April 2007 - Volume 1, Issue 2

FACTORS AFFECTING INFANT FEEDING PRACTICES AT AQABA, SOUTH OF JORDAN

	Wajdi Amayreh MBBS, MRCPCH (1), Abdulla Ghanma MD (1) Wijdan Al-Jbour MD (1) , Kholoud Zayadeen RN (2) (1) From the Department of Pediatrics, Royal Medical Services (2) From the Department of Nursing, Royal Medical Services.
	Dr Wajdi Amayreh, P O Box 1479, Irbid, Jordan. Mobile: 0777261044; Email: wajdidr@yahoo.com

ABSTRACT Objective: To study the role of various factors that could influence the type of feeding among infants at Aqaba region, South of Jordan. Setting: Princess Haya Hospital Outpatient Department, Aqaba, Jordan. Patients and methods: Prospective interviews with mothers of infants up to the age of one year seen consecutively during outpatient clinic visits at Princess Haya Hospital in Aqaba-Jordan were conducted between December 2005 and August 2006 using a structured 12 item questionnaire. Results: 260 interviews were conducted, 119 infants (45.7%) were exclusively breastfed, the rate was 47.5% for infants in the first 6 months of life, and dropped to 41% during the next 6 months. 141/260 (54.2%) of infants used formula, of these 88.6% belong to non-working housewives, 79% belong to low income families <300 Jordanian Dinars per month. 13% of mothers used unsuitable formula. Only 61% of working mothers used formula whereas the figure was 53.4% for housewives. The reasons given for switching to formula feeding in order of frequency were: inadequate milk supply 81/141 (57.4%), working mothers 8/141 (5.6%), pregnancy 8/141 (5.6%) and other reasons 44/141 (31%). The exclusive breastfeeding, mixed feeding and exclusive formula feeding rates were 45.7%, 36% and 18% respectively. Conclusion: The misconception of mothers regarding breast milk insufficiency was the most common reason for using formula. Illiterate, non-working and less educated mothers frequently used formula. These findings suggest a need for mass educational campaigns at the various levels aimed at explaining the benefits of breastfeeding and outlining the possible disadvantages of unnecessary use of formula.

Key words: Pattern Of Feeding, Formula, Breast Milk. INTRODUCTION

Breastfeeding is the ideal and most natural way of nurturing infants, and as human milk is species-specific, all substitute feeding preparations differ markedly from it, making human milk uniquely superior for infant feeding (1). Breastfeeding confers significant health, nutritional, immunologic, developmental, psychological, social, economic and environmental benefits to infants, mothers, families, and society(2).

However, breastfeeding is said to be on the decline(3), and there is a trend toward bottle feeding both in urban and rural areas( 4 ). This probably is affected not only by knowledge on breastfeeding but also by factors such as education, occupation and socioeconomic status of the parents(5,6).

The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding for the first 6 months of life (1,7), which is the infant's consumption of human milk with no supplements of any type except for vitamins, minerals and medications.

We aimed in this present study to analyse the feeding patterns in the South of Jordan and to evaluate the role of different factors contributing to bottle feeding. PATIENTS AND METHODS

This is a prospective study conducted at Princess Haya Hospital at Aqaba-Jordan between December 2005 and August 2006.

We carried out a prospective analysis on feeding patterns of infants up to the age of one year. 260 interviews with mothers of infants below 12 months of age attending outpatient clinics using a designed questionnaire including infant's name, record number, age in months, sex, patterns of feeding, type of formula used, reason for formula feeding, family income, dwelling, maternal education and occupation.

Infants attending the clinic without any of their parents were excluded from the study to ensure reliability of information collected. RESULTS

Total number of cases reviewed was 260. The exclusive breastfeeding, mixed feeding and exclusive formula feeding were 46%, 36% and 18% respectively. Breast feeding rate was 47.5% in the first 6 months of life and dropped to 41% in the next 6 months of life. The feeling of insufficient breast milk was the most common reason for switching to formula use followed by, work, pregnancy and other reasons as shown in table 1).

141/260 (54.2%) infants were formula users. Of formula users 125/141 (88.6%) were infants of nonworking housewives, whereas 10/26 (38%) of working mothers' infants were breast feeders. Level of education had minimal role on the type of feeding, table 2), although 22/56 (39%) of highly educated mothers were working mothers. 112/141 (79%) of formula users belong to low income families <300 Jordanian Dinars (US $ 400) per month.

19/141 (13%) were using unsuitable formula i.e.: Nido, Halibna, cow, goat and camel's milk. DISCUSSION

Although breastfeeding is said to be on the decline(3), the alarming thing in this issue is the significant drop in the breast feeding rate figures in Jordan since 1981 as different studies showed the rate of breast feeding to be between 80% and 90.5% (8, 9) whereas the rate for exclusive breast feeding in our study was 47.5% in the first 6 months of life and dropped to 41% in the next 6 months which is approaching the rates in developed countries as seen in table ( III).

Success in breastfeeding involves success in 3 stages: success in initiation, success in establishment, and success in sustaining the process. Each stage is affected by a number of factors. Health education and counselling on the benefits and practicality of breastfeeding during antenatal visits and on subsequent hospital visits in the immediate post-partum period and on well baby check ups have an important role in this success.

The feeling by mothers of insufficient breast milk was the most common reason for switching to formula use in our study which is similar to findings in other studies in the region (10-12 ). On further evaluation by the paediatricians interviewing the mothers it was felt that in most of the cases this was a misconception. As these infants were having adequate weight gain and appropriate number of wet nappies per day. Contrary to what could be expected, employment status didn't have a big role in the choice to either breast or formula feed as only 5.6% of formula users used it because of working status (P=0.5).

Education had minimal effect on the pattern of feeding in the present study, however, highly educated nonworking mothers breast fed their babies more frequently which is in keeping with the findings in a study done in 1999 by Najdawi F et al in south of Jordan which showed that education was related positively to continued breastfeeding(13), which along with our present study contrasts with the findings by Akin JS et al in 1986 who found that women's level of education in Jordan had a negative impact on the decision to ever breast feed the child or not (14).

Dwelling didn't have a statistically significant role in the choice of feeding (P=0.3), which contrasts with findings in previous studies in Jordan which showed that being an urban dweller had a negative impact on breast feeding (8,14). CONCLUSIONS AND RECCOMMENDATIONS

Formula feeding is a common practice in this part of the country and breast feeding seems to be on the decline. The misconception of mothers regarding breast milk insufficiency was the most common reason for using formula. Illiterate, nonworking, less educated and low income group mothers frequently used formula.

A number of recommendations are suggested which hopefully could reverse the current trend:

• The need for mass educational campaigns at the various levels aimed at explaining the benefits of breastfeeding and outlining the possible disadvantages of unnecessary use of formula is an urgent necessity.
  
• The workplace needs to be more accommodating to breastfeeding mothers, so that they can continue breastfeeding after returning to work.
  
• Infant formula promotional literature should not be displayed in the hospital's clinics, and clinic personnel should not distribute the companies' literature to patients who inquire about infant feeding.
  
• Passing legislation making infant feeding bottles and teats available only through prescription by an authorized health professional.
  
  

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1. American Academy of Pediatrics, Section On breast Feeding. Breast Feeding and the Use of Human Milk .Pediatrics. 2005; 115(2):496-505.
   
2. Pereira GR, Barbosa NM. Controversies in Neonatal Nutrition: Human milk for full term infants. Pediatr Clin North Am 1986; 33: 65-89.
   
3. Lawson M. Infant feeding habits in Riyadh. Saudi Med J 1988; 2: 27-29.
   
4. Al-Nahedh NN, Morley DC. Infant feeding practices and the decline of breast feeding in Saudi Arabia. Nutr Health. 1994;10(1):27-31.
   
5. Switsky LT, Vietze P, Switsky HN. Attitudinal and demographic predictors of breastfeeding and bottle feeding behavior by mothers of six-week old infants. Psychol Rep 1979; 45: 3-14.
   
6. Bloom K, Goldbloom R, Robinson S, et al. Factors affecting the mother's choice of infant feeding method. Acta Paediatr Scand Suppl 1982; 300: 3-8.
   
7. World Health Organization. The optimal duration of exclusive breastfeeding. Note for the press No. 7, April 2,2001. Available at: www.who.int/inf-pr-2001/er/note2001-07.html.
   
8. Jain AK, Bongaarts J. Breastfeeding: patterns, correlates, and fertility effects. Stud Fam Plann. 1981;12 (3):79-99.
   
9. McDivitt JA, Zimicki S, Hornik R, et al. The impact of the Healthcom mass media campaign on timely initiation of breastfeeding in Jordan. Stud Fam Plann. 1993; 24(5):295-309.
   
10. Fida NM. Pattern of infant feeding at a University Hospital in Western Saudi Arabia. Saudi Med J. 2003; 24(7):725-9.
    
11. Azaiza F. Patterns of breastfeeding among rural Moslem women in Israel: a descriptive account. Isr J Med Sci. 1995; 31(7):411-7.
    
12. Marandi A, Afzali HM, Hossaini AF. The reasons for early weaning among mothers in Tehran. Bull World Health Organ .1993; 71(5):561-569.
    
13. Najdawi F, Faouri M. Maternal smoking and breast feeding. East Mediterr Health.1999; 5(3); 450-456.
    
14. Akin JS, Bilsborrow RE ,Guilkey DK, et al. Breast feeding patterns and determinants in Jordan. Popul Bull ECWA. 1986; 28:5-41