Factors associated with a low prevalence of exclusive breastfeeding during hospital stay in urban and semi-rural areas of southern Vietnam

Le et al. International Breastfeeding Journal https://doi.org/10.1186/s13006-018-0188-3 (2018) 13:46 RESEARCH Open Access Factors associated with a low prevalence of exclusive breastfeeding during hospital stay in urban and semi-rural areas of southern Vietnam Quynh-Nhi Thi Le1,2, Khanh-Lam Phung1, Van-Thuy Thi Nguyen1, Katherine L. Anders3, Minh-Nguyet Nguyen1, Diem-Tuyet Thi Hoang4, Thuy-Tien Thi Bui4, Vinh-Chau Van Nguyen5, Guy E. Thwaites1, Cameron Simmons1,6 and Stephen Baker1,7,8* Abstract Background: There is a paucity of data regarding risk factors associated with suboptimal breastfeeding practices in urbanized areas of low-middle income countries (LMICs). Methods: Through a large prospective birth cohort, which enrolled 6706 infants in Vietnam between 2009 and 2013, we investigated the practice of exclusive breastfeeding during hospital stay in urban and semi-rural populations and aimed to identify factors associated with suboptimal breastfeeding practices. Univariate and multivariable logistic regression were performed to determine factors associated with not exclusive breastfeeding during hospital stay. Results: Of 6076 mothers, 33% (2187) breastfed their infant exclusively before hospital discharge; 9% (364/4248) in urban and 74% (1823/2458) in semi-rural areas. Exclusive breastfeeding up to 4 months was recorded in 15% (959/ 6210) of participants; this declined to < 1% (56/6093) at 6 months. Delivery by Caesarean section (Odds Ratio [OR] 0. 07; 95% Confidence Interval [CI] 0.04, 0.11 and OR 0.05; 95% CI 0.03, 0.08) and neonatal complications (OR 0.2; 95% CI 0.07, 0.47 and OR 0.25; 95% CI 0.14, 0.46) were common and highly significant risk factors associated with a lack of exclusive breastfeeding during hospital stay in urban and semi-rural settings, respectively. Conclusions: To our knowledge, this is the first large-scale investigation aimed at identifying factors associated with exclusive breastfeeding during hospital stay in Vietnam. Breastfeeding promotion strategies should prioritize common risk factors in hospital, such as Caesarean section and neonatal complications, and other location specific factors associated with socioeconomics. Keywords: Breastfeeding, Rural, Urban, Vietnam, Risk factor, C-section * Correspondence: 1 The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam 7 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Le et al. International Breastfeeding Journal (2018) 13:46 Background Optimum breastfeeding is proven to be effective and cost-efficient in preventing child mortality and morbidity [1]. Vietnam has observed a substantial improvement in child nutrition in the last decade and despite breastfeeding being a common social practice in Vietnam (98% mothers report breastfeed their children at some point [2]), it has been estimated than only 24% of Vietnamese mothers practice exclusive breastfeeding when their children are < 6 months old [3]. Infant formula is widely promoted and used in Vietnamese hospitals, with > 50% children fed infant formula during the first 3 days after birth [4]. Very few hospitals (9%) have been accredited to the full implementation of the Baby-Friendly Hospital Initiative (BFHI), which supports exclusive breastfeeding, despite this initiative being launched in 1994 [1, 5, 6]. Previous studies have shown that good breastfeeding practices in the first few months of life are associated with early and correct infant feeding after birth in the first few days and before hospital discharge [7]. Recent studies from Vietnam have measured the initiation of breastfeeding within 1 hour after birth, which is a common indicator in breastfeeding behavioural studies; the rates were: 47.5% in an urban southern area in 2000 [8], 73.6% in a rural northern area in 2002 [9], and 90.6% in an urban central area in 2017 [10]. Notably, there were locations where children born into less affluent households were subjected to early breastfeeding more commonly than children born into more affluent households [3]. In contrast, an additional study from northern Vietnam found a higher prevalence of initiating breastfeeding within 1 hour after delivery in urban areas in comparison to rural areas [11]. This observation was explained by a higher education level of mothers from urban areas. There are little accurate data regarding breastfeeding practices in low-middle income countries (LMICs) that are undergoing economic development and urbanization, such as Vietnam [3]. It is important to further investigate differences in breastfeeding practices and associated factors between different settings in such locations. In 2008 we initiated a birth cohort for investigating determinants of infectious diseases in urban and semi-rural infant populations in southern Vietnam [12]. Here, using data from this cohort, we aimed to assess the prevalence of various breastfeeding practices, including exclusive breastfeeding, and any breastfeeding activity during hospital stay. We further aimed to explore patterns of infant feeding during the first year of life and identify risk factors associated with inadequate breastfeeding practices during hospital stay in urban and semi-rural areas. Understanding these factors may assist in providing supporting information for promoting health strategies for expectant mothers and their infants. Page 2 of 10 Methods Study location Mothers residing in District 8 of Ho Chi Minh City, in Cao Lanh City and in Cao Lanh District (in Dong Thap Province) were invited to join the study. Ho Chi Minh City is the largest city in southern Vietnam with population of 7,820,000 in 2013 and density of 3731 person/ km2 [13]. District 8 is an urban area within Ho Chi Minh City with population of > 400,000 people and density of > 20,000 person/ km2 [14]. Dong Thap is a semi-rural province in the Mekong Delta, located 165 km southwest of Ho Chi Minh City. Cao Lanh City, the provincial capital, had a population of 163,030 people and a population density of 1523 person/km2 in 2013; 44.7% of the population live in a rural setting [15]. Cao Lanh District is a larger geographical area than Cao Lanh City with a population of 202, (...truncated)