Evidence of inflated exclusive breastfeeding estimates from a clinical trial in Bangladesh

Roberts, Thomas J.; Hoy-Schulz, Yana Emmy; Jannat, Kaniz; Parsonnet, Julie

doi:10.1186/s13006-018-0179-4

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Having an alternative method to study whether infants are exclusively breastfed for the entire recommended time versus at one point in time is useful because it helps understand the proportion of infants that, fed according to the WHO recommendations, receive the full benefits of optimal breastfeeding. Several studies in low‐income settings in Asia, Africa and Central America compared the use of a single 24‐h recall with recall since birth with similar results to ours (Engebretsen et al, 2007 ; Fenta et al, 2017 ; Hussein et al, 2019 ; Khanal et al, 2016 ; Roberts et al, 2018 ; Van Beusekom et al, 2013 ). Fenta and colleagues, for example, compared the use of a single 24‐h recall, seven repeated 24‐h recalls and since‐birth recall in rural Ethiopia ( 2017 ).…”

Section: Discussionsupporting

confidence: 82%

Exclusive breastfeeding: Measurement to match the global recommendation

Alayón

Varela

Mukuria‐Ashe

et al. 2022

Maternal & Child Nutrition

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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.

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Section: Discussionsupporting

confidence: 82%

Exclusive breastfeeding: Measurement to match the global recommendation

Alayón

Varela

Mukuria‐Ashe

et al. 2022

Maternal & Child Nutrition

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“…Thus, evidence from quasi-experimental studies, such as this one, will continue to be relied upon to generate evidence to policymakers and employers on the effectiveness of workplace breastfeeding interventions. Fourth, the use of a 24-h recall method may have overestimated EBF (Roberts et al, 2018;Tylleskär et al, 2011). Additionally, mothers might have overreported EBF because of social desirability.…”

Section: Discussionmentioning

confidence: 99%

Effect of a baby‐friendly workplace support intervention on exclusive breastfeeding in Kenya

Kimani-Murage

Wilunda

Macharia

et al. 2021

Maternal & Child Nutrition

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Exclusive breastfeeding (EBF) during the first 6 months of life is crucial for optimizing child growth, development and survival, as well as the mother's wellbeing. Mother's employment may hinder optimal breastfeeding, especially in the first 6 months. We assessed the effectiveness of a baby-friendly workplace support intervention on EBF in Kenya. This pre-post intervention study was conducted between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/ breastfeeding women residing on the farm and consisted of workplace support policies and programme interventions including providing breastfeeding flexi-time and breaks for breastfeeding mothers; day-care centres (crèches) for babies near the workplace and lactation centres with facilities for breast milk expression and storage at the crèches; creating awareness on available workplace support for breastfeeding policies; and home-based nutritional counselling for pregnant and breastfeeding women. EBF was measured through 24-h recall. The effect of the intervention on EBF was estimated using propensity score weighting. The study included 270 and 146 mother-child dyads in the nontreated (preintervention) group and treated (intervention) group, respectively. The prevalence of EBF was higher in the treated group (80.8%) than in the nontreated group (20.2%); corresponding to a fourfold increased probability of EBF [risk ratio (RR) 3.90; 95% confidence interval (CI) 2.95-5.15]. The effect of the intervention was stronger among children aged 3-5 months (RR 8.13; 95% CI 4.23-15.64) than among those aged <3 months (RR 2.79; 95% CI 2.09-3.73).The baby-friendly workplace support intervention promoted EBF especially beyond 3 months in this setting.

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“…Exclusive breastfeeding prevalence estimates obtained using the 24-h recall method often overestimated the true prevalence [ 9 – 12 ]. Studies indicated a 9.2 and 47.4% overestimation when breastfeeding practice data collected using single 24-h recall was compared with prospectively collected data [ 13 , 14 ]. In our former publication, we have identified a 23.5% overestimation of the prevalence of EBF practice when estimates from single 24-h recall was compared with the cumulative score of seven repeated 24-h recalls [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

One-week recall period gives a more accurate estimate of exclusive breastfeeding practice than 24-h recall among infants younger than six months of age

et al. 2021

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Background The World Health Organization recommends a 24-h recall period to estimate breastfeeding practice of mothers of infants aged younger than six-months. Though 24-h recall was preferred for its low recall bias and for practical reasons, it can overestimate exclusive breastfeeding practice (EBF). Validating this indicator will help account for the deviation from the true estimate. This prospective cohort study measured accuracy of the 24-h recall method and validates a week recall as an alternative approach for use in a small sample population. Method The study was conducted from March to April 2018 involving 408 mother-infant pairs living in Butajira Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Participants were prospectively followed for 14 consecutive days; where their breastfeeding practice in the past 24 h was measured daily. Exclusive breastfeeding prevalence estimate obtained using the 24-h recall method and recall periods spanning a varying number of days (short period recalls) was compared against the cumulative of the responses from a prospectively measured repeated 24-h recalls over the course of 14 days. McNemar statistics was used to assess statistical significance of the difference in the EBF prevalence estimates of the single 24-h recall and the reference standard. Sensitivity, specificity, positive predictive value and negative predictive values were calculated to determine the level of accuracy. Receiver Operating Characteristics curve was used to measure the difference in performance between the two methods. Result The highest prevalence (71.4%) of exclusive breastfeeding practice was estimated using the single 24-h recall method whereas the lowest breastfeeding practice (47.1%) was obtained from a cumulative of 14 repeated 24-h recalls. A week recall (a recall over 7 days’ period), resulted in the smallest discrepancy in estimate (7.1%) as compared to cumulative estimate of 14 repeated 24-h recalls. Comparing against our reference standard, a week recall had 96.7% sensitivity and 83.5% specificity in estimating exclusive breastfeeding practice. Conclusions Using single 24-h recall method overestimated exclusive breastfeeding prevalence. However, a week recall gave an estimate close to the estimate from the standard method. A week recall has a potential to balance the tradeoff between the accuracy of EBF estimates and the resource implication of using multiple prospective measurements that have a proven superior accuracy.

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Evidence of inflated exclusive breastfeeding estimates from a clinical trial in Bangladesh

Cited by 4 publications

References 10 publications

Exclusive breastfeeding: Measurement to match the global recommendation

Exclusive breastfeeding: Measurement to match the global recommendation

Effect of a baby‐friendly workplace support intervention on exclusive breastfeeding in Kenya

One-week recall period gives a more accurate estimate of exclusive breastfeeding practice than 24-h recall among infants younger than six months of age

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