Duration of exclusive breastfeeding; validity of retrospective assessment at nine months of age

Abstract

BackgroundIn cross sectional, case control and retrospective cohort studies, duration of Exclusive Breastfeeding (EBF) usually depends on maternal recall. Retrospective data are often subjected to recall bias and could lead to a potential for exposure misclassification. The purpose of the present paper is to assess the validity of maternal recall of EBF duration during infancy, after cessation of EBF and to evaluate the two methods to collect retrospective data on EBF.MethodsA cohort study was carried out in Naula Medical Officer of Health (MOH) area. Study cohort included all infants born during the months of February to April 2008 and currently residing in Naula MOH area. Baseline data collection was carried out using the pregnancy record, the child health development record and by using an interviewer administered structured questionnaire. Data extraction from the pregnancy record and the child health development record were carried out by public health midwives. The interviewer administered structured questionnaire was administered by the MOH during the follow-up visits. Duration of EBF was assessed in three ways; based on prospective data since birth: Retrospective data based on an event calendar: and the Mother reported EBF duration.ResultsA total of 114 mother-infant pairs were recruited and followed up. Proportion of infants receiving EBF up to the completion of the sixth month by the three methods were; data since birth (actual EBF rate) - 23.9%; mother reported data - 77.7% and event calendar method - 41.3%. Median duration of EBF reported in the three methods was 5, 6, and 5 respectively. A statistically significant difference was observed in these differences from Kaplan-Meire Survival analysis (Log rank test - Chi square-63.4, p < 0.001). Validity of retrospective methods was analysed using data since birth as the gold standard. Sensitivity of both methods to detect exclusively breastfed babies were 100.0%. Specificity of mother recall data was 26.2% (95%CI-17.9, 36.8%) compared to 75.0% (95% CI-64.5, 83.2%) in the event calendar method.ConclusionsRetrospective evaluation methods systematically overestimate the duration of EBF. Maternal recall data provide highly unspecific data whereas use of an event calendar provided more valid data. Reporting of data accrual methods in breastfeeding studies will allow the readers to interpret findings accurately and the use of event calendars rather than direct questioning as a valid method of determining EBF is recommended.

Risk factors for exclusive breastfeeding lasting less than two months—Identifying women in need of targeted breastfeeding support

“…Nevertheless, it has been shown that women successfully recall what happened during the process of giving birth and the following hours, even a long time later [28]. Agampodi and co-authors [29] argued that retrospective evaluation methods systematically overestimate the duration of breastfeeding, but our prevalence of 77% women breastfeeding exclusively for at least two months is similar to that of breastfeeding rates in Uppsala county during the same year (76,2%) [30]. A possible limitation of this study is that a question about intention to breastfeed was not directly posed, as we assumed that nearly all mothers had planned to breastfeed.…”

The accuracy of dietary recall of infant feeding and food allergen data

“…Agampodi et al . reported similar findings at 9 months follow‐up, concluding that estimations of longer than observed EBF were likely a result of social desirability bias rather than recall bias. With regard to longer durations of recall, Promislow et al .…”

“…Bland et al (9) reported that 72% of mothers did not recall the period of exclusive breastfeeding (EBF) accurately 6-9 months post-delivery, with 57% overestimating the duration and 15% underestimating the duration. Agampodi et al (11) reported similar findings at 9 months follow-up, concluding that estimations of longer than observed EBF were likely a result of social desirability bias rather than recall bias. With regard to longer durations of recall, Promislow et al (7) assessed the validity of maternal recall of the duration of breastfeeding in elderly American women 34-50 years later, reporting a sensitivity for recall of having breastfed of 94%.…”

“…As a result of the prolonged latency period between exposure and outcome, it is imperative to assess the validity of studies investigating the accuracy of recall over long periods. Although some long term recall studies reported good accuracy (8,12,13) , other studies with a shorter duration of recall did not find this question as reliable (9,11,14) .…”

Feasibility and acceptability of a mobile app in an ecological momentary assessment of early breastfeeding

“…Indeed, accurate maternal recall of breastfeeding behavior positively correlates with shorter total recall period and seminal rather than nuanced events (e.g., infant age at complete weaning from breastfeeding more accurately recalled than age at first introduction of formula or solid foods), with a tendency for mothers to overestimate duration of exclusive breastfeeding (Burnham et al 2014, Agampodi et al 2011, Cupul-Uicab et al 2009, Barbosa et al 2012, Li et al 2005). Gillespie et al (2006) found that accuracy of recalled reasons for breastfeeding cessation varied 1–3.5 years after birth, with mastitis and return to work having greater recall validity than nipple trauma.…”