Efficacy of in-hospital counseling to improve mothers' knowledge, attitudes and practice regarding infant-feeding and hygiene behaviors in Bangladesh

Background: Contaminated water used to clean bottles or mix artificial milk can lead to transmission of infectious organisms. Though the WHO recommends exclusive breastfeeding (EBF) for all children under 6 months of age, bottle-feeding has increased in Bangladesh in recent years. At ICDDR,B, mothers of children admitted for diarrheal illness attend daily classes on proper hygiene and hand-washing techniques. Breast-feeding counselors educate and support mothers in converting to EBF.

Methods: We identified 15 mothers between October and December of 2007 who had presented to the hospital for a child 6 months of age or less suffering from diarrheal illness and who had converted to EBF during counseling. We conducted structured interviews with these mothers 7-10 days after hospital discharge to assess changes in their knowledge, attitudes and practices regarding infant-feeding and hygiene behaviors and to identify their current EBF status.

Results: Mothers reported increased hand-washing following ICDDR,B classes. Hand-washing increased after dirt exposure (P=0.013), before and after food preparation (P=0.005 and P=0.002, respectively), and before and after cleaning babies (P=0.007 and P=0.016, respectively). Of the 15 mothers interviewed, eleven (73%) maintained EBF status after discharge. Mothers who did not continue to exclusively breastfeed were more likely to live in slums (50% vs. 9.1%) and could cite fewer disadvantages of using artificial milk.

Conclusions: In-hospital counseling can improve mothers' infant-feeding and hygiene behaviors. Living conditions and socio-economic status may be important predictors of reversion to non-EBF status. Mothers may benefit from follow-up counseling to reinforce proper hygiene and infant-feeding techniques.