counterparts (p<0.05). Mothers that were housewives (AOR = 9.992; 95% CI: 4.485-22.260) were more likely to have good practice of EBF compared with their counterparts (p<0.05).
Table 4. Effects of socio-economic and demographic variables associated with practice of exclusive breastfeeding among mothers in Bangladesh with at least one child aged 6–12 months.
| Explanatory variables | Adjusted odds ratio (AOR) | 95% CI for AOR | P-value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Age (years) | ||||
| ≤30R | ||||
| ≥31 | 0.084 | 0.050 | 0.143 | 0.001 |
| Education IlliterateR Literate | 1.269 | 0.968 | 1.563 | 0.001 |
| Occupation | ||||
| HousewifeR | ||||
| Service holder | 9.992 | 4.485 | 22.260 | 0.001 |
| Place of delivery | ||||
| HospitalR | ||||
| Home | 0.208 | 0.111 | 0.389 | 0.001 |
| Type of family | ||||
| JointR | ||||
| Single | 0.024 | 0.010 | 0.057 | 0.001 |
| Monthly family income (BDT) | ||||
| ≤6,699R | ||||
| ≥7,000 | 0.092 | 0.050 | 0.168 | 0.001 |
| Model summary: Model chi-square=388.475(P-value 0.001) Nagelkerke R2=0.765 | ||||
Discussion
This study surveyed the knowledge and practice of EBF among mothers in rural area of Rajshahi district, Bangladesh. There are two major findings for this study. First, poor knowledge and practice of EBF was seen in 32.0% and 27.9% of mothers. Second, mothers that had good knowledge and practice about EBF were aged ≤30 years, were housewives, had a hospital delivery, were joint family members and had ≤6,999 BDT monthly family income.
The study assumed that most of the mothers would have good knowledge and practice of EBF; however, the study demonstrated that a small percentage of mothers in this area were assessed as having a good level of knowledge and practice of EBF. This study therefore highlights the need for EBF health education programs to educate mothers.
Until now, according to the best of our knowledge this type of study has not been performed in Bangladesh, but similar studies have been conducted in different populations22. The study found that, middle aged mothers (≤30 years) had low knowledge and practices as compared with older respondents (>31 years) and similar results have been found in other countries23. The present study found that hospital delivery respondents had low knowledge and practices as compared with their counterpart, which is consistent with a previous study in Ethiopia24. An extra assumption was that most of the service holder mothers, and those with secondary and higher level of education would have a better knowledge and practice than housewives or those who did not have a high level of education; however, we found that housewives had good knowledge and practices compared with those that were service holders. This study result is consistent with previous other studies25,26.
Those mothers that had joint families had a good of knowledge and practice compared with single mothers. This may be because those mothers in joint families can share their knowledge with other family members. The study also found that mothers from families with ≤6,999 BDT monthly income had good knowledge and practice.
As a final point, the idea of good knowledge and practices of EBF had various definitions. Therefore it is challenging to measure, particularly using the questionnaire used in the present study. However, this study measures knowledge and practice through a lot of indicators, which were seen in a previous study27.
This study had a few limitations. Firstly, it was a village based study and people are busy. Secondly, there are 64 districts and 491 sub-districts (upazilas) in Bangladesh, and in this study we considered only one district and one upazila; therefore, more upazilas should be looked.
Conclusions
This study found that there are huge knowledge and practice gaps regarding EBF among mothers that have at least one child aged 6–12 months. As malnutrition will be decreased if EBF is widely established, this study suggests that EPF related education and interventions could play an important role to increase the level of knowledge and practice concerning EBF among this population of mothers. Health policy makers of Bangladesh should consider performing a study with a larger sample size so that further information can be obtained regarding knowledge and practice of EBF in Bangladesh.
Data availability
Underlying data
The underlying data for this study cannot be openly shared since the consent to participate obtained from the mothers explicitly stated that their data would remain confidential and only be reported in an aggregated manner. Anyone wishing to access the underlying data should first contact the corresponding author (md.hossain@umt.edu.my) who will facilitate contact with the ethical review board who approved the study. Data will be provided to all applicants that apply to access the data.
Extended data
Figshare: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study, https://doi.org/10.6084/m9.figshare.9975704.v128.
This project contains the following extended data:
Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).
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CITE
how to cite this article
Mat Min R and Hossain MM. Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.12688/f1000research.20148.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Version 1
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PUBLISHED 11 Nov 2019
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How to cite this report:
Liu Z and Ruan Y. Reviewer Report For: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.5256/f1000research.22133.r56433)
The direct URL for this report is:
https://f1000research.com/articles/8-1903/v1#referee-response-56433
https://f1000research.com/articles/8-1903/v1#referee-response-56433
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 29 Jun 2020
Zhitao Liu,
Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention, Kunming, Yunnan, China
Approved with Reservations
VIEWS 7
This study surveyed the knowledge and practice of exclusive breastfeeding (EBF) and its relation to various social-economic, demographic factors among mothers with at least one child aged 6-12 months in rural area of Rajshahi district, Bangladesh. Poor knowledge and practice of EBF was reported. Conclusions
... Continue reading
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HOW TO CITE THIS REPORT
Liu Z and Ruan Y. Reviewer Report For: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.5256/f1000research.22133.r56433)
The direct URL for this report is:
https://f1000research.com/articles/8-1903/v1#referee-response-56433
https://f1000research.com/articles/8-1903/v1#referee-response-56433
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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How to cite this report:
Azad K. Reviewer Report For: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.5256/f1000research.22133.r57778)
The direct URL for this report is:
https://f1000research.com/articles/8-1903/v1#referee-response-57778
https://f1000research.com/articles/8-1903/v1#referee-response-57778
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 16 Dec 2019
Kishwar Azad,
Diabetic Association of Bangladesh, Dhaka, Bangladesh; Ibrahim Medical College, Dhaka, Bangladesh
Not Approved
VIEWS 12
The article titled, ‘Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh’: A cross sectional study, examines the knowledge and practices regarding exclusive breastfeeding among mothers with at least one child aged 6-12 months.
I have the following comments:
I have the following comments:
- The authors’ claim that
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HOW TO CITE THIS REPORT
Azad K. Reviewer Report For: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.5256/f1000research.22133.r57778)
The direct URL for this report is:
https://f1000research.com/articles/8-1903/v1#referee-response-57778
https://f1000research.com/articles/8-1903/v1#referee-response-57778
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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How to cite this report:
Anyiam FE. Reviewer Report For: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.5256/f1000research.22133.r56807)
The direct URL for this report is:
https://f1000research.com/articles/8-1903/v1#referee-response-56807
https://f1000research.com/articles/8-1903/v1#referee-response-56807
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 04 Dec 2019
Approved with Reservations
VIEWS 13
The article titled: Knowledge and practices about breastfeeding in rural areas of
Rajshahi District, Bangladesh, is a cross-sectional study focused on mothers with at least one child age 6-12 months residing in a rural community. The study is relevant, especially ... Continue reading
Rajshahi District, Bangladesh, is a cross-sectional study focused on mothers with at least one child age 6-12 months residing in a rural community. The study is relevant, especially ... Continue reading
CITE
HOW TO CITE THIS REPORT
Anyiam FE. Reviewer Report For: Knowledge and practices about breastfeeding in rural areas of Rajshahi District, Bangladesh: A cross-sectional study [version 1; peer review: 2 approved with reservations, 1 not approved]. F1000Research 2019, 8:1903 (https://doi.org/10.5256/f1000research.22133.r56807)
The direct URL for this report is:
https://f1000research.com/articles/8-1903/v1#referee-response-56807
https://f1000research.com/articles/8-1903/v1#referee-response-56807
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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