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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

European Journal of Clinical Nutrition volume 78, pages 135–140 (2024)Cite this article

Subjects

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.

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Fig. 1: Agreement between maternal recall and DTM method on exclusive breastfeeding practice by participating countries in Asia.

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Data availability

Data generated from this study are deposited at the IAEA repository on human milk intakes and can be available upon request.

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Acknowledgements

We would like to express gratitude to the International Atomic Energy Agency (IAEA) for providing technical support (Technical Cooperation RAS6073) and supplies for the study. This work was also supported, in part, by the national funding for participating countries. IAEA participated in the design, management, analysis, interpretation, preparation, review, and approval of the manuscript.

Author information

Authors and Affiliations

  1. Food and Nutrition Acedemic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand

    Pattanee Winichagoon, Tippawan Pongcharoen & Kunchit Judprasong

  2. Centre for Health Services Policy, Health Policy Agency, Ministry of Health, Jakarta, Indonesia

    Tetra Fadjarwati

  3. Research Center for Radiation Process Technology, National Research and Innovation Agency (BRIN), Jakarta, Indonesia

    Ermin Winarno

  4. Nutrition Science, School of Healthcare Sciences, Universiti Kebangsaan, Kuala Lumpur, Malaysia

    Norima A. Karim

  5. National Center for Maternal and Child Health (NCMCH), Ulaanbaatar, Mongolia

    Enkhzul Purevsuren

  6. Pakistan Institute of Nuclear Science and Technology, Pakistan Atomic Energy Commission, Isalambad, Pakistan

    Tanvir Ahmad & Ayesha Yameen

  7. Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka

    Manjula Hettiarachchi

  8. Department of Micronutrient Research and Application, National Institute of Nutrition, Hanoi, Vietnam

    Nga Tran Thuy & Hien Vu Thi Thu

  9. Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh

    Munirul Islam

  10. Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria

    Christine Slater & Alexia J. Murphy-Alford

  11. Division of Epidemiology and Biostatistics, St. John’s Research Institute, Bangalore, India

    Tinku Thomas

Authors
  1. Pattanee Winichagoon
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  14. Christine Slater
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Contributions

PW, TP, CS, AJMA conceived the study and led the planning of the study protocol with inputs from country authors and MI; TP, TF, EW, NK, EP, TA, AY, MH, KJ, NTT, HVTT conducted field data, sample collection, and sample analysis; TT performed statistical analysis; PW drafted the first draft of the manuscript with inputs and approval of final manuscript from all authors.

Corresponding author

Correspondence to Pattanee Winichagoon.

Ethics declarations

Competing interests

Pattanee Winichagoon, Tippawan Pongcharoen, Tetra Fadjarwati, Ermin Winarno, Norima A Karim, Enkhzul Purevsuren, Tanvir Ahmad, Ayesha Yameen, Manjula Hettiarachchi, Kunchit Judprasong, Nga Tran Thuy, Hien Vu Thi Thu, Munirul Islam, Christine Slater, Tinku Thomas, and Alexia J Murphy-Alford, confirmed no conflicts of interest.

Ethical approval

This study was conducted according to the guidelines laid down in the Declaration of Helsinki. The approval for the study in the country was obtained from the Ethical Review Committee in each country by the respective lead authors and other administrative approvals were also their responsibility.

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Cite this article

Winichagoon, P., Pongcharoen, T., Fadjarwati, T. et al. 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. Eur J Clin Nutr 78, 135–140 (2024). https://doi.org/10.1038/s41430-023-01353-0

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  • DOI: https://doi.org/10.1038/s41430-023-01353-0

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