Prevalence of exclusive breastfeeding and associated factors among refugees from Palestine in Jordan: a cross-sectional study

Abstract Background WHO and UNICEF recommend early initiation of breastfeeding, within the first hour after delivery, and exclusive breastfeeding (EBF) in the first 6 months of infant life. The most recent data available (from 2001) show that the EBF prevalence among Palestinian refugee infants under 4 months in Jordan was 24%. The study objectives were to estimate the current prevalence of EBF and early initiation, and to examine factors associated with EBF among refugees from Palestine in Jordan registered with UNRWA. Methods A cross-sectional facility-based study was conducted between April and June, 2017, in all areas of operation of UNRWA in Jordan; North Amman, South Amman, Irbid, and Zarqa. The study targeted Palestinian refugee mothers of children under 6 months of age surveyed at five UNRWA health centres. One health centre was randomly selected from each area (but two from Zarqa) with proportionate probability, excluding those for which there were problems of accessibility. All eligible mothers who attended maternal and child health services on the day of the survey and agreed to participate were recruited, and the process repeated until the required number of participants was achieved. A structured questionnaire was used to collect data. We used the WHO definition of EBF to measure the proportion of infants under 6 months of age that were breastfed exclusively in the previous 24 hours. Bivariate and multivariate logistic regression analysis were employed to identify the independent predictors of EBF. The study protocol was approved by UNRWA and Nagasaki University. Informed written consent was obtained from each participant prior to the interview. Findings A total of 307 participants (mean age, 27·4 years; range 17–45) were included in the analysis. Nearly one third (31%; 95 out of 307) lived in a refugee camp. The prevalence of EBF in infants under 6 months was 34% (105 out of 307; 95% CI 29–40), and 49% (148 out of 307; 95% CI 43–54) of mothers started breastfeeding within 1 hour after delivery. The rate of EBF was significantly higher in younger infants. Multiparous mothers (adjusted odds ratio 2·38; 95% CI 1·23–4·59) and mothers who did not have problems with breastfeeding (2·12; 95% CI, 1·25–3·57) were more likely to breastfeed exclusively. Interpretation The prevalence of EBF has improved since 2001, but is still below the WHO recommendation of 50%. Providing adequate support, especially to first-time mothers, mothers who have problems (eg, difficulty in latching on and mastitis), and mothers of older infants, may be a feasible strategy to improve the prevalence of EBF among refugees from Palestine in Jordan. Funding Jointly funded by Nagasaki University and UNRWA.