Do Mothers Tell the Truth? Validating Self Reports on Exclusive Breastfeeding in Nairobi Slums

December 9, 2013

The increasing double burden of malnutrition in Africa is partly due to poor breastfeeding practices in early life. Optimal breastfeeding (early initiation, exclusive breastfeeding and continued breastfeeding for at least two years) plays a paramount role in child health, growth and survival while lack of it has debilitating effects, not only on the child, but the community and the country at large. As a result, there have been several interventions and research activities geared towards promoting, protecting and supporting optimal breastfeeding at global, national levels and community levels.

Monitoring and evaluation is an integral part of these activities. However, monitoring breastfeeding practices has been a challenge as it mainly relies on mothers’ self-reports which are highly subject to bias. Simple traditional methods like anthropometrics (comparative study of human body measurements and properties) and test weighing, where the baby is weighed after each feed, have also been used but these are quite invasive and cumbersome for the mother and baby while their accuracy and precision are questionable. (Hector D.J et al, 2011)

The stable isotope technique also known as the ‘dose to the mother’ is the ultimate solution to these challenges. The technique involves ingestion of deuterium oxide (an isotope of hydrogen) by the breastfeeding mother, which is then transmitted to the baby through breast milk. Saliva samples are collected from the mother and the baby at regular intervals and analyzed for deuterium concentration using a Fourier Transform Infrared Red (FTIR) machine. The breast milk intake by the baby is then deduced by determining the rate of disappearance of the stable isotope from the mother and its appearance in the child. This helps in determining if a child has been exclusively breastfed or otherwise.

Due to its high precision, convenience, accuracy and non- invasive nature, the technique has been declared a gold standard for determining breast milk intake in children, against which other techniques are cross validated to ensure credible and accurate data. The technique is safe for use in pregnant, lactating women and infants with no adverse effects (Hills A.P et al, 2010)

APHRC is conducting a study on maternal, infant and young child nutrition in two slums in Nairobi where the stable isotope technique is being used to validate the self-reported data collected on exclusive breastfeeding practices among women. This will provide accurate and credible evidence on the rates of exclusive breastfeeding in urban poor settings and thus inform policy and practice with regards to promotion, protection and support of breastfeeding in Kenya.