Study population
The mothers who have newborn hospitalized in NICU ward of teaching hospital Ibn Roch of Casablanca from January to June 2021. We included any mothers who could give the breast milk to her newborn. We excluded any couple mother/newborn that had any BMF counter indication, none Moroccan mother, couples mother/newborn rehospitalzed or absents in the study period.
Operational definitions:
Exclusive breastfeeding (EBF)
The newborn received only breast milk from his/her mother or a wet nurse for the first 6 months and no other solids or liquids with the exception of drops or syrups consisting of vitamins, minerals.
Partial breastfeeding or mixed feeding
The newborn received some breast feeds and some artificial feeds either milk or cereal, or other food or water
Artificial feeding
the newborn received breast- milk substitutes and not breastfeeding at all.
Sampling
Sample size determination
The sample size was determined using a single population proportion formula (n = P (1-P) \(\frac{{{Z}{\alpha }}^{2}}{{{I}}^{2}}\) ) assuming an expected rate for exclusive breastfeeding in previous survey conducted in Morocco to be 12,4% [10] with a 95% confidence level, at a 5% margin of error. The calculated sample size using the above assumptions became 162.
Sampling procedure
During the period of this study the monthly admission of NICU was around 100, we included randomly between 5 and 10 couples mother/newborn per week.
Data collection procedure
Data were collected by face to face interview using questionnaire
Questionnaire
The questionnaire was made based on review of literature and the content was validated by the panel of 3 experts (2 professors in neonatology and 1 public health professor).The pilot study was conducted among 20 post-partum mothers in maternity ward of Ibn Rochd teaching hospital. It contained 6 dimensions (socioeconomic-obstetric, BF practice, health care staff support, relatives support, BMF information source and newborn characteristics).
Variables and measurement
Outcome
BF Practice: it was measured by binary variable BF performed or not (yes, no).
Determinants:
Socio-obstetric characteristics : age_residence ( urban, rural)_education level (unschooled, primary school, secondary school, upper/university)_matrimonial status (single,widow,married,divorced)_profession (household wife, self-employed, paid worker)_family monthly income [low (< 3000, middle (3000–7000), high (> 7000 dirhams)]_ number of prenatal visits_ number of child alive_ BF knowledge score from answers of 16 questions(good answer = 1 and other answer = 0) about benefits, kangourou, initiation, diversification, expression and conservation of breast milk.
Supports during hospitalization: care staff supports (yes, no) _relatives supports (yes, no)
Prior council or information about BF (yes, no)
Information sources about BF: media (yes, no) _ health care staff (yes, no) _family/friends (yes, no)
Newborn characteristics (gestational age, gender, reason of hospitalization, hospital stay and weight)
The ethical approval for this study was obtained from Neonatal medicine and resuscitation service of Ibn Rochd teaching hospital of Casablanca. Informed consent statement was attached with each questionnaire for the participants who could read if they were willing to participate in the study. And read and explained by investigators for participants who couldn’t read. Any data that can compromise anonymity of respondents was omitted from the questionnaire.
Data Analysis
Data analysis was performed using R version 3.6.3 software.
Percentages (frequencies), median (with interquartile range) were used to describe the study population.
The multiple binary logistic regression model were used to analyze the association between potential determinants and outcome (BF practice = yes and no), using stepwise model selection backward/forward on Bayesian information criterion (BIC). The potential determinants with p value \(\le\) 0.05 in multivariate analysis were considered as determinants associated significantly to the BF practice.