Breastfeeding in the WHO Multicentre Growth Reference Study

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Abstract
Aim: To document how children in the WHO Multicentre Growth Reference Study (MGRS) complied with feeding criteria and describe the breastfeeding practices of the compliant group. Methods: The MGRS longitudinal component followed 1743 mother–infant pairs from birth to 24 mo in six countries (Brazil, Ghana, India, Norway, Oman and the USA). The study included three criteria for compliance with recommended feeding practices that were monitored at each follow‐up visit through food frequency reports and 24‐h dietary recalls. Trained lactation counsellors visited participating mothers frequently in the first months after delivery to help with breastfeeding initiation and prevent and resolve lactation problems. Results: Of the 1743 enrolled newborns, 903 (51.8%) completed the follow‐up and complied with the three feeding criteria. Three quarters (74.7%) of the infants were exclusively/predominantly breastfed for at least 4 mo, 99.5% were started on complementary foods by 6 mo of age, and 68.3% were partially breastfed until at least age 12 mo. Compliance varied across sites (lowest in Brazil and highest in Ghana) based on their initial baseline breastfeeding levels and sociocultural characteristics. Median breastfeeding frequency among compliant infants was 10, 9, 7 and 5 feeds per day at 3, 6, 9 and 12 mo, respectively. Compliant mothers were less likely to be employed, more likely to have had a vaginal delivery, and fewer of them were primiparous. Pacifier use was more prevalent in the non‐compliant group. Conclusion: The MGRS lactation support teams were successful in enhancing breastfeeding practices and achieving high rates of compliance with the feeding criteria required for the construction of the new growth standards.