Breastfeeding education, early skin-to-skin contact, and other strong determinants of exclusive breastfeeding in an urban population: results from a prospective study

Objective: The current study aims to demonstrate independent associations between social, educational, and health practice interventions as determinants of exclusive breastfeeding in an urban Ecuadorian population. Design: Prospective survival analyses. Setting: Ecuadorian mother-child dyads in urban settings. Participants: We followed-up 363 mother-baby dyads who were attended in health care centres in Portoviejo, province of Manabi, for up to 150 days. Main outcome measures: We performed a survival analysis, by setting the time-to-abandonment of exclusive breastfeeding measured in days of life, periodically assessed by phone, as the primary outcome. Crude and adjusted mixed-effects Cox proportional hazards model were performed to estimate hazard ratios (HR) for each explanatory variable. Results: The median time of follow-up (P25 to P75) was 125 (121 to 130) days, and the incidence rate of abandonment of breastfeeding was 8.9 per 1000 persons-days in the whole sample. The three more significant protective determinants of exclusive breastfeeding were (i) sessions of prenatal breastfeeding education, with a reduced risk of abandoning the practice of exclusive breastfeeding of 30% (95%CI: 50% to 10%) per each extra session, (ii) self-perception of milk production, with a reduced risk of abandoning the practice of exclusive breastfeeding of 57% (95%CI: 50% to 10%) per each increase in the perceived quantity of milk production; and (iii) receiving early skin-to-skin contact represented a 90% risk reduction of interrupting breastfeeding (95%CI: 94% to 70%) vs. not receiving. Conclusions: Prenatal education on breastfeeding, self-perception of milk production, and early skin-to-skin contact appears to be strong determinants of exclusive breastfeeding in urban Ecuadorian mother-baby dyads; further, educational level of the mother, excreta management conditions are important determinants too.