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  • Title: Infant feeding in Bolivia: a critique of the World Health Organization indicators applied to demographic and health survey data.
    Author: McCann MF, Bender DE, Rangel-Sharpless MC.
    Journal: Int J Epidemiol; 1994 Feb; 23(1):129-37. PubMed ID: 8194908.
    Abstract:
    Infant feeding is a multidimensional activity that can be described and analysed in many different ways. The World Health Organization (WHO) has recently issued recommended indicators for assessing infant feeding practices. This paper presents these indicators and demonstrates their applications using the 1989 Demographic and Health Survey (DHS) data for Bolivia. The results indicate that, although most Bolivian infants are breastfed and two-thirds are breastfed for > 1 year, supplementary feeding practices deviate considerably from international recommendations. Only 58% of infants < 4 months old are receiving breastmilk alone (the 'exclusive breastfeeding rate') and a similarly low percentage (54.7%) of 6-9 month olds are receiving the recommended combination of breast milk plus solid or semi-solid foods (the 'timely complementary feeding rate'). Furthermore, almost half of breastfed infants < 12 months old are also receiving bottle feeds. The infant feeding practices of city residents are least likely to conform to the infant feeding recommendations, while practices of mothers who have always lived in the country are most likely to be similar to the WHO guidelines. Mothers who have moved to the city since the age of 12 are most likely to be giving their infants other milks in addition to breast milk and to be bottle feeding their infants. The WHO infant feeding indicators provide a useful framework for quantifying infant feeding practices, and most of the indicators can readily be applied to DHS data. Nonetheless, improvements can be made in both the indicators themselves and the DHS questionnaire to improve reporting of internationally comparable infant feeding information. 1989 Demographic and Health Survey data for Bolivia is used to examine trends in World Health Organization (WHO) designated breast feeding measures. WHO measures are evaluated. WHO measures are the exclusive breast feeding rate (under 4 months), predominant breast feeding with supplementation of nonmilk liquids (under 4 months), timely complementary feeding rate, continuous breast feeding rate for children aged 12-15 months, bottle feeding rate, ever breast fed rate, and median duration of breast feeding. The timely complementary feeding rate or those 6-9 months receiving solid or semisolid foods is 55%. The continuous feeding rate is 66% for the 12-15 month old infants, and just under 50% for infants aged 20-23 months. Almost 50% of breast feeding infants also receive bottle feeding. 97% are ever breast fed. The median duration of breast feeding is 17 months. At under 4 months 57.6% receive both breast milk and other milk and not solids, and 8% are not breast fed. At 6-9 months 54.7% are receiving breast milk and solids, and almost 33% receive breast milk and other milk. About 15% are not being breast fed. At 10-11 months about 15% are still being exclusively breast fed, and almost 25% are not being breast fed at all. At 12 months about 4% receive breast milk and no solids. Exclusive breast feeding occurs among just under 50% of mothers who have always lived in the city and among those who migrated to the city. The highest rates are among women who lived in the country. The greatest differences in breast feeding are among mothers who always either lived in a city or the country. The lowest complementary feeding rate occurs in the city-always group (39.3%). The highest complementary feeding rate occurs among the town group (73.1%). Continued breast feeding is lowest in the city-always group. The highest proportion of infants receiving bottles is among infants with mothers who migrated to the city (72.0%) followed by city-always mothers (60.1%). The WHO indicators are found to be useful standards for guiding research and developing policy and practice norms.
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