Choosing the Best Measuring Stick: Comparing the Exclusive Breast-Feeding Rates of Two Definitions in Bangladesh

BACKGROUND: Exclusive breast-feeding is one of the most potent practices to prevent childhood illness and death. Therefore, its accurate measurement among children is crucial to measure their risk. In Bangladesh, which experiences one of the highest child mortality rates, two definitions of exclusive breastfeeding (EBF) are currently used in population surveys. World Health Organization's definition (WHO) describes EBF as children who receive only breast milk (not even water) in last 24 hours before the survey. The second definition (applied by several Bangladeshi agencies, including the National Nutrition Program, NNP) considers only breast milk fed from birth to last day of interview as EBF. OBJECTIVES: The paper compared the EBF rates obtained by applying both definitions in a single population of the country. For this purpose, the data of the baseline (2005) and midterm evaluation (2006) studies of Plan Bangladesh's Integrated Nutrition Program was used. Plan Bangladesh is an international, humanitarian development organization working in rural and urban areas of the country. These data comprises 256 and 113 children aged less than 6 months from rural and urban areas, respectively. RESULTS: The baseline study showed that the EBF rates were 44.4% and 57.6%, using the WHO and NNP definitions, respectively. However, midterm evaluation data showed that the EBF rates were 83.2% (WHO) and 59.6% (NNP). Highest differences were observed among the 2 to 4 month age group. The mean differences observed were -14.66 (CI -21.6 to -7.6) for the baseline study and 23.8 (CI 11.9 to 35.8) for midterm study. The differences observed were highly significant p=0.003 for baseline and p=0.004 for midterm study. CONCLUSION: Significant differences were observed in the prevalence of EBF rates by using the WHO and NNP definitions. Moreover, the definition of EBF needs to be consistent within the country and also with international indicators. Therefore, the authors recommend that the WHO definition be considered for nationwide application.