Factors Affecting Exclusive Breastfeeding, Using Adaptive LASSO Regression

Exclusive breastfeeding (EBF) in the first six months of the life can significantly improve maternal and children health, and it is especially important in low- and middle-income countries. We aimed to determine the factors affecting EBF duration in a sample of Iranian infants.

This prospective study was conducted between April 2012 and October 2014 in Fars, Iran. Women (N=2640), who had given birth to healthy term infants were categorized into EBF versus non-EBF groups. Demographic information from mothers and infants, medical and drug history, and pregnancy related factors were compared between the two groups. Multivariable analysis was performed using Adaptive Lasso regression. P<0.05 was considered significant.

The mean duration of EBF was 4.63±1.99 months. There was an inverse association between the mother's educational level and duration of EBF (P<0.001). Also, we found that mothers who were housewives had a significantly longer duration of EBF (4.68±1.97) compared to mothers with either part-time (4.21±2.01) or full-time jobs (4.02±2.12) (P<0.001). By eliminating the redundant factors, the proposed multivariable model showed the infant's weight gain during EBF, singleton/multiple pregnancies, maternal perception of quantity of breast milk, post-partum infection, use of pacifier, neonate's irritability, birth place and mother's full-time job as the most important factors affecting the duration of EBF. Twin pregnancies, post-partum infection, cesarean section by maternal request, use of a pacifier and irritability in the neonatal period significantly reduced the duration of EBF.

Health policy-makers should promote EBF programs among the educated as well as working mothers in order to positively affect the community's health status.