Behavior Change Communication is associated with human milk intake but not exclusive breastfeeding rate measured by deuterium-oxide turnover method among infants aged 4-5 months in rural Senegal

Abstract Background: Breastfeeding promotion is widely recognized as one of the most cost-effective investments in promoting optimal child health, growth, and development. Several studies have shown that breastfeeding education and counselling interventions have a significant impact on improving breastfeeding practices, including exclusive breastfeeding (EBF) rates. However, very few studies have evaluated the association between breastfeeding educations on infant breast milk intake. The objective of this study was to assess the contribution of behavior change communication provided by the Nutrition Enhancement Program (NEP) on infant breast milk intake and breastfeeding practices. Methods: We conducted a comparative cross-sectional study in 12 Local Communities in rural Senegal of which 6 located in the NEP intervention area and the remaining, in the non-intervention area. Breast milk intake and EBF were measured using the deuterium dose-to-mother isotope dilution in 140 mother-infant pairs aged 4-5 months. The 24-hour recall questionnaire was also use to assess EBF. The nutritional status of mothers and infants were measured by anthropometry. Student's t-test, ANOVA, and chi-square test and McNemar test were used to compare means and percentages. A mixed model linear regression was performed to identify the associated factors of breast milk intake, measured by reference method. Results: Breast milk intake was significantly higher in infants from the NEP area (994.7 ±197.3 g/d), compared to those from the non-NEP area (913.6 ± 222.8) g/d), p=0.023. Consumption of water from sources other than breast milk was not different between the groups. EBF rate measured by DTM was 37.0% and 28.4% in the NEP area and the non-NEP area, respectively. There was no difference on exclusive breastfeeding rate between the two areas regardless of evaluation method. Stunting and wasting were associated with lower milk intake of 119.1 g/d and 199.6 g/d respectively. Conclusions: Breast milk intake of 4-5 months old infants is higher in the NEP area where breastfeeding education and counselling are provided to mothers compared to the non-NEP area. There was no influence of the intervention on EBF rates between the two areas. Lower breast milk consumption was associated with stunting and wasting.