Factors associated with exclusive breast-feeding: A cross-sectional survey in Kaiyuan, Yunnan, Southwest China

Autoři: Yuan Ruan aff001;  Qiang Zhang aff001;  Juanjuan Li aff001;  Rong Wan aff001;  Jun Bai aff002;  Wenzhong Wang aff002;  Yutong Zhou aff002;  Qingqing Wan aff001;  Jiang Zhao aff001;  Siyang Yu aff001;  Min Peng aff001;  Zhitao Liu aff001
Působiště autorů: Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China aff001;  Department of Public Health, Kaiyuan Centre for Disease Control and Prevention (CDC), Honghe, Yunnan, China aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223251


Breastfeeding has a wide range of benefits for both infants and mothers. The identification of factors associated with exclusive breastfeeding (EBF) are important to increase the prevalence of EBF. The study aimed to determine the prevalence of EBF within the first six months and its associated factors in Kaiyuan, Yunnan Province, Southwest China. This cross-sectional study was conducted in Kaiyuan, a middle-sized city of Yunnan Province, Southwest China. Mothers of infants under twelve months were randomly selected for a face to face interview in four towns (two in urban areas and two in rural areas) in Kaiyuan. A structured questionnaire was applied for collection of sociodemographic information, mothers’ and infants’ health, and breastfeeding information. A 24-hour food recall survey was used to collect infant feeding information. A logistic regression analysis was performed to identify the factors independently associated with exclusive breastfeeding for infants up to six months of age. The number of 417 mothers with infants under six months was interviewed. The prevalence of EBF at six months was 27.34%. Logistic regression indicated that EBF within six months was more likely to be practiced by mothers who had higher average household income per year (OR = 2.09, 95% CI: 1.05–4.17 p = 0.037; OR = 1.85, 95% CI: 1.04–3.28 p = 0.037), and mothers who received breastfeeding information (OR = 2.46, (95%CI: 1.45–4.18, p = 0.0009). The prevalence of EBF in Kaiyuan, Southwest China is considerably lower than national and international recommendations. Yearly household income, and mothers who received breastfeeding information are associated with higher EBF prevalence. Breastfeeding information should be given to mothers in order to increase the prevalence of EBF.

Klíčová slova:

Birth weight – Breast milk – Employment – Infants – Labor and delivery – Mothers – Socioeconomic aspects of health


1. Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 3–13. doi: 10.1111/apa.13147 26249674

2. Duijts L, Ramadhani MK, Moll HA. Breastfeeding protects against infectious diseases during infancy in industrialized countries. A systematic review. Matern Child Nutr 2009; 5: 199–210. doi: 10.1111/j.1740-8709.2008.00176.x 19531047

3. Duijts L, Jaddoe VW, Hofman A, Moll HA. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics 2010; 126: e18–25. doi: 10.1542/peds.2008-3256 20566605

4. Lamberti LM, Zakarija-Grkovic I, Fischer Walker CL, Theodoratou E, Nair H, Campbell H, et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Public Health 2013; 13 Suppl 3: S18.

5. Horta BL, Loret de Mola C, Victora CG. Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 14–19. doi: 10.1111/apa.13139 26211556

6. Victora CG, Horta BL, Mola CLD, Quevedo L, Pinheiro RT, Gigante DP, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Global Health 2015; 3: 199–205.

7. Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 30–37. doi: 10.1111/apa.13133 26192560

8. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 96–113. doi: 10.1111/apa.13102 26172878

9. Aune D, Norat T, Romundstad P, Vatten LJ. Breastfeeding and the maternal risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis 2014; 24: 107–115. doi: 10.1016/j.numecd.2013.10.028 24439841

10. World Health Organization. Up to what age can a baby stay well nourished by just being breastfed? http://www.who.int/features/qa/21/en/ Cited March 2018

11. Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–490. doi: 10.1016/S0140-6736(15)01024-7 26869575

12. Wold Health Organization. Essential Nutrition Actions: Improving maternal, newborn, infant and young child health and nutrition. http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/ Cited March 2018

13. Guo S, Fu X, Scherpbier RW, Wang Y, Zhou H, Wang X, et al. Breastfeeding rates in central and western China in 2010: implications for child and population health. Bull World Health Organ 2013; 91: 322–331. doi: 10.2471/BLT.12.111310 23678195

14. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387: 491–504. doi: 10.1016/S0140-6736(15)01044-2 26869576

15. Chen TL, Tai CJ, Chu YR, Han KC, Lin KC, Chien LY. Cultural factors and social support related to breastfeeding among immigrant mothers in Taipei City, Taiwan. J Hum Lact 2011; 27: 41–48. doi: 10.1177/0890334410376519 20858846

16. Mirkovic KR, Perrine CG, Scanlon KS, Grummer-Strawn LM. Maternity leave duration and full-time/part-time work status are associated with US mothers’ ability to meet breastfeeding intentions. J Hum Lact 2014; 30: 416–419. doi: 10.1177/0890334414543522 25034868

17. World Health Organization. Indicators for assessing infant and young child feeding practices: part 1. http://www.who.int/nutrition/publications/infantfeeding/9789241599757/en/ Cited March 2018

18. Jessri M, Farmer AP, Maximova K, Willows ND, Bell RC, Team APS. Predictors of exclusive breastfeeding: observations from the Alberta pregnancy outcomes and nutrition (APrON) study. BMC Pediatr 2013; 13: 77. doi: 10.1186/1471-2431-13-77 23679578

19. World Health Organization. Babies and mothers worldwide failed by lack of investment in breastfeeding. http://www.who.int/mediacentre/news/releases/2017/lack-investment-breastfeeding/en/ Cited March 2018

20. Jama NA, Wilford A, Masango Z, Haskins L, Coutsoudis A, Spies L, et al. Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: a qualitative prospective cohort study in KwaZulu-Natal, South Africa. Int Breastfeed J 2017; 12: 43. doi: 10.1186/s13006-017-0135-8 29026431

21. Hector D, King L, Webb K, Heywood P. Factors affecting breastfeeding practices: applying a conceptual framework. N S W Public Health Bull 2005; 16: 52–55. 16106273

22. Kaneko A, Kaneita Y, Yokoyama E, Miyake T, Harano S, Suzuki K, et al. Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding. J Epidemiol 2006; 16: 57–63. doi: 10.2188/jea.16.57 16537985

23. Balogun OO, Kobayashi S, Anigo KM, Ota E, Asakura K, Sasaki S. Factors Influencing Exclusive Breastfeeding in Early Infancy: A Prospective Study in North Central Nigeria. Matern Child Health J 2016; 20: 363–375. doi: 10.1007/s10995-015-1835-6 26520155

24. Saffari M, Pakpour AH, Chen H. Factors influencing exclusive breastfeeding among Iranian mothers: A longitudinal population-based study. Health Promot Perspect 2017; 7: 34–41. doi: 10.15171/hpp.2017.07 28058240

25. Hauck YL, Fenwick J, Dhaliwal SS, Butt J. A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns. Matern Child Health J 2011; 15: 260–268. doi: 10.1007/s10995-009-0554-2 20077131

26. Colombo L, Crippa BL, Consonni D, Bettinelli ME, Agosti V, Mangino G, et al. Breastfeeding Determinants in Healthy Term Newborns. Nutrients 2018; 10.

27. Kitano N, Nomura K, Kido M, Murakami K, Ohkubo T, Ueno M, et al. Combined effects of maternal age and parity on successful initiation of exclusive breastfeeding. Prev Med Rep 2016; 3: 121–126. doi: 10.1016/j.pmedr.2015.12.010 26844198

28. Al-Sahab B, Lanes A, Feldman M, Tamim H. Prevalence and predictors of 6-month exclusive breastfeeding among Canadian women: a national survey. BMC Pediatr 2010; 10: 20. doi: 10.1186/1471-2431-10-20 20377899

29. Acharya P, Khanal V. The effect of mother’s educational status on early initiation of breastfeeding: further analysis of three consecutive Nepal Demographic and Health Surveys. BMC Public Health 2015; 15: 1069. doi: 10.1186/s12889-015-2405-y 26482789

30. Kristiansen AL, Lande B, Overby NC, Andersen LF. Factors associated with exclusive breast-feeding and breast-feeding in Norway. Public Health Nutr 2010; 13: 2087–2096. doi: 10.1017/S1368980010002156 20707948

31. Azzeh FS, Alazzeh AY, Hijazi HH, Wazzan HY, Jawharji MT, Jazar AS, et al. Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia. Children (Basel) 2018; 5: 8.

32. Khanal V, Scott JA, Lee AH, Karkee R, Binns CW. Factors associated with Early Initiation of Breastfeeding in Western Nepal. Int J Environ Res Public Health 2015; 12: 9562–9574. doi: 10.3390/ijerph120809562 26287223

33. Amin T, Hablas H, Al Qader AA. Determinants of initiation and exclusivity of breastfeeding in Al Hassa, Saudi Arabia. Breastfeed Med 2011; 6: 59–68. doi: 10.1089/bfm.2010.0018 21034163

34. Kang NM, Choi YJ, Hyun T, Lee JE. Associations of Breastfeeding Knowledge, Attitude and Interest with Breastfeeding Duration: A Cross-sectional Web-based Study. J Korean Acad Nurs 2015; 45: 449–458. doi: 10.4040/jkan.2015.45.3.449 26159146

35. Hawkins SS, Stern AD, Baum CF, Gillman MW. Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis. Public Health Nutr 2015; 18: 189–197. doi: 10.1017/S1368980014000238 24625787

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2019 Číslo 10
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