@2024 Afarand., IRAN

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ISSN: 2251-8215    Sarem Journal of Reproductive Medicine 2017;1(2):49-53

Background
Preserving and promoting the health of children in all physical, mental, social and spiritual ‎dimensions need proper nutrition, timely prevention of diseases, reduction of psychological stress, ‎and the creation and strengthening of emotional, mental and educational relationships in the family. ‎Extensive studies around the world show that breastfeeding plays a significant role in all of the above ‎‎[1].‎
Previous Studies
The World Health Organization has introduced exclusive breastfeeding since birth to the end of the ‎sixth month, and then the mother's breastfeeding with complementary nutrition up to two years of age ‎has been identified as the best source of food for baby growth and development [2]. With regard to the ‎benefits of exclusive breastfeeding, the most important indicator of success of breast feeding programs ‎in the world is exclusive breastfeeding [3]. Unfortunately, the statistics on the exclusive breastfeeding ‎of mothers in Iran are very disturbing, so that in 2005 this figure was 27.1% in urban population of ‎Iran and 29.1% in rural population and in Isfahan province only 15.7% of urban children and 24.3% of ‎rural children under the age of 6 months were exclusively breastfed [4].‎ Various studies have been conducted to investigate the factors associated with exclusive breastfeeding. ‎Some of these studies have associated factors such as high education of parents [5, 6], and the positive ‎attitude of the mother towards lactation [7], with the increase of exclusive breastfeeding and factors ‎such as the use of a pacifier, mother`s occupation [7] and low weight at birth [8] have been associated ‎with discontinuation of exclusive breastfeeding.‎
Aim(s)
Exclusive breastfeeding in different societies can be affected by various individual, social and ‎economic factors. The purpose of this study was to investigate the factors related to exclusive nutrition ‎in infants under 6 months of breast milk in urban and rural communities of Isfahan.‎
Research type
This study is cross-sectional. ‎
Research society, place and time
In this research, during 2007-2008, mothers referring to urban and rural health centers of Isfahan ‎province (459 residents of the city and 102 rural residents) who had an infant under the age of 6 ‎months, were studied. ‎
Sampling method and number
The needed sample size with 95% confidence level and maximum error of 0.1 was calculated 427 that ‎for more accuracy 561 samples were selected. For sampling, the cities of Golpayegan, Isfahan and ‎Falavarjan were selected. In each city, 20% of the urban and rural health centers were randomly ‎selected and sampling was done from urban and rural areas of each city in health centers proportional ‎to the number of children under the age of 6 months.‎
Used devices&materials
Data were gathered using a questionnaire and a face-to-face interview. In this study, only infants less ‎than 6 months of age who were not twins and whose birth weight exceeded 2500 grams and maternal ‎gestational age was more than 37 weeks were studied. Data were analyzed using SPSS 15 software and ‎logistic regression model.‎
Findings by Text
Mothers who had stopped breastfeeding contained 2.1% of the samples, and 27.9% (25.9% in the ‎urban places and 32.4% in the rural places) had exclusive breastfeeding. Most of the recent births were ‎‎57.9% by cesarean section. In most of the units studied, 67% had junior high school and senior high ‎school education and 3.5% were employed. Also, 85.6% of infants used breast milk colostrum and ‎‎88.9% of mothers and newborns were roommate after delivery. 21.6% of mothers had started lactation ‎less than an hour after delivery. The main source of the majority of infants (65%) was breast milk and ‎the total number of infants who did not have exclusive breastfeeding was 397 (Table 1).‎ Water consumption among infants less than 6 months was more than other foods (Table 2).‎ The first reasons (73.3%) for the early onset of auxiliary food was insufficiency of breast milk, and the ‎second reason was the recommendation of the relatives (49.2%). In 40.8% of cases, physicians and ‎health workers had recommended mothers to onset supplementary food or milk powder (Table 3).‎The most common reason for water use (55%) was the recommendation of the surrounding people, ‎that in 39.29%, the family, and in 15.7% of the cases physician and health workers had advised the ‎mother to use the water. The second cause of water consumption (43.98%) was thirst and the third ‎cause (10.7%) was crying and restlessness of the child, and a small percentage of the cause was ‎reported as jaundice and constipation.‎ Cesarean delivery (p <0.05) and delay in the start of lactation (p <0.05) were associated with a ‎reduction in exclusive breastfeeding and having girl (p <0.01) and receiving lactation training after ‎Delivery in health care centers (p <0.001) was positively correlated with exclusive breastfeeding ‎‎(Table 4). There was not a significant relationship between exclusive breastfeeding and maternal age, ‎maternal and spouse education, maternal occupation, contraceptive methods, breast problems ‎‎(wounds, congestion, etc.), education during pregnancy and hospital, satisfaction with child sex, ‎wanted or unwanted pregnancy, first infant feeding, infant use of the pacifier, mother and child ‎coexistence in the hospital, and skin contact with mother and baby skin immediately after delivery.‎
Main comparison to the similar studies
In Nepal, 84.4% of children less than 2 months had exclusive breastfeeding [9]. In Chana, 51.6% of ‎infants less than 6 months have exclusive breastfeeding [7]. In Brazil, 39% of the infant in the third ‎month had exclusive breast milk [5].‎ The results of this study showed that there is a negative and significant relationship between recent ‎cesarean delivery and exclusive breastfeeding nutrition, which has similar results in other researches ‎in this field [10, 11]. In the present study, mothers who started lactation at one hour after delivery had ‎a significant reduction in their exclusive nutrition. In this regard, research was conducted in Taiwan ‎and showed that the delay in the start of lactation led to a reduction in breastfeeding exclusive ‎breastfeeding [12]. A study in Babol City, in 1997, has also shown that the delay in breastfeeding ‎increases the risk of non-exclusiveness of breastfeeding [13]. ... [14].‎ The results of this study on the gender of the baby indicated that the level of exclusive nutrition in ‎female infants is approximately twice that of male infants. Kaneko et al., 2006, has shown that female ‎infant is associated with an increase in exclusive nutrition [15]. In contrast, Mansoori, in 1994, ‎showed that having a male gender is associated with an increase in exclusive breastfeeding [16]. ‎According to different results in researches, it seems that the effect of child sex on the type of nutrition ‎is due to a cultural phenomenon and physiological factors do not affect it and the role of this general ‎belief in the region that the duration of breastfeeding in girls should be 4 months longer than Boys is ‎related to this.‎ In this study, mothers who did not receive postpartum lactation training decreased their infant ‎exclusive nutritional status. Chye et al. (1997) and Ford et al. (18) have suggested education as a ‎positive factor with exclusive breastfeeding, but Imani et al. [19] and Jalali Aria et al. did not observe ‎any significant relationship between lactation training and exclusive nutrition in 2001 [20]. It seems ‎that lack of significant relationship in the above researchers and the current research in Iran, is due to ‎the lack of a prenatal education program in the prenatal care programs. ‎ There was no significant relationship between the use of pacifier and exclusive breastfeeding in this ‎study. In other studies, the use of pacifier had a significant relationship with exclusive breastfeeding ‎‎[1, 2, 5, and 6]. The lack of significant relationship between use of pacifier and breastfeeding in this ‎study may be due to the fact that only small percent of the infants were using pacifier in this study. … ‎‎[21].‎
Suggestions

Limitations

Conclusions
Delay in the start of breastfeeding and cesarean delivery are factors that reduce the level of exclusive ‎breastfeeding in infants below the age of 6 months in urban and rural communities of Isfahan, while ‎having a female infant and receiving postnatal nursing education, are factors that increase the level of ‎exclusive nutrition of infants with breast milk.‎
Acknowledgments

Conflict of interest

Ethical Permissions

Funding Sources

TABLES and CHARTS

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