Discordance in exclusive breastfeeding between maternal recall and deuterium dose-to-mother technique during the first 6 months of infants: A multi-country study in Asia

Winichagoon P 1 , Pongcharoen T 2 , Fadjarwati T 3 , Winarno E 4 , Karim NA 5 , Purevsuren E 6 Show all authors , Ahmad T 7 , Yameen A 7 , Hettiarachchi M 8 , Judprasong K 2 , Tran Thuy N 9 , Vu Thi Thu H 9 , Islam M 10 , Slater C 11 , Thomas T 12 , Murphy-Alford AJ 11

Affiliations 

  • 1 Food and Nutrition Acedemic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand. pattanee.win@mahidol.ac.th
  • 2 Food and Nutrition Acedemic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand
  • 3 Centre for Health Services Policy, Health Policy Agency, Ministry of Health, Jakarta, Indonesia
  • 4 Research Center for Radiation Process Technology, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
  • 5 Nutrition Science, School of Healthcare Sciences, Universiti Kebangsaan, Kuala Lumpur, Malaysia
  • 6 National Center for Maternal and Child Health (NCMCH), Ulaanbaatar, Mongolia
  • 7 Pakistan Institute of Nuclear Science and Technology, Pakistan Atomic Energy Commission, Isalambad, Pakistan
  • 8 Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
  • 9 Department of Micronutrient Research and Application, National Institute of Nutrition, Hanoi, Vietnam
  • 10 Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
  • 11 Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
  • 12 Division of Epidemiology and Biostatistics, St. John's Research Institute, Bangalore, India
Eur J Clin Nutr, 2024 Feb;78(2):135-140.
PMID: 37838807 DOI: 10.1038/s41430-023-01353-0

Abstract

PURPOSE: This study aimed to assess the agreement in EBF between maternal recall and the dose-to-mother (DTM) technique.

METHODS: Indonesia, Malaysia, Mongolia, Pakistan, Sri Lanka, Thailand, and Vietnam participated in the study. A total of 207 and 118 mother-infant pairs were assessed at 3 and 6 months of child's age. Using a standardized questionnaire, mothers were asked to recall child feeding during the previous 24 h, at 3 and 6 months. Those recalled to be EBF proceeded to be assessed using DTM technique. Non-milk oral intake (NMOI) cutoff of 86.6 g/d was used to classify EBF.

RESULTS: According to DTM, 66% of infants were EBF at 3 months, while only 22% were EBF at 6 months. At 3 months, the overall % agreement between maternal recall and DTM method was 68%, kappa 0.06 (95% CI: 0.07-0.20), and at 6 months, the % agreement was only 21%, kappa -0.031 (95% CI -0.168 to 0.107). Human milk intakes were similar at 3 months and 6 months when expressed as g/d, but decreased when expressed as g/kg/d, with a large variation within and between countries; Pakistan being the lowest.

CONCLUSION: This study showed there were declining levels of EBF from 3 to 6 months in the participating countries from Asia and the agreement between maternal recall and DTM technique to classify EBF was low. To ensure that the DTM technique can be more widely used in evaluating breastfeeding promotion programs, consensus on the appropriate NMOI cutoff and simplification of the DTM protocol is necessary.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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