Potential Determinants and Effects of Exclusive Breastfeeding Among Infants at a Tertiary Care Center, Kerala, India

Background: Exclusive breastfeeding (EBF) is the first fundamental right of the child. Globally less than half of the infants are optimally breastfed. Suboptimal breastfeeding can lead to increased respiratory and gastrointestinal infections. This study was undertaken to assess the potential determinants and effects of EBF among infants at a tertiary care hospital in south India since interventions to improve breastfeeding in communities have to be tailored to the needs of the population. Methods: This cross-sectional study was done among infants at the pediatric unit of a tertiary care hospital in central Kerala, from October 2019 to April 2020, using a structured questionnaire. Results: Two hundred fifty-seven infants were included in the final analysis. 70.4% of babies were exclusively breastfed for the first six months, although 80.9% were breastfed within the first hour after birth. Among determinants of EBF, unemployed mothers and mothers without a post-graduate degree were more likely to continue EBF for six months (OR 2.8 95% CI [1.6-4.9] and OR 2.7 95% CI [1.5-4.9], respectively). Antenatal counseling appeared to have some beneficial effects but the result was not statistically significant. The mean number of respiratory infections, infections requiring hospitalization, and mean antibiotic use was lower in the exclusively breastfed group, though this result was not statistically significant. However, a significantly lower number of breastfed babies had constipation (OR 0.4, 95% CI 0.2-0.9) when compared to formula-fed babies. Conclusion: A higher percentage of infants presenting to our hospital has been exclusively breastfed as compared to the state average. Potential determinants of EBF include maternal education and employment and the potential effect of EBF includes protection against constipation. Further emphasis on counseling mothers antenatally, providing postnatal lactation support and counseling, providing mothers with adequate maternity leave will play a major role in promoting EBF in our community.