Factors Associated with Age at Breastfeeding Cessation in Amazonian Infants: Applying a Proximal–Distal Framework
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Introduction Breastfeeding is an important determinant of child survival and normal growth and development, but breastfeeding prevalence is generally low in Brazil. Factors associated with infant feeding practices there are not well understood. This paper examines factors associated with breastfeeding cessation in a township in the western Brazilian Amazon. Methods A cross-sectional, population-based study was conducted among children younger than 25 months and collected information on maternal and child characteristics. Survival analysis based on a proximal–distal framework examined the association between breastfeeding duration and socioeconomic and maternal/child biological factors. Results The median breastfeeding duration among 101 children who were no longer breastfeeding was 120 days. Almost two-thirds (63 %) of these children stopped breastfeeding before 6 months of age. In the larger sample of 209 children, 74.6 % had previously been bottle-fed. Considering the full proximal–distal model, a child who had ever been bottle-fed was expected to cease breastfeeding about 88 % sooner than one who was never bottle-fed (p < 0.001). Children in the second-poorest wealth quartile stopped breastfeeding sooner than children in the poorest quartile (p < 0.05). Discussion Breastfeeding cessation in the study area occurred much earlier than the recommended 2 years of age. Factors associated with ending breastfeeding early included ever-use of a bottle, having a single mother, and belonging to the second-poorest wealth quartile. Further research is needed to better understand these factors and other barriers women face to continuing breastfeeding.
KeywordsBreastfeeding Breastfeeding duration Infant health Amazon Brazil
The authors gratefully acknowledge all families and health professionals in Acrelândia for their collaboration in this study. This study was funded by the Brazilian National Council for Scientific and Technological Development (CNPq; Grant Nos. 551359/2001-3, 502937/2003-3, 307728/2006-4, and 470573/2007-4), the São Paulo Research Foundation (FAPESP; Grant no. 2007/53042-1), and the Coordination for the Improvement of Higher Education Personnel (CAPES, Ministry of Education of Brazil). ADK received funding as part of Award Number R25TW007505 from the Fogarty International Center, National Institutes of Health, USA. The funders had no influence on the study design, data collection, analysis or interpretation, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
Conflicts of interest
The authors declare no conflicts of interest.
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