The Effects of Parity on Duration of Exclusive Breastfeeding in Kilimanjaro Region, Tanzania – A Prospective Cohort Study

Background: Breastfeeding is essential for a child’s healthy growth and development. The World Health Organization recommends early inhiation and six months of continuation of exclusive breastfeeding (EBF). Parity might influence EBF uptake, but it remains unclear how previous breastfeeding duration affects subsequent children's breastfeeding duration among multiparous women. Methods: : Secondary data analysis of a prospective cohort of pregnant women (third trimester) and their infant (followed until age 12 months) enrolled from 2002-2015 in Kilimanjaro-Tanzania. In this analysis, eligible mothers were multipara women who entered the study as primigravida. To evaluate how parity affects EBF duration, Kaplan-Meier survival curves and multivariate Cox-proportional hazard models were applied. Results: : Only 56.3% of children-initiated breastfeeding within one hour of birth. Early initiation of breastfeeding did not differ between firstborn and subsequent-born children (p=0.88) and did not change over time. While 69% of women practiced EBF for three months, only 5% did so for 6 months. The proportion of children receiving EBF for the recommended 6 months rose from 3.2% for firstborns to 5.1% for second-borns, 9.6%, for third-borns and 15.8% for fifth-borns. The mean EBF duration increased from 11.1 weeks in 2000/2005 to 15.0 weeks in 2011/2015, corresponding to 87% higher hazards for longer EBF (aHR: 1.87 95%CI: 1.32-2.63) for children born between 2011 and 2015 compared to those born between 2000 and 2005. Children born to mothers with medium and high SES had 31% (aHR: 1.31 95%CI: 1.10-1.56) and 23% (aHR:1.23 95%CI: 1.00-1.54) higher hazards for prolonged EBF compared to children born to mothers with low SES. Compared to those women who delivered at home, children delivered in health facilities had 22% greater hazards for longer EBF (aHR: 1.22 95%CI: 1.01-1.52). Conclusion: In this study in Tanzania, an unacceptable low proportion of women completed 6 months EBF, but parity was not independently associated with EBF duration for multiparous women. The increase in EBF duration between 2000 and 2015 shows that EBF is responsive to policy changes and public health efforts. EBF counselling should be improved, especially for women of poor SES and women who deliver at home.