Reliability of reported breastfeeding duration among reproductive-aged women from Mexico

Center for Population Health Research, Instituto Nacional de Salud Pública, 62508 Cuernavaca, Morelos, México.
Maternal and Child Nutrition (Impact Factor: 3.06). 04/2009; 5(2):125-37. DOI: 10.1111/j.1740-8709.2008.00159.x
Source: PubMed


Breastfed children have lower risk of infectious diseases, post-neonatal mortality and chronic diseases later in life. Because epidemiologic studies usually rely on reported history of previous breastfeeding, data on the accuracy and precision of recalled histories allow improved interpretation of the epidemiologic findings.
We evaluated the reliability of two reported breastfeeding durations in 567 reproductive-aged women from Mexico using information obtained from nearly identical sets of questions applied at different times after weaning. We compared differences between reports, and examined the intraclass correlation coefficient (ICC) for any and for exclusive breastfeeding (EBF). Logistic regression was used to evaluate the determinants of poor recall (difference between reports of >20%).
The reliability of duration of any breastfeeding was high (ICC 0.94). Overall, differences between reports of duration were usually <1 month, and for 385/567, the difference was ≤0.5 months. Predictors of poorer recall were having ≥4 children, and time between reports of >2 months. The only predictor of better recall was greater age of the baby at weaning. The reliability of EBF duration was lower (ICC 0.49).
In this population with a relatively long duration of breastfeeding, reliability of any breastfeeding duration was high. Age, education and previous breastfeeding were not important predictors of recall, in contrast to findings in earlier studies. Consistent with previous reports, however, parity and length of recall were associated with poorer recall of duration of any breastfeeding. Future studies that use reported breastfeeding duration may want to consider the effect of these variables on recall.

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    • "Additionally, several studies have linked a history of breastfeeding with long-term maternal and child health outcomes, including reduced risk of type 2 diabetes [2], metabolic syndrome [3], hypertension and myocardial infarction [4] in mothers, as well as reduced risk of obesity [5] and type 2 diabetes [6], and lower blood pressure [7] and cholesterol levels [8] in children. Such studies have often relied on maternal recall of breastfeeding history, but, though this has been found to be an accurate estimate shortly after delivery [9,10], less is known about the long-term accuracy. Two previous studies have evaluated a recall interim of more than two decades, one of which comprised only college-educated women [11] while the other addressed a fairly small study sample [12]. "
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    ABSTRACT: Background Studies on the health benefits from breastfeeding often rely on maternal recall of breastfeeding. Although short-term maternal recall has been found to be quite accurate, less is known about long-term accuracy. The objective of this study was to assess the accuracy of long-term maternal recall of breastfeeding duration. Methods In a prospective study of pregnancy and birth outcome, detailed information on breastfeeding during the child’s first year of life was collected from a cohort of Norwegian women who gave birth in 1986–88. Among 374 of the participants, data on breastfeeding initiation and duration were compared to recalled data obtained from mailed questionnaires some 20 years later. Intraclass correlation coefficient (ICC), Bland-Altman plot, and Kappa statistics were used to assess the agreement between the two sources of data. Logistic regression was used to assess predictors of misreporting breastfeeding duration by more than one month. Results Recorded and recalled breastfeeding duration were strongly correlated (ICC=0.82, p < 0.001). Nearly two thirds of women recalled their breastfeeding to within one month. Recall data showed a modest median overestimation of about 2 weeks. There were no apparent systematic discrepancies between the two sources of information, but recall error was predicted by the age when infants were introduced to another kind of milk. Across categories of breastfeeding, the overall weighted Kappa statistic showed an almost perfect agreement (κ = 0.85, 95% confidence interval [CI] 0.82 – 0.88). Conclusion Breastfeeding duration was recalled quite accurately 20 years after mothers gave birth in a population where breastfeeding is common and its duration long.
    BMC Medical Research Methodology 11/2012; 12(1):179. DOI:10.1186/1471-2288-12-179 · 2.27 Impact Factor
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    ABSTRACT: Evaluations of large-scale health and nutrition programmes in developing countries are needed for determining the effectiveness of interventions. This article critically analyses a non-governmental organization (NGO)-led large-scale, multi-country, 10-year micronutrient and health (MICAH) programme with an 'adequacy evaluation', that is, a documentation of time trends in the expected direction. MICAH was implemented from 1996 to 2005 in selected areas of Ethiopia, Ghana, Malawi and Tanzania, reaching >6 million people with numerous health and nutrition interventions. Coverage and impact were monitored through surveys at baseline, midpoint and end of funding. The data were subjected to post-hoc methods of quality determination, and, if of suitable quality, included in the adequacy evaluation. Most collected data were of moderate or high quality and therefore included in the adequacy evaluation. There were moderate to large improvements in vitamin A status in Ethiopian school-age children, children <5 years of age in Tanzania and Ghana and mothers in Ghana. Iodine status improved in Malawi and Tanzania. Anaemia rates and malaria prevalence decreased in women, pregnant women and pre-school children in Ghana, Malawi and Tanzania, but anaemia increased in Ethiopian women. Large increases were reported for rates of exclusive breastfeeding and immunization. Child growth improved to the maximum that would be predicted with the given interventions. Numerous nutrition and health impacts were observed in the intervention areas, often of a magnitude equal to or larger than observed in controlled interventions or trials. These results show the value of integrated long-term interventions.
    International Journal of Epidemiology 03/2010; 39(2):613-29. DOI:10.1093/ije/dyp389 · 9.18 Impact Factor
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    ABSTRACT: . Breastfeeding, complimentary feeding practices and childhood malnutrition in the Bolivian Andes. Northern Potosí is one of the poorest parts of Bolivia with the highest indicators of rural poverty, malnutrition and food insecurity in the Bolivian Andes. The objective of this research was to characterize the levels of mal-nutrition and describe infant feeding practices in Potosi, Bolivia and use this information to develop an effective, gender sensitive and culturally relevant intervention encouraging good infant feeding prac-tices. Standard methods were used to collect anthropometric data. Weight and height data were collected for 400 children under five years of age from 30 communities. In six of these communities, in-terviews and focus group discussions were conducted with 33 moth-ers and other families in addition to household observational data that were collected to describe infant feeding practices. Nearly 20% of children were underweight; stunting was widespread as well. 38% of mothers initiated breastfeeding 12 hours or more after birth. 39% of mothers initiated complementary feeding in the first three months following birth. The type of complementary food given to children was usually inadequate. With this research we could see that nutri-tional deficiencies often begin when the mother starts breastfeeding and when first introduced complementary feeding. Interventions aimed at improving maternal and child nutrition will require changes in parents' behavior, greater recognition and community support of the importance of child feeding, and the inclusion of strategies to reach young people, involve men, and make high quality nutrition promotion more widely available in the communities Key words: Breast feeding, feeding practices, malnutrition, Bolivia. RESUMEN. El Norte de Potosí es una de las partes más pobres de Bolivia, contiene los indicadores más altos de pobreza rural desnutrición e inseguridad alimentaria de los Andes bolivianos. El propósito fue caracterizar los niveles de desnutrición y las prácticas de alimentación de infantes para desarrollar un programa de intervenciones efectivas, sensibles al género y culturalmente relevantes, fomentando las buenas prácticas de alimentación infantil. Para la toma de los datos antropométricos se usó métodos estándares. Se tomaron el peso y la talla de 400 niños/as menores de cinco años de 30 comunidades. En seis de estas comunidades, se usaron entrevistas y discusiones con grupos focales con 33 madres y otros familiares, además de observaciones en los hogares para describir las prácticas de alimentación de los infantes. Casi el 20% de los niños/as son de bajo peso; además los niños/as tienen altos niveles de retraso en la talla. El 38% de las mamás empezaron la lactancia materna después de 12 horas. El 39% inició la alimentación complementaria, en los primeros tres meses. El tipo de alimento complementario que se da al infante en general fue inadecuado. Con este estudio se pudo ver que las deficiencias nutricionales a menudo empiezan cuando la madre inicia la lactancia materna y cuando introduce por primera vez la alimentación complementaria. Para las intervenciones que estén destinadas a mejorar la nutrición materno-infantil se requerirá cambios en el comportamiento personal, un mayor reconocimiento y apoyo comunitario; estrategias para llegar a la gente joven, hacer participar a los hombres y una mayor disponibilidad de servicios de calidad. Palabras clave: Lactancia materna, prácticas alimentación, desnutrición, Bolivia.
    Archivos latinoamericanos de nutrición 03/2010; 60(1):7-14. · 0.23 Impact Factor
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