Exclusive breastfeeding: Measurement to match the global recommendation
Silvia Alayón1,2, Veronica Varela1,3, Altrena Mukuria-Ashe1,2
1USAID Advancing Nutrition, Arlington, Virginia, USA.
Insights
Accurately measuring exclusive breastfeeding (EBF) for the recommended 6 months is crucial. The EBF-AI method offers a practical and reliable approach for large surveys, aligning with WHO recommendations.
Area of Science:
- Public Health
- Nutrition Science
- Pediatrics
Background:
- World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life.
- Current EBF measurement methods, like point prevalence (EBF-24H), may overestimate adherence to the 6-month recommendation.
- Accurate EBF assessment is vital for monitoring infant feeding practices and public health interventions.
Purpose of the Study:
- To compare the accuracy and feasibility of five different methods for measuring exclusive breastfeeding (EBF).
- To identify a measurement method that aligns with WHO/UNICEF recommendations and is suitable for large-scale surveys.
- To evaluate the overestimation potential of current EBF assessment techniques.
Main Methods:
- Compared five EBF measurement methods: EBF-24H, EBF-24H-Pul, EBF-SB, EBF-SB-Pul, and EBF-AI.
- Utilized data from three large-scale cross-sectional surveys.
- Analyzed estimates based on 24-hour recall, since-birth recall, and age of introduction of liquids/foods.
Main Results:
- EBF-24H-Pul and EBF-SB-Pul yielded lower EBF estimates, aligning better with WHO recommendations but posing sample size challenges.
- The EBF-AI method provided intermediate estimates, aligned well with WHO recommendations, and is easily implementable in large household surveys.
- The standard EBF-24H method tended to overestimate the proportion of infants exclusively breastfed for the full 6 months.
Conclusions:
- The EBF-AI method is a promising tool for accurately assessing 6-month exclusive breastfeeding in large surveys.
- Further validation of EBF-24H-Pul, EBF-SB-Pul, and EBF-AI is recommended to confirm their accuracy in measuring EBF for the entire recommended period.
- Developing and validating precise EBF measurement tools is essential for effective public health policy and infant nutrition monitoring.
Abstract:
The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life. To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0-5.9 months of age, as recommended by WHO and UNICEF. This measure tends to overestimate the percentage of infants that are exclusively breastfed for the entire recommended period. We compared five methods of measuring EBF, using data from three large-scale cross-sectional surveys. The five methods were: the WHO/UNICEF recommended method (EBF-24H); an estimate of EBF for 6 months, using the 24-h recall among infants 4-5.9 and 6-7.9 months (EBF-24H-Pul); a since birth recall (EBF-SB); an estimate of EBF for 6 months, using the since-birth recall among infants 4-5.9 and 6-7.9 months (EBF-SB-Pul); a retrospective measure of EBF collected from infants 6-11.9 months, based on the age of introduction of liquids and foods (EBF-AI). EBF-24H-Pul and EBF-SB-Pul produced lower estimates of EBF than other measures, while also aligning better with the WHO recommendation, but may be difficult to estimate from multipurpose surveys due to sample size limitations. The EBF-AI method produced estimates between these, aligns well with the WHO recommendation and can be easily collected in large-scale household surveys. Additional validation of the EBF-24-Pul, EBF-SB-Pul, and EBF-AI methods is recommended to understand how accurately they measure EBF for the recommended 6-month period.
