Prevalence and determinants of continued breastfeeding beyond 6 months among Algerian women. Evidence for Multiple Indicators Cluster Surveys
Background and rationale. Breastfeeding is considered the best nutrition for infants and plays a significant role in a child’s growth and development. In this regard, the World Health Organization (WHO) strongly recommends exclusive breastfeeding for the first 6 months of life, as well as continued breastfeeding when safe and appropriate complementary foods are introduced, up to 2 years of age or beyond. Nonetheless, breastfeeding practices remain sub-optimal in many parts of the world. In this respect, many children have shown not to be breastfed up to 6 months of age or are not breastfed during their first hours of life or are weaned too early. This allows for the use of infant formula, which can be life threatening due to poor hygiene, storage conditions or inappropriate foods. Likewise, breastfeeding rates in the Middle East and North Africa (MENA) region are lower than the global average. In Algeria, the breastfeeding rate up to 6 months of age is among the lowest in the world according to previous Multiple Indicators Cluster Surveys (MICS) reports. In addition, by the end of the sixth month, the percentage of children exclusively breastfed is less than 3% and only 23% of children receive breast milk at 22-23 months. The median duration of breast-feeding is 12 weeks. However, the socio-demographic factors associated with this sub-optimal breastfeeding practice are not explored in these reports, as studies and research conducted in this context using other data are few and mostly conducted in limited geographical areas.
Materials and methods. This stands for a descriptive cross-sectional study of all children who were breastfed in the MICS database, carried out in 2019, 8 709 children, including 4 471 boys and 4 238 girls, registered in the database. To explore factors associated with the duration of breastfeeding, we only included weaned children to minimize bias related to children who were still breastfeeding. This allowed to analyze data from 3 761 children, including 1 930 boys (5.4%) and 1,831 girls (48.6%). Through using a logistic regression model, we could attain the assessment of the role of different socio-demographic, economic and geographical factors in the maintenance of breastfeeding beyond 6 months.
Results. The prevalence of breastfeeding is 81.1%; the rate of exclusive breastfeeding of children aged 0-6 months is 28.7%. The factors associated with breastfeeding beyond six months are area of residence, mother’s occupational status and wealth quintile. In fact, rural area appears to be a factor favoring the continuation of breastfeeding beyond six months, compared with urban area (OR = 1.29; CI [1.032-1.369]). Mothers living in the Eastern Highlands geographic region appear to be 1.56 times more likely to maintain breastfeeding for more than six months compared to those living in the Southern region (OR = 1.56; CI [1.123 – 1.677]). Children of non-working mothers are almost 1.5 times more likely to be breastfed after 6 months than those of working mothers (OR = 1.489; CI [1.107 – 1.947]). Parents belonging to the “richest” wealth quintiles appear to increase the chance of continued breastfeeding after 6 months with a 1.24-fold increase compared to those belonging to the “poorest” quintile (OR = 1.24; CI [1.086 – 1.812]). Factors such as the child’s gender, maternal education level, and functional difficulties do not appear to be determining factors for the continuation of breastfeeding after six months.
Discussion and conclusion. The prevalence and factors associated with the initiation and continuation of breastfeeding vary from one country to another. Notwithstanding the numerous studies to better comprehend mothers’ breastfeeding behaviour and various initiatives for promotion thereof, many countries have low rates. In consequence, the downward trend in breastfeeding is directly linked to advances in the production and marketing of industrial milks, the lack of information and awareness among mothers and the lack of training of health professionals. In this respect, it is highly recommended to encourage behavioural changes, to improve communication about the duration of breastfeeding, to increase the use of postnatal counselling and training of paramedical staff according to the recommendations with support for mothers.
This study is of great interest in developing countries like Algeria, in order to adopt preventive interventions, and to organise communication and pre- and post-natal counselling in the breastfeeding project. Clearly, this study should be enhanced with supplementary qualitative studies concerning the factors contributing to early discontinuation of breastfeeding.
Prévalence et déterminants de l’allaitement maternel poursuivi au-delà de 6 mois chez les femmes algériennes. Analyse à partir des données de l’enquête par grappes à indicateurs multiples
Introduction. L’allaitement maternel (AM) est considéré comme la meilleure alimentation pour les nourrissons et joue un rôle important dans la croissance et le développement de l’enfant. À cet égard, l’Organisation mondiale de la santé (OMS) recommande fortement l’allaitement exclusif dans les 6 premiers mois de la vie, ainsi que la poursuite de l’allaitement lors de l’introduction d’aliments sûrs et appropriés jusqu’à l’âge de 2 ans ou au-delà.
Justification. Alors que la littérature existante sur l’AM dans les pays développés est foisonnante, force est de constater que dans les pays en développement à l’instar de l’Algérie, cette problématique est sous analysée. Notre étude contribue à estimer la prévalence de l’AM et à identifier les facteurs qui lui sont associés.
Méthodes. Il s’agit d’une étude transversale descriptive de l’ensemble des enfants qui ont été allaités et qui figurent dans la base de données de l’enquête à indicateurs multiples (MICS) réalisée en 2019, soit 8 709 enfants, dont 4 471 garçons et 4 238 filles. Afin d’explorer les facteurs associés à la durée de l’AM nous n’avons retenu que les enfants sevrés afin de minimiser le biais concernant les enfants qui étaient toujours allaités, ce qui nous a permis d’analyser les données de 3 761 enfants, dont 1 930 garçons (51,4 %) et 1 831 filles (48,6 %). En utilisant un modèle de régression logistique, nous avons pu évaluer le rôle de différents facteurs socio-démographiques, économiques et géographiques dans le maintien de l’allaitement au-delà de 6 mois.
Résultats. Le taux d’AM global était de 81,1 % ; le taux d’allaitement exclusif des enfants de 0 à 6 mois s’élevait à 28,7 %. Cependant, les principaux facteurs associés à l’AM étaient le milieu de résidence, la région géographique, le statut professionnel de la mère et le quintile de richesse. Les facteurs tels que le sexe de l’enfant, le niveau d’instruction et les difficultés fonctionnelles des mères ne semblaient pas être des facteurs déterminants pour le maintien de l’allaitement après six mois.
Discussion - Conclusion. La prévalence de l’allaitement est quasiment identique à celle des études locales recensées. Cependant, les déterminants du recours à l’allaitement ne sont pas toujours en phase avec nos conclusions. Cette étude revêt une grande importance dans les pays en développement tels que l’Algérie, en vue de l’adoption d’interventions préventives, notamment en matière de communication et de conseils pré et postnataux dans le cadre du projet d’allaitement.