Information oN the selected mothers and children
In this study, breastfeeding without complementary foods for six months is considered as EBF. If the breastfeeding was interrupted before 6 months, it was considered as cessation of EBF. The mean and median of the EBF duration were calculated.
The ‘recall since birth’ method, which is widely used in assessing the prevalence of EBF [19, 20] was followed. In Sri Lanka, the third dose of pentavalent and oral polio vaccines (OPV) are administered at the age of 6 months. To help the mothers to recollect the information related to early cessation of EBF and initiation of complementary feeding, they were questioned relating to the third dose of vaccination.
The selected mothers (n338; two mothers did not agree to participate [response rate, 99.4%]) had 167 male children (49.4%), and the mean age of the total selected children was 24.2 (± 6.9) months. Low birth weight (LBW) (< 2500 g) babies were delivered by 16.3% (55/338) of the mothers. Vaginal delivery (87.9%) was higher than the cesarean section (p<0.05). Delivery of male babies by cesarean section 53.7% was more than by vaginal delivery 48.8% (p≥0.05). The mothers who delivered through vagina (n = 297) and caesarian section (n = 41) had 15.8 and 19.5%) LBW babies (p≥0.05).
The majority of the mothers were Hindus (85.2%), and they delivered 16.3% of LBW babies, while 16.0% of the Christian mothers delivered LBW babies (p≥0.05). The caesarean section (11.5%) was lower among the Hindu mother than among Christian mothers (16%) p≥0.05.
It was observed that 48.2% of mothers from extended families and 50.3% from nucleated families had male babies (p≥0.05). The delivery by caesarian section was higher among the mothers from nucleated families (13.2%) than those from extended families (10.6%) p≥0.05). The higher percentage of LBW babies were delivered by mothers from nucleated families (17.8%) than those from extended families (14.2%) (p≥0.05). The mothers from nucleated and extended families respectively delivered 49.7 & 53.8% of male babies (p≥0.05), and among them, 17.0 & 23.1% were with LBW babies, respectively, by normal vaginal delivery and cesarean section (p≥0.05).
The highest percentage of mothers had three children (36.1%), while 14.8% of mothers had only one child (Table 1a). Among the mothers who had the vaginal delivery, the majority had 3 children (35.4%), and those who delivered through cesarean section had 2 children (41.5%). The mothers with more than one child delivered 54.0% of male babies. The mothers, who had 3 children, delivered 14.8% LBW babies and 51.6% male babies. Of the mothers who had only one child (14.8%), 24.0% delivered LBW babies.
Educational levels of the mothers were categorized into no formal education (no schooling), primary education (grades one to five), junior secondary education [grades six to General Certificate of Education (GCE)-Ordinary Level (O/L)], senior secondary [grades twelve to GCE- Advance Level (A/L)], senior secondary pass, and tertiary education (diploma, degree, and postgraduate degree). It was found that 8.0, 85.5 and 5.9% of the mothers, respectively, had education up to primary, secondary and tertiary levels, while two mothers (0.6%) had never attended schools (Table 1a). The mothers who delivered babies with normal birth weight had the highest education secondary pass (94.4%), followed by those who had senior secondary
Table 1
a: Number of children, education and the knowledge of the mothers EBF from the rural areas of Jaffna District (n = 338) who practiced EBF and the mean duration of EBF.
Variable | Total | EBF |
No. | % | No. | % | p-value | Mean Duration (Months) | p-value* | Crude OR (95% CI) | p-value |
Number of Children |
1 | 50 | 14.8 | 26 | 78.8 | 0.831 | 5.24 (± 1.75) | 0.973 | 1 | 0.632 |
2 | 115 | 34.0 | 46 | 66.7 | 5.16 (± 1.39) | 1.86 (0.7–4.91) |
3 | 122 | 36.1 | 53 | 72.6 | 5.22 (± 1.5) | 1.4 (0.53–3.74) |
≤4 | 51 | 15.1 | 23 | 15.5 | 5.30 (± 1.46) | 1.61 (0.53–4.93) |
Education level Mothers a |
No formal education | 2 | 0.6 | 0 | 0 | 0.028 | 3.0 (± 1.41)a | 0.012 | 6.42 (1.62–25.62) | |
Primary | 27 | 8.0 | 4 | 44.4 | | 4.0 (± 2.18) | |
Junior Secondary | 134 | 39.6 | 66 | 75.9 | | 5.26 (± 1.51)a | | 1.17 (0.52–2.61) | 0.027 |
Senior Secondary | 83 | 24.6 | 44 | 78.6 | | 5.54 (± 1.03) | | 1 | |
Secondary Pass | 72 | 21.3 | 26 | 65.0 | | 5.03 (± 1.64) | | 1.97 (0.79–4.91) | |
Diploma /Degree | 20 | 5.9 | 8 | 57.1 | | 5.29 (± 1.0) | | 2.75 (0.8–9.47) | |
Knowledge on EBF* |
Yes | 147 | 70.7 | 101 | 68.7 | 0.149 | 5.14 (1.54) | 0.053 | 1 | 0.244 |
No | 61 | 29.3 | 47 | 77.0 | | 5.41 (1.24 | | 1.53 (0.77–3.05) |
aPrimary level: grade 1–5; Junior secondary/up to general common examination-ordinary level (GCE [O/L]): from grade 6–11; Senior secondary/up to general common examination-advance level (GCE [A/L]): Grade 11–13; Diploma/degree holders: undergraduate or graduate degree or diploma holders. *Knowledge on EBF was collected from the mothers who have children aged between 6 to 23 months (n = 208).
(85.5%) and up to junior secondary level [77.6%]. Among the mothers (14.9%) who had a cesarean section, the highest numbers had an education up to junior secondary, followed with secondary pass (38.7%) and senior secondary level (25.8%). The mothers who had three or more children had education up to senior secondary level (37.3%) followed with those studied up to junior secondary level (31.4%). The majority of the mothers (82.2%) were unemployed (Table 1b). LBW babies were delivered by 17.2% of unemployed and 13.3% of employed mothers (p≥0.05). More unemployed mothers had three or more children (80.4%) than employed mothers (19.6%) (p > 0.05).
The total family income included the total income of all the family members. The median and mean monthly income were LKR 20,000.00 [interquartile range (IQR) = 15,000.00] and LKR 24,351.04 (± 15,022.36), respectively. The LBW babies of 65.5, 29.1 and 5.5% were from families with the total monthly income of ≤ LKR 19,999.99, 20000.00-39999.99 and > 40000.00, respectively (p < 0.05). Prevalence of cesarean section was highest among the mothers who had a total monthly income of LKR 20000.00-39999.99 (14.5%) followed with those with LKR 19,999.99 (8.2%). The mothers who had three or more children were from families which had a monthly income of ≤ LKR 19,999.99 (51.0%), followed with LKR 20000.00-39999.99 (41.2%) (Table 1b).
Household assets were considered to construct the Wealth Status based on the principal component analysis[21, 22] and classified as poor, second, middle, and fourth classes. The majority of the mothers (47.3%) were from the middle class and, equal numbers were from the poor and fourth classes (11.5%) (Table 1b). LBW babies (< 2500 g) were delivered mainly by mothers from the second class (38.2%) followed by those from the middle class (32.7%) (p≥0.05). Cesarean section
Table 1
b: Employment, total monthly income of the family and the wealth index of the EBF mothers from the rural areas of Jaffna District (n = 338) and mean duration of EBF.
Variable | Total | EBF |
No. | % | No. | % | p-value | Mean EBF Duration (Months) | p-value* | Crude OR (95% CI) | p-value | AOR | p value |
Employment of Mothersa |
Unemployed | 278 | 82.2 | 131 | 74.4 | 0.036 | 5.26 (± 1.47) | 0.547 | 1 | 0.019 | 1 | 0.14 |
Professional | 41 | 12.1 | 13 | 50.0 | 4.92 (± 1.44) | 2.57 (1.9–5.56) | | 4.31 (1.34–13.9) |
Non-professional | 19 | 5.6 | 4 | 66.7 | 5.33 (± 1.21) | |
Total Income (LKRc/Month)b |
≤19,999 | 159 | 47.0 | 55 | 61.1 | 0.003 | 4.92 (± 1.6) | 0.023 | 1 | 0.003 | 1 | |
20000-39,999 | 131 | 38.8 | 78 | 83.0 | 5.51 (± 1.27) | 0.32 (0.16–0.64) | 0.34 (0.084–1.41) | 0.139 |
≥40,000 | 48 | 14.2 | 15 | 62.5 | 5.17 (± 1.46) | 0.94 (0.37–2.39) | | 1.20 (0.317–4.45) | 0.799 |
Wealth Statusc |
Poor class | 39 | 11.5 | 21 | 70.0 | 0.013 | 5.03 (± 1.67) | 0.033 | 1 | 0.013 | - | - |
Second class | 100 | 29.6 | 48 | 73.8 | 5.34 (± 1.29) | 0.83 (0.32–2.15) | - | - |
Middle class | 160 | 47.3 | 68 | 77.3 | 5.40 (± 1.36) | 0.69 (0.27–1.73) | - | - |
Fourth class | 39 | 11.5 | 11 | 44.0 | 4.48 (± 1.76) | 2.97 (0.98–9.02) | - | - |
aProfessional job: skill work at government and non-government sectors, and mothers get regular monthly salary; Non-professional job: unskilled works, including non-skilled self-employments, and mothers get mostly daily wage |
bIncome is based on the Sri Lankan rupees (LKR) |
cHousehold assets were used to obtain the wealth index based on principal component analysis (PCA) [22].
aModel summary; Model chi-square = 2.888 (p-value = 0.717), Nagelkerke R2 of the fitted model = 0.222.
bThe information on recommended duration and definition of EBF were obtained from the mothers.
was highest among the mothers (48.8%) from the middle-class wealth status (p≥0.05). The second-class wealth status mothers were the highest in number with three or more children (43.1%) (p < 0.05) (poor class: 15.7%); middle class: 9.4%; fourth class:15.4%. Unemployed were the highest among the poor-class mothers (89.7%) followed with the second-class (89.0%), the middle-class (80.6%), and the fourth-class mothers (64.1%) (p < 0.01). Similarly, 55.0% of the employed mothers were within a total monthly income of LKR ≥40,000.00 LKR, while 16.7% were in the low-income group (LKR < 19,999.99) (p < 0.000). As expected, among the low-income families, 93.7% of the mothers were unemployed, indicating that the income of the female members contributed to the total income of the households in rural areas of Jaffna District.
Prevalence OF EBF FOR six months
EBF was considered as the children those who did not receive any food or drink except for medicines and vitamins or mineral drops and breast milk since birth [23, 24]. Of the total of 338 mothers, 208 mothers who had children between 6 and 23 months of age were selected for the assessment of EBF, as 130 of them had children older than 24 months and found it difficult to recall the information on EBF. EBF recommended by WHO was practiced by 71.2% of the mothers (180 days). This section considered 148 rural mothers who exclusively breastfed their babies.
EBF was higher for female babies (53.4%) than for male babies (46.6%) (p≥0.05) (Table 2). In this present study, 67.6% of male and 74.5% of female babies were EBF (p≥0.05).
The mean birth weight of the EBF babies was 2947.48 (± 467.46) g, and 9.5% of the mothers had LBW babies (< 2500 g) (Table 2), where more male babies (11.6% were with LBW than
Table 2
Prevalence of EBF (n = 148) to the babies classified based on gender and birth weight, born by different mode of delivery to the mothers having different religions, type of families and number of children.
EBF Period (Months) | Gender No. (%) | Birth weighta No. (%) | Mode of delivery No. (%) | Type of family No. (%) | Religion No. (%) | No. of Children (No., %) |
Male | Female | NBW | LBW | Caesarian | Vaginal | Nucleated | Extended | Hindu | Christian | 1 | 2 | 3 | > 3 |
A | 69 (67.6) | 79 (74.5) | 134 (76.1) | 14 (43.8) | 16 (51.6) | 132 (74.6) | 84 (68.9) | 64 (74.4) | 126 (70.4) | 22 (75.9) | 26 (78.8) | 46 (66.7) | 53 (72.6) | 23 (69.7) |
B | 41.3 | 46.2 | 47.3 | 25.5 | 39.0 | 44.4 | 42.6 | 45.4 | 43.8 | 44.0 | 52.0 | 40.0 | 43.4 | 45.1 |
C | 46.6 | 53.4 | 90.5 | 9.4 | 10.8 | 89.2 | 56.8 | 43.2 | 85.1 | 14.9 | 17.6 | 31.1 | 35.8 | 15.5 |
EBF Period (Months) | Educational Level (No., %) | Knowledge on EBF | Employment | Monthly Income (x10000) (No., %) | Wealth Index (No., %) |
No Formal Educ | Prim | Junior Secon | Senior Secon | Secon pass | Dip or Degree | Yes | No | Unemployed | Professional | Non-Professional | ≤19.999 | 2.0-3.9999 | ≥4.0 | Poor | 2nd | Middle | 4th |
A | 0 (0.0) | 4 (44.4) | 66 (75.9) | 44 (78.6) | 26 (65.0) | 8 (57.1) | 101 (68.7) | 47 (77.0) | 131 (74.4) | 13 (50.0) | 4 (66.7) | 55 (61.1) | 78 (83.0) | 15 (62.5) | 21 (70.0) | 48 (73.8) | 68 (77.3) | 11 (44.4) |
B | 14.8 | 14.8 | 48.6 | 53.0 | 50.3 | 40.0 | 68.7 | 33.4 | 47.1 | 50.0 | 66.7 | 34.6 | 59.5 | 31.3 | 53.8 | 48.0 | 42.5 | 28.2 |
C | 0.0 | 2.7 | 44.6 | 29.7 | 52.7 | 5.4 | 68.2 | 31.8 | 88.5 | 15.5 | 2.7 | 37.2 | 52.7 | 10.1 | 14.2 | 32.4 | 45.9 | 7.4 |
A-With total respective sub-population (%) (n = 208); B-Within the total population (%) (n = 338); C-Within EBF Population (%) (n = 148) |
aBirth weight; low birth weight (LBW) was defined as birth weight of a baby is less than 2500 g, NBW-normal birth weight ≥2500 g |
female babies (7.6%). Among the LBW babies (n32), only 43.8% were EBF, and among the EBF babies, only 9.5% were LBW babies.
The EBF was practiced by 89.2% of mothers who had a vaginal delivery and had 45.5% male children, while 10.8% of the mothers had caesarian sections and 56.3% (9/16) had male children. Only 51.6%% of the mothers who had cesarean section EBF.
EBF was practiced by 43.2 & 56.8% of mothers from extended & nucleated families, respectively (p≥0.05) (Table 2), and 36.2 & 63.8% of these mothers, respectively, had male children. Among the mothers from extended & nucleated families 6.3 & 11.9%, respectively, had LBW babies. The mothers from extended & nucleated families who practiced EBF had 12.5 & 9.5% caesarian deliveries.
In the selected population, 85.1% of mothers were Hindus. The EBF was practiced by almost equal percentage of Hindu (70.4%) and Christian (75.9%) mothers. However, among the EBF mothers, Hindus (85.1%) were more than Christian mothers (14.9%) (Table 2). Among the Hindu & Christian mothers who practiced EBF, 48.4 (61/126) & 36.4% (8/22), respectively, had male babies 9.5 and 9.1% had LBW babies. Among the Hindu and Christian mothers who had cesarean sections, 10.3 and 13.6%, respectively, practiced EBF. 54.0% Hindu and 72.7% Christian mothers from nucleated families practiced EBF.
EBF was practiced by more mothers who had one child (52%) than those with two or more children (Table 2). However, among the EBF mothers, those with 3 children were more in numbers (Table 2). The mothers with ≥ 4 & <4 children and EBF had 8.7 & 9.6% LBW children.
The mothers who had the education up to the senior secondary or higher level were the highest among who practiced EBF (50.3%) (Table 2). However, the mothers who had the educational level up to the junior secondary level were the highest among those who practiced EBF (44.6%), whereas 35% was the highest among those who had not EBF (p < 0.05).
Only 68.2% of the mothers who were aware of the WHO recommended the duration of EBF as six months practiced EBF (Table 2). The mothers who were aware of the EBF and practiced EBF had 43.6% of male babies, 9.9% of LBW babies, 89.1% had vaginal delivery, and 54.5% were from nucleated families.
Among the employed mothers (30 Nos.) only 26 were holding professional jobs while the rest were having non-professional jobs. Thus, among mothers those who were unemployed and with professional jobs, 47.1 and 50.0% were respectively practicing EBF (Table 2). However, among the EBF mothers, unemployed mothers were higher (88.5%) than the employed mothers. Less number of employed mothers who had male babies (23.5%) practiced EBF. The EBF by employed and unemployed mothers respectively had 11.8 & 9.2% of LBW babies. The employed & unemployed mothers who practiced EBF 82.4 & 66.4% respectively had the knowledge on EBF (p > 0.05). Among the mothers who are employed & unemployed and practiced EBF, 82.4 & 90.1% respectively had vaginal delivery. Among these employed & unemployed mothers 41.2 & 58.8% who practiced EBF were from nucleated families. The present study observed that 76.5 & 23.5% of the employed Hindus & Christian mothers and the 86.3 & 13.7% of the unemployed Hindus & Christian mothers practiced EBF (p > 0.05). Among these employed mothers, 17.6, 23.5 & 47.1% and 11.8% were having > 3, 3 & 2 children and one child and the unemployed mothers 15.3, 37.4 & 29.0% and 18.3% were having > 3, 3 & 2 children and one child, respectively, practiced EBF.
The majority of the (among the 338) mothers were from families (47.0%) which had the monthly income of < 19,999. Of the mothers who practiced EBF (n = 148), 37.2, 52.7 and 10.1% were from families which had the monthly income of 19,999.99, 20,000.00–39,999.99, and > 40,0000.00 respectively (Table 2). The mothers who practiced EBF were with the total monthly income of LKR 20,000.00–39,999.99 had highest percentage (4.1%) of LBW babies followed with those who had LKR > 40,0000.00 (0.7%) and LKR 19,999.99 (4.7%).
Among the mothers who had 89.2% of vaginal delivery and practiced EBF (n = 16) had the total monthly income of LKR > 40,0000.00 had lowest percentage (12.5%) of LBW babies followed with those who had the monthly income of LKR 19,999.99 (31.3%) and LKR 20,000.00–39,999.99 (56.3%).
Highest number of the mothers was belonging to middle class (160nos.) while higher number of the poor class mothers practiced EBF (53.8%). However, among those who practiced EBF more middle-class mothers practiced EBF followed with those from the second class. EBF was practiced by 70.0, 73.8, 77.3 and 44.0% of mothers from poor, second, middle, and fourth classes of wealth status respectively (Table 2). The mothers from the second-class wealth status had EBF for highest number (56.3%) of male babies (p > 0.05) and these mothers had highest percentage (16.7%) of LBW babies followed with those from middle class (7.4%) and poor class (4.8%. Interestingly, no LBW babies had been EBF by the mothers of fourth-class wealth status.
Cessation of EBF Before Six Months (Nos. 60)
The mothers (60 nos.) who did not abide to the WHO recommendation i.e., who did not practice EBF for 6 months (60nos.) and were considered for this section (28.8%) (Tables 3a and 3b). Table 3a gives the information on the early cessation of EBF by 1st, 2nd, 3rd, 4th and 5th months. About 10% of the mothers ceased EBF by the 1st month while 28.3% of the mothers ceased EBF by the 3rd month.
More mothers with male babies ceased EBF before 4th month but during 4th month majority of the mothers with female babies ceased EBF (Table 3a). Among the 60 mothers, more mothers with male babies (55%) ceased EBF before the completion of 6 months than those who had female babies (45%).
The mean birth weight of the babies who were not EBF for six months was 2779.48 (± 475.81) g. Among these babies, 30% had LBW babies (< 2500 g) (Table 3a). NBW & LBW male babies were 52.4 & 61.1% respectively while the female babies were 47.6 & 38.9% respectively. Early cessation of EBF was more for the NBW babies than for the LBW babies (Table 3a).
The early cessation of EBF was by 75% of the mothers who had normal vaginal delivery and 53.3% of the mothers who had male children, while of the 25% mothers who had caesarian section had 60% male children. Almost same number of mothers ceased EBF by 2nd, 3rd, 4th and 5th months while higher number of mothers who had vaginal delivery ceased EBF by 3rd, 4th and 5th months (Table 3a).
Higher number of mothers from nucleated families ceased EBF (63.3%) than those from the extended families (36.7%) (p≥0.05). The cessation of EBF by the mothers from nucleated
Table 3
a: Early cessation of EBF (n = 60), to the babies of different sex, birth weights and delivered by different modes by the mothers belonging to different types of families, religions, and having different number of children.
EBF Period (Months) | Children No. (%) | Gender No. (%) | Birth weight No. (%) | Mode of delivery No. (%) | Type of family No. (%) | Religion No. (%) | No. of Children (No., %) |
Male | Female | NBW | LBW | Cesarean | Vaginal | Nucleated | Extended | Hindu | Christian | 1 | 2 | 3 | > 3 |
1 | A | 6 (2.9) | 2 (2.0) | 4 (3.8) | 3 (1.7) | 3 (9.4) | 3 (9.7) | 3 (1.7) | 2 (1.6) | 4 (4.7) | 5 (2.8) | 1 (0.8) | 3 (9.1) | 1 1.4) | 2 (2.7) | 0 (0.0) |
B | 1.8 | 0.6 | 1.2 | 0.9 | 0.9 | 0.9 | 0.9 | 0.6 | 1.2 | 1.5 | 0.3 | 0.9 | 0.3 | 0.6 | 0 |
C | 10 | 3.3 | 8.3 | 5.0 | 5.0 | 5.0 | 5.0 | 3.3 | 6.7 | 8.3 | 1.7 | 5.0 | 5.0 | 3.3 | 0 |
2 | A | 9 (4.3) | 5 (4.9) | 4 (3.8) | 6 (3.4) | 3 (9.4) | 2 (6.5) | 7 (4.0) | 7 (5.7) | 2 (2.3) | 9 (5.0) | 0 (0.0) | 0 (0.0) | 3 (4.3) | 4 (5.5) | 2 (6.1) |
B | 2.7 | 1.5 | 1.2 | 1.8 | 0.9 | 0.6 | 2.1 | 2.1 | 0.6 | 2.7 | 0.0 | 0.0 | 0.9 | 1.2 | 0.6 |
C | 15.0 | 8.3 | 6.7 | 10.0 | 5.0 | 3.3 | 1.7 | 11.7 | 3.3 | 15.0 | 0.0 | 0.0 | 3.3 | 6.7 | 3.3 |
3 | A | 17 (8.2) | 10 (9.8) | 7 (6.6) | 13 (7.4) | 4 (12.5) | 4 (12.9) | 13 (7.3) | 8 (6.6) | 9 (10.5) | 11 (6.1) | 6 (20.7) | 2 (6.1) | 7 (10.1) | 5 (6.8) | 3 (9.1) |
B | 5.0 | 3.0 | 2.1 | 3.8 | 1.2 | 1.2 | 3.8 | 2.4 | 2.7 | 3.3 | 1.8 | 0.6 | 2.1 | 1.5 | 0.9 |
C | 28.3 | 16.7 | 11.7 | 21.7 | 8.3 | 6.7 | 21.7 | 13.3 | 15.0 | 18.3 | 10.0 | 3.3 | 11.7 | 8.3 | 5.0 |
4 | A | 13 (6.3) | 11 (10.8) | 2 (1.9) | 7 (4.0) | 6 (18.8) | 3 (9.7) | 10 (5.6) | 9 (7.4) | 4 (4.7) | 13 (7.3) | 0 (0.0) | 0 (0.0) | 7 (10.1) | 5 (6.8) | 1 (3.0) |
B | 3.8 | 3.3 | 0.6 | 2.1 | 1.8 | 0.9 | 3.0 | 2.7 | 1.2 | 3.8 | 0.0 | 0.0 | 2.1 | 1.5 | 0.3 |
C | 27.7 | 18.3 | 3.3 | 11.7 | 10.0 | 5.0 | 16.7 | 15.0 | 6.7 | 21.7 | 0.0 | 0.0 | 11.7 | 8.3 | 5.0 |
5 | A | 15 (7.2) | 5 (4.9) | 10 (9.4) | 13 (7.4) | 2 (6.3) | 3 (9.7) | 12 (6.8) | 12 (9.8) | 3 (3.5) | 15 (8.4) | 0 (0.0) | 2 (6.1) | 5 (7.2) | 4 (5.5) | 4 (12.1) |
B | 4.4 | 1.5 | 3.0 | 3.8 | 0.6 | 0.9 | 3.6 | 3.6 | 0.9 | 4.4 | 0.0 | 0.6 | 1.5 | 1.2 | 1.2 |
C | 25.0 | 8.3 | 16.7 | 21.7 | 3.3 | 5.0 | 20.0 | 20.0 | 5.0 | 25.0 | 0.0 | 3.3 | 8.3 | 6.7 | 6.7 |
A- With Total respective sub-Population (%) (n = 208); B- Within the total population (%) (n = 338); C-Within EBF Population (%) (n = 60) |
Table 3
b: Early cessation of EBF (n = 60) by the mothers having different educational levels, knowledge on EBF, employments, monthly total family income and wealth index.
EBF Period (Months) | Educational Levela (No., %) | Knowledge on EBF | Employmentb | Monthly Income (x 10,000) (No., %)c | Wealth Indexd (No., %) |
No Formal | Prim | Junior | Seni Second | Secon Pass | Dip/ Degree | Yes | No | Un Emp | Professional | Un-Professional | ≤19.999 | 2.0-3.9999 | ≥4.0 | Poor | 2nd | Middle | 4th |
1 | A | 0 (0.0) | 1 (11.1) | 3 (3.4) | 0 (0.0) | 2 (5.0) | 0 (0.0) | 6 (4.1) | 0 (0.0) | 5 (2.9) | 1 (3.8) | 0 (0.0) | 3 (3.3) | 2 (2.1) | 1 (4.2) | 1 (3.3) | 1 (1.5) | 2 (2.3) | 2 (8.0) |
B | 0 | 3.7 | 2.2 | 0 | 2.7 | 0 | 0.3 | 0 | 1.8 | 2.4 | 0 | 3.33 | 2.1 | 4.1 | 3.3 | 1.5 | 2.2 | 8.0 |
C | 0.0 | 1.7 | 6.7 | 0.0 | 3.3 | 0.0 | 10 | 0.0 | 8.3 | 1.7 | 0.0 | 5.0 | 3.3 | 1.6 | 1.6 | 1.6 | 3.3 | 3.3 |
2 | A | 1 (50) | 1 (11.1) | 5 (5.7) | 1 (1.8) | 1 (2.5) | 0 (0.0) | 4 (2.7) | 5 (8.2) | 9 (5.1) | 0 (0.0) | 0 (0.0) | 6 (6.7) | 3 (3.2) | 0 (0.0) | 2 (6.7) | 2 (3.1) | 4 (4.5) | 1 (4.0) |
B | 50.0 | 3.7 | 3.7 | 1.2 | 1.4 | 0 | 1.4 | 9.4 | 3.2 | 0 | 0 | 6.6 | 3.1 | 0.0 | 6.6 | 3.0 | 4.5 | 4.0 |
C | 1.7 | 1.7 | 8.3 | 1.7 | 1.7 | 0.0 | 6.7 | 8.3 | 15 | 0.0 | 0.0 | 1.0 | 5.0 | 0.0 | 3.3 | 3.3 | 6.6 | 1.6 |
3 | A | 0 (0.0) | 2 (22.2) | 5 (5.7) | 5 (8.9) | 4 (10.0) | 1 (7.1) | 15 (10.2) | 2 (3.3) | 14 (8.0) | 2 (7.7) | 1 (16.7) | 11 (12.2) | 4 (4.3) | 0 (0.0) | 4 (13.3) | 4 (6.2) | 5 (5.7) | 5 (16.6) |
B | 0 | 7.4 | 3.7 | 6.0 | 5.6 | 5.0 | 1.8 | 4.0 | 3.2 | 4.9 | 5.3 | 12.2 | 4.2 | 0.0 | 13.3 | 6.1 | 5.6 | 20.0 |
C | 0.0 | 3.3 | 8.3 | 1.7 | 6.7 | 1.7 | 25 | 3.3 | 23.3 | 3.3 | 1.7 | 18.3 | 6.6 | 0.0 | 6.6 | 6.6 | 8.3 | 8.3 |
4 | A | 1 (50) | 1 (11.1) | 4 (4.6) | 1 (1.8) | 4 (10) | 2 (14.3) | 10 (6.8) | 3 (4.9) | 7 (4.0) | 6 (23.1) | 0 (0.0) | 8 (8.9) | 3 (3.2) | 2 (8.3) | 1 (3.3) | 7 (10.8) | 1 (1.1) | 4 (16.0) |
B | 50 | 3.7 | 3.0 | 1.2 | 5.6 | 10 | 3.5 | 5.7 | 2.5 | 14.6 | 0.0 | 8.8 | 3.1 | 8.3 | 3.3 | 10.7 | 11.4 | 16.0 |
C | 1.7 | 1.7 | 6.7 | 1.7 | 6.7 | 3.3 | 16.7 | 5.0 | 11.7 | 10.0 | 0.0 | 13.3 | 5.0 | 3.3 | 1.7 | 11.7 | 1.7 | 6.7 |
5 | A | 0 (0.0) | 0 (0.0) | 4 (4.6) | 5 (8.9) | 3 (7.5) | 3 (21.4) | 11 (7.5) | 4 (6.6) | 10 (5.7) | 4 (15.4) | 1 (16.7) | 7 (7.8) | 4 (4.3) | 2 (8.3) | 1 (3.3) | 3 (4.6) | 8 (9.1) | 3 (12.0) |
B | 0.0 | 0.0 | 3.0 | 6.0 | 4.2 | 15.0 | 3.9 | 7.5 | 3.6 | 9.8 | 5.3 | 7.7 | 4.2 | 8.3 | 3.3 | 4.6 | 9.0 | 12.0 |
C | 0.0 | 0.0 | 6.7 | 8.3 | 5.0 | 5.0 | 18.3 | 6.7 | 16.7 | 6.7 | 1.7 | 11.6 | 6.6 | 3.3 | 1.6 | 5.0 | 13.3 | 5.0 |
A- With Total respective sub-Population (%) (n = 208); B- Within the total population (%) (n = 338); C-Within EBF Population (%) (n = 60) |
aPrimary level: grade 1–5; Junior secondary/up to general common examination-ordinary level (GCE [O/L]): from grade 6–11; Senior secondary/up to general common examination-advance level (GCE [A/L]): Grade 11–13; Diploma/degree holders: undergraduate or graduate degree or diploma holders |
bProfessional job: skill works at government and non-government sectors, and mothers get regular monthly salary; Non-professional job: unskilled works, including non-skilled self-employments, and mothers get mostly daily wage.
cIncome is based on the Sri Lankan rupees (LKR).
dHousehold assets were used to obtain the wealth index based on principal component analysis (PCA) [22].
families increased from 1st to 5th months while the numbers fluctuated among the mothers from the extended families (Table 3a). The mothers from extended & nucleated families who did not practice EBF respectively had 59.1 & 52.6% male children. Among these mothers from extended & nucleated families respectively had 22.7 & 34.2% LBW babies. Further 18.2 & 28.9% of the mothers from extended & nucleated families had caesarian section.
Among the 60 mothers who ceased EBF, the Christian mother only one ceased EBF at 1st month and another 6 numbers at 3rd month (Table 3a). But the cessation of EBF was increased with time by the Hindu mothers. Among the mothers who ceased EBF early, 88.3 & 11.7% were Hindu & Christian respectively (p > 0.05). These Hindu & Christians mothers respectively had 52.2 & 71.4% male children and, 28.3 & 42.9% LBW babies. The Hindu & Christian mothers who had cesarean section and ceased EBF early were 26.4 & 14.3% respectively were from extended families and 64.2 & 57.1% respectively were from nucleated families.
More mothers who had 2 (38.3%) & 3 (33.3%), children ceased EBF early than those with only one child (11.7%) (Table 3a). The mothers with ≥ 4 & <4 children ceased EBF early had 30.0 & 30% LBW children, respectively.
In this study, more mothers with senior secondary level education (53.3%) ceased EBF than the mothers with other levels of education (Table 3b).
Among the mothers who had ceased EBF early, 76.7% were aware of the WHO recommended duration of EBF as for six months and among them 54.3% had male babies, 23.9% had LBW babies, 19.6% had cesarean section and 60.9% were from nucleated families (Table 3b).
Among the mothers who ceased EBF early, 75.0% were unemployed (Table 3b). Among the employed mothers 40.0% had male babies. More LBW babies were delivered by unemployed mothers (31.1%) than employed mothers (26.7%). More employed mothers (80.0%) who ceased EBF early had the knowledge of EBF than the unemployed mothers (75.6%). Among the mothers who were employed & unemployed, 13.3 & 28.9% respectively had cesarean section and 73.3% employed and 60.0% unemployed mothers were from nucleated families. Further 86.7 & 13.3% of the employed Hindu & Christian mothers and, 88.9 and 11.1% of the unemployed Hindu and Christian mothers ceased EBF early. Among these mothers, the employed mothers 13.3, 40, and 46.7% respectively had > 3, 3, and 2 children and among the unemployed mothers 17.8, 31.1 & 35.6%, and 15.6% respectively had > 3, 3 & 2 children and 1 child (Table 3b).
Of the mothers who ceased EBF early, majority (58.3%) had the monthly family income of 19,999.99 (Table 3b). Majority of the LBW babies were delivered by the mothers (34.3%) who ceased EBF were with the total monthly income of LKR < 19,999.00 followed with those who had LKR 19,999.00–39,999.99 (31.3%). Among the mothers who had (75%) of vaginal delivery and ceased EBF early had the total monthly income of LKR < 19,999.99 and had 22.2% of LBW babies.
Early cessation of EBF was highest (33.3%) among those who were from middleclass wealth status (Table 3b). The mothers from the poor class and ceased EBF early had highest number (66.7%) of male babies and LBW babies (55.6%) followed with those from fourth (42.9%) and second classes (35.6%).