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      Prevalence of exclusive breastfeeding among mothers in the informal sector, Kampala Uganda

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      Journal: PLoS ONE
      Publisher: Public Library of Science

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          Abstract

          Exclusive breastfeeding (EBF) for the first six months of life is effective in preventing infant morbidity and mortality. However, 36% of Ugandan children below 6 months are not breastfed exclusively despite its active promotion. This study determined the prevalence and factors associated with exclusive breastfeeding among mothers working in the informal sector in Kampala district. A community based cross-sectional study targeting 428 interviews with mothers with children aged 0–5 months was conducted. Analysis was done using modified Poisson regression in Stata version 14. The prevalence of exclusive breastfeeding was 42.8%. The factors associated with exclusive breastfeeding included: attending antenatal care at least 4 times (APR = 1.24; 95% CI: 1.01–1.51), intention to exclusively breastfeed for 6 months (APR = 1.26; 95% CI: 1.01–1.57) or longer (APR = 1.38; 95% CI: 1.06–1.76), proper breastfeeding practices (APR = 4.12; 95% CI: 2.88–5.90), age of the infant (APR = 0.78; 95% CI: 0.65–0.94) and (APR = 0.48; 95% CI: 0.39–0.60) for children aged 2–3 and 4–5 months respectively and working in a lower position (APR = 0.68; 95% CI: 0.55–0.83). Mothers should be encouraged to attend antenatal care where they learn about the benefits of exclusive breastfeeding to children below 6 months hence enabling them to make informed decisions about exclusive breastfeeding. The government of Uganda should ensure maternity leave benefits of the employment act are enforced in the informal sector to allow women to practice EBF.

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          Factors that positively influence breastfeeding duration to 6 months: a literature review.

          Shahla Meedya, Kathleen Fahy, Ashley Kable (2010)
          What modifiable factors positively influence breastfeeding duration to 6 months postpartum? This question was posed in order to be able to develop a midwifery intervention aimed at prolonging breastfeeding. An online literature search was conducted in Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews. The search strategy included the following keywords: breastfeeding, duration, initiation, cessation, factors, intervention, education, partner, intention, confidence, self-efficacy and support. Additional studies were located and extracted from online publications of New South Wales Department of Health, Australia. Bio-psycho-social factors that are positively associated with breastfeeding duration were identified. Modifiable factors that influence women's breastfeeding decisions are: breastfeeding intention, breastfeeding self-efficacy and social support. Existing midwifery breastfeeding promotion strategies often include social support but do not adequately address attempts to modify breastfeeding intention and self-efficacy. The modifiable factors that are positively associated with breastfeeding duration are the woman's breastfeeding intention, her breastfeeding self-efficacy and her social support. Intervention studies to date have focussed on modifying these factors individually with variable results. No interventional studies have been conducted with the aim of positively modifying all three factors simultaneously. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.
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            Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda.

            David Musoke, Petra Boynton, Ceri Butler … (2014)
            The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.
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              Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries

              Ghada Saad–Haddad, Jocelyn DeJong, Nancy Terreri … (2016)
              Background Antenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop–off in use between ANC1+ and ANC4+, and explores inequalities in women’s use of ANC services. It also identifies determinants of utilization and describes countries’ ANC–related policies, and programs. Methods We performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women’s education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country–based informants. Results Each country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence–based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women’s education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman’s education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify. Conclusion Secondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub–groups, all countries can benefit from specific in–country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women’s perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or implemented properly to ensure that women receive the recommended number of ANC visits with appropriate content, especially, poor and less educated women residing in rural areas.
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                Author and article information

                Contributors
                Phoebe Nabunya:
                ORCID: http://orcid.org/0000-0001-5181-6622
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Ruth Mubeezi: Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Phyllis Awor: Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Jennifer Yourkavitch: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 24 September 2020
                Publication date Collection: 2020
                Volume: 15
                Issue: 9
                Electronic Location Identifier: e0239062
                Affiliations
                [1 ] Department of Biostatistics and Epidemiology, Makerere School of Public Health, Kampala, Uganda
                [2 ] Department of Disease Control and Environmental Health, Makerere School of Public Health, Kampala, Uganda
                [3 ] Department of Community Health and Behavioral Sciences, Makerere School of Public Health, Kampala, Uganda
                University of North Carolina at Greensboro, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤]

                Current address: Uganda Public Health Fellowship, Nakasero Hill, Kampala, Uganda

                Author information
                http://orcid.org/0000-0001-5181-6622
                Article
                Publisher ID: PONE-D-19-33484
                DOI: 10.1371/journal.pone.0239062
                PMC ID: 7514031
                PubMed ID: 32970700
                SO-VID: e6a717d4-b9ae-4757-bf04-a8f5808f482e
                Copyright © © 2020 Nabunya et al
                License:

                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 author and source are credited.

                History
                Date received : 3 December 2019
                Date accepted : 30 August 2020
                Page count
                Figures: 0, Tables: 4, Pages: 14
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Breast Feeding
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: Neonatology
                Subject: Breast Feeding
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: Infants
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: Infants
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Antenatal Care
                Subject: Social Sciences
                Subject: Economics
                Subject: Labor Economics
                Subject: Employment
                Subject: Biology and Life Sciences
                Subject: Nutrition
                Subject: Diet
                Subject: Beverages
                Subject: Milk
                Subject: Breast Milk
                Subject: Medicine and Health Sciences
                Subject: Nutrition
                Subject: Diet
                Subject: Beverages
                Subject: Milk
                Subject: Breast Milk
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Fluids
                Subject: Milk
                Subject: Breast Milk
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Fluids
                Subject: Milk
                Subject: Breast Milk
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Body Fluids
                Subject: Milk
                Subject: Breast Milk
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Parenting Behavior
                Subject: Social Sciences
                Subject: Psychology
                Subject: Behavior
                Subject: Parenting Behavior
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Psychological Attitudes
                Subject: Social Sciences
                Subject: Psychology
                Subject: Psychological Attitudes
                Custom metadata
                Data Availability To protect the confidentiality of participant information, ethical restrictions have been imposed on the data used in this study. Interested researchers may submit queries related to data access to the HDREC at MakSPH ( maksphhdrec@ 123456musph.ac.ug ) or to the corresponding author of this study. The Data set is titled EBF Data May 2028 Kampala 2. The list of variables are included in the Supporting Information file.

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