Maternal Breastfeeding Exposure, Knowledge, Attitude, Intention, and Practice in Lebanon: Results from the MINA Cohort Study

Abstract

Background and Objective: Despite the importance of adequate breastfeeding during early life, its rates in Lebanon remain low. This study aims to examine the association of maternal exposure, knowledge, attitude, and intentions to breastfeeding during pregnancy with breastfeeding practices at 4 and 6 months postpartum among Lebanese women. Methods: Data for this study are derived from the Mother and Infant Nutrition Assessment (MINA) study, a longitudinal cohort study, conducted from 2015 to 2018 in Lebanon and Qatar. The data analyzed in this study focus on the Lebanese arm of the cohort, which took place in two hospitals (AUBMC and MGH). A total of 194 pregnant women were recruited in this study. The data were extracted from visits 1 (at the first trimester), 3 (at the third trimester), 4 (at 4 months postpartum), and 5 (at 6 months postpartum). It included 1) sociodemographic characteristics, 2) breastfeeding exposure, 3) breastfeeding knowledge (Infant Feeding Knowledge Test), 4) breastfeeding attitude (Iowa Infant Feeding Attitude Scale), breastfeeding intention (Infant Feeding Intention Scale), and 5) breastfeeding practices (WHO definitions). Simple linear regressions were used to examine the determinants to the breastfeeding exposure, knowledge, attitude, and intention scores. Simple logistic regressions were used to determine the factors associated with breastfeeding initiation and exclusivity at 4 and 6 months. Results: Overall, participants had a high breastfeeding exposure score (2.8±0.5), good breastfeeding knowledge score (12.7±2.1), neutral breastfeeding attitude score (64.1±7.0), and strong breastfeeding intention score (13.2±3.6). After birth, 61% of the participants have initiated breastfeeding within less than one hour. Exclusive breastfeeding practices among the studied population were 41% at 4 months and 26% at 6 months. Major gaps in knowledge and attitudes identified among the Lebanese mothers were related to the duration of breastmilk completeness, breastmilk adequacy, breastfeeding misconceptions, and concerns. Participants from MGH had significantly lower breastfeeding exposure [-0.2(-0.4,0.0)] and knowledge scores [-2.1(-2.9, -1.2)] than those from AUBMC. Breastfeeding knowledge was more prevalent among women with the following characteristics: older age [1.3(0.2,2.4)], higher maternal education 3 [1.9(0.8,3.0)], higher paternal education [1.7(0.8, 2.6)], maternal employment status [1.4(0.6, 2.2)], and higher-income individuals [2.2(0.8, 3.7)]. Participants who were not pregnant with their first child and had a household crowding index of greater than or equal to one person per room had significantly lower mean intention scores to exclusive breastfeeding by -1.3(-2.6,-0.0) and -1.67(-3.1,-0.3), respectively. Women who were residing in other districts than Beirut had a significantly higher mean breastfeeding intentions score by 2.0(0.0, 3.9) than those residing in other districts. There was a significant positive association between exclusive breastfeeding at 4 months with breastfeeding intentions [1.4(1.1, 1.7)]. Also, exclusive breastfeeding at 6 months was negatively associated with breastfeeding exposure [0.1(0.0, 0.7)]. Conclusion: The findings from this study highlighted the gaps in knowledge and attitudes related to breastfeeding among lactating mothers in Lebanon. Considering these findings, it is recommended to develop context and culture-specific prenatal breastfeeding education, postnatal peer/professional support, and workplace support.