Is exclusive breastfeeding an option or a necessity in Africa? A pooled study using the deuterium oxide dose-to-mother technique

Accepted: 1 August 2019
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Given the valuable health, development, and economic benefits of human milk Exclusive Breastfeeding (EBF) is recommended by the World Health Organisation for the first six months of an infant’s life. Many resource-limited regions in Africa do not line-up with these recommendations, therefore EBF promotion efforts on the continent need to be scaled up and monitored. This study explores the human milk intake volumes of 5 countries (Benin, Central African Republic, Morocco, South Africa and Tanzania) both at country level and in a pooled sample of children at 3 months (n= 355) and at 6 months (n=193). Mean human milk intake volumes in the pooled samples were 697.6 g/day at 3 months and 714.9 g/day at 6 months. EBF was determined both by maternal recall as well as using the deuterium oxide dose-to-mother technique, using two different cut-offs of non-milk oral intake. Comparison of these results showed substantial over-reporting of EBF by maternal recall, which suggests that actual rates of EBF are even lower than reported, thus highlighting the importance of scaling-up EBF promotion strategies.
WHO. Infant and young child nutrition: global strategy on infant and young child feeding. Geneva, Switzerland; 2002.
Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387,475-90. DOI: https://doi.org/10.1016/S0140-6736(15)01024-7
UNICEF. “From the first hour of life” Making the case for improved infant and young child feeding everywhere, UNICEF data and analytics, Division of data, research and policy and nutrition section, New York; 2016.
Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003;361:2226-34. DOI: https://doi.org/10.1016/S0140-6736(03)13779-8
Jones G, Steketee RW, Black RE, et al. How many child deaths can we prevent this year? Lancet 2003;362:65-71. DOI: https://doi.org/10.1016/S0140-6736(03)13811-1
Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010;125:e1048-56. DOI: https://doi.org/10.1542/peds.2009-1616
Rollins NC, Bhandari N, Hajeebhoy N, et al. on behalf of The Lancet Breastfeeding Group. Why invest, and what will it take to improve breastfeeding practices? Lancet 2016;387:491-504.
UN Sustainable development goals 2016. http://www.undp.org/content/undp/en/home/sustainable-development-goals.html (Accessed 09 July 2018).
Hatloy A, Oshaug A. Human milk: an invisible food resource. J Hum Lact 1997;13:299-305. DOI: https://doi.org/10.1177/089033449701300415
Aguayo VM, Ross J. The monetary value of human milk in Francophone west Africa: a PROFILES analysis for nutrition policy communication. Food Nutr Bull 2002;23:153-61. DOI: https://doi.org/10.1177/156482650202300204
Bernard JY, De Agostini, M, Forhan, A, et al. Breastfeeding duration and cognitive development at 2 and 3 years of age in the EDEN mother-child cohort. J Pediatr 2013;163:36-42 e1. DOI: https://doi.org/10.1016/j.jpeds.2012.11.090
WHO Regional Office for Africa. Atlas of African Health Statistics 2018: universal health coverage and the Sustainable Development Goals in the WHO African Region, 2018.
Mulol H, Coutsoudis A. Breastmilk output in a disadvantaged community with high HIV prevalence as determined by the deuterium oxide dose-to-mother technique. Breastfeed Med 2016;11:64-9. DOI: https://doi.org/10.1089/bfm.2015.0139
WHO, UNICEF. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV, Geneva 2016.
WHO. Acceptable medical reasons for use of breast-milk substitutes 2009,1-11. http://apps.who.int/iris/bitstream/10665/69938/1/WHO_FCH_CAH_09.01_eng.pdf?ua=1 (Accessed 09 July 2018).
International Business Times, Sep 8, 2016.
http://www.ibtimes.co.uk/cash-strapped-egypt-check-if-mothers-can-breastfeed-before-supplying-subsidised-baby-formula-1580424 (Accessed 09 July 2018).
WHO. Progress on sanitation and drinking water. Update and MDG assessment, WHO Press; 2015.
Sachdev HP, Krishna J, Puri RK, et al. Water supplementation in exclusively breastfed infants during summer in the tropics. Lancet 1991;337:929-33. DOI: https://doi.org/10.1016/0140-6736(91)91568-F
WHO. Indicators for assessing infant and young child feeding practices. Part 1 Definitions. Geneva, Switzerland; 2008.
Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev 2005;63:103-10. DOI: https://doi.org/10.1111/j.1753-4887.2005.tb00128.x
Coward WA, Cole TJ, Sawyer MB, Prentice AM. Breast-milk intake measurement in mixed-fed infants by administration of deuterium oxide to their mothers. Hum Nutr-Clin Nutr 1982;36:141-8.
IAEA. Stable isotope technique to assess intake of human milk in breastfed infants, Human health series no. 7, Vienna; 2010. Available from https://www-pub.iaea.org/books/iaeabooks/8168/Stable-Isotope-Technique-to-Assess-Intake-of-Human-Milk-in-Breastfed-Infants (Accessed 09 July 2018).
Da Costa TH, Haisma H, Wells JC, et al. How much human milk do infants consume? Data from 12 countries using a standardized stable isotope methodology. J Nutr 2010;140:2227- 32. DOI: https://doi.org/10.3945/jn.110.123489
Moore SE, Prentice AM, Coward WA, et al. Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling. Am J Clin Nutr 2007;85:1075-82. DOI: https://doi.org/10.1093/ajcn/85.4.1075
Medoua GN, Sajo Nana EC, Ndzana AC, et al. Breastfeeding practices of Cameroonian mothers determined by dietary recall since birth and the dose-to- the-mother deuterium-oxide turnover technique. Matern Child Nutr 2012;8:330-9. DOI: https://doi.org/10.1111/j.1740-8709.2011.00293.x
Samuel TM, Thomas T, Bhat S, Kurpad AV. Are infants born in baby-friendly hospitals being exclusively breastfed until 6 months of age? Eur J Clin Nutr 2012;66:459-65. DOI: https://doi.org/10.1038/ejcn.2011.179
Motswagole BS, Matenge STP, Mongwaketse T, et al. Application of the deuterium-oxide dose-to-mother technique to determine the exclusivity of breasfeeding in women in Kanye, Botswana. South Afr J Clin Nutr 2015;28:128-33. DOI: https://doi.org/10.1080/16070658.2015.11734547
Mulol H, Coutsoudis A. Limitations of maternal recall for measuring exclusive breastfeeding rates in South African mothers. Int Breastfeed J 2018;13:19. DOI: https://doi.org/10.1186/s13006-018-0159-8
Diana A, Liu Z, Luftimas D, et al. Development of a non-milk water intake cutoff to identify exclusive breastfed infants using the deuterium oxide dose-to-mother technique. Ann Nutr Metab 2017;71(Suppl 2):1119.
Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa
statistic. Fam Med 2005;37:360–3. DOI: https://doi.org/10.1145/1151954.1067560
Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 1973;33:613-9. DOI: https://doi.org/10.1177/001316447303300309
Ghasemi A, Zahediasl S. Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab. 2012;10:486-9. DOI: https://doi.org/10.5812/ijem.3505