Data collection and ethics
The questionnaire used in the face-to-face interview was
adapted from the validated Nepal Demographic and Health
Survey and another breastfeeding instrument [14], and
was subsequently pretested on 25 postpartum women
for cultural appropriateness, content validity and understanding;
see Additional file 1. Fifteen female data enumerators
conducted the baseline interview from December
2011 to January 2012 to collect information on sociodemographics
and obstetric characteristics of the pregnant
women. The cohort of participants was then followed up
at 4 weeks, 12 weeks and 22 weeks postpartum through repeated
household visits by the same enumerators. Infant
feeding information, including breastfeeding knowledge
and support, husband’s and mother/mother-in-law’s preferences
and feeding plans, was collected at 4 weeks during
the second visit. Attitude towards breastfeeding was asked
at the third visit, perception of sufficiency of breast milk
was solicited at 4 and 22 weeks, whereas supplementary
feeding was assessed at all three follow-up visits.
The study was approved by the Human Research
Ethics Committee of Curtin University (approval number
HR 130/2011), Ethical Review Board of the Nepal
Health Research Council (approval number 88/2011) and
the District Public Health Office of Kaski. An information
sheet was distributed and read to each participant before
obtaining her signed or thumb-print consent. Confidentiality
of the information provided was maintained throughout
the study.
Statistical analysis
All data entry was performed by the first author, who
further checked for correctness and consistency upon
completion. Descriptive statistics were used to summarise
the outcome variables and other variables of interest
using the SPSS package version 20. Four levels of education
were recorded: none, primary (1-5th grade), secondary
(6-10th grade) and college (after 10th grade). Employment
status was categorised as: employed (full-time salaried job),
semi-employed (wage based labour, small business or
employed abroad), and unemployed (agricultural, housewife
or nothing). ‘Breastfeeding information’ was recorded
as “none” if the woman did not receive such information
from anywhere. Absence of ‘encourage to breastfeed’
meant there was no encouragement or motivation from
anybody else to breastfeed after delivery. Similarly, lack of
‘advice on feeding method’ implied no one had advised
the participant how to feed her newborn. Intended
duration of breastfeeding and target time to introduce
solid foods were initially recorded as continuous variables
but recoded as categorical to facilitate analysis.
Results
Participant profile
Of the 639 women who took part in the second interview
at 4 weeks after delivery, 615 and 515 participants
were eventually followed up at the third (12 weeks) and
fourth (22 weeks) interviews. Attrition was due to lost to
follow up (n = 39) during the period and non-completers
at 5 months (n = 85). Table 1 shows the socio-demographic
characteristics of the cohort. At baseline about half the
women were first time mothers, within the age range 20–
24 years, and belonged to the upper caste. Almost 80% of
them were unemployed while the majority (70.8%) received
secondary or above education. These characteristics were
similar at subsequent follow ups (Table 1). Moreover, no
significant differences in these variables were found between
drop outs and women remaining in the cohort at
the two time points, suggesting that the loss-to-follow-up
was random and no apparent bias was introduced through
attrition.
Data collection and ethicsThe questionnaire used in the face-to-face interview wasadapted from the validated Nepal Demographic and HealthSurvey and another breastfeeding instrument [14], andwas subsequently pretested on 25 postpartum womenfor cultural appropriateness, content validity and understanding;see Additional file 1. Fifteen female data enumeratorsconducted the baseline interview from December2011 to January 2012 to collect information on sociodemographicsand obstetric characteristics of the pregnantwomen. The cohort of participants was then followed upat 4 weeks, 12 weeks and 22 weeks postpartum through repeatedhousehold visits by the same enumerators. Infantfeeding information, including breastfeeding knowledgeand support, husband’s and mother/mother-in-law’s preferencesand feeding plans, was collected at 4 weeks duringthe second visit. Attitude towards breastfeeding was askedat the third visit, perception of sufficiency of breast milkwas solicited at 4 and 22 weeks, whereas supplementaryfeeding was assessed at all three follow-up visits.The study was approved by the Human ResearchEthics Committee of Curtin University (approval numberHR 130/2011), Ethical Review Board of the NepalHealth Research Council (approval number 88/2011) andthe District Public Health Office of Kaski. An informationsheet was distributed and read to each participant beforeobtaining her signed or thumb-print consent. Confidentialityof the information provided was maintained throughoutthe study.Statistical analysisAll data entry was performed by the first author, whofurther checked for correctness and consistency uponcompletion. Descriptive statistics were used to summarisethe outcome variables and other variables of interestusing the SPSS package version 20. Four levels of educationwere recorded: none, primary (1-5th grade), secondary(6-10th grade) and college (after 10th grade). Employmentstatus was categorised as: employed (full-time salaried job),semi-employed (wage based labour, small business oremployed abroad), and unemployed (agricultural, housewifeor nothing). ‘Breastfeeding information’ was recordedas “none” if the woman did not receive such informationfrom anywhere. Absence of ‘encourage to breastfeed’meant there was no encouragement or motivation fromanybody else to breastfeed after delivery. Similarly, lack of‘advice on feeding method’ implied no one had advisedthe participant how to feed her newborn. Intendedduration of breastfeeding and target time to introducesolid foods were initially recorded as continuous variablesbut recoded as categorical to facilitate analysis.ResultsParticipant profileOf the 639 women who took part in the second interviewat 4 weeks after delivery, 615 and 515 participantswere eventually followed up at the third (12 weeks) andfourth (22 weeks) interviews. Attrition was due to lost tofollow up (n = 39) during the period and non-completersat 5 months (n = 85). Table 1 shows the socio-demographiccharacteristics of the cohort. At baseline about half thewomen were first time mothers, within the age range 20–24 years, and belonged to the upper caste. Almost 80% ofthem were unemployed while the majority (70.8%) receivedsecondary or above education. These characteristics weresimilar at subsequent follow ups (Table 1). Moreover, nosignificant differences in these variables were found betweendrop outs and women remaining in the cohort atthe two time points, suggesting that the loss-to-follow-upwas random and no apparent bias was introduced throughattrition.
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