During the hospitalization in the Dhaka hospital of the international Centre for Diarrhoeal Disease Research, Bangladesh, of a group of partially breast-fed infants aged 1-12 weeks who had been admitted with acute diarrhoea, their mothers were individually counselled by breast-feeding counsellors to start exclusive breast-feeding. The counselling was repeated 1 week later at home, and the women's infant-feeding practices were evaluated 2 weeks after their infants had been discharged from hospital. A total of 25% of the mothers failed to breast-feed exclusively despite having been counselled. The case studies of these mothers illustrate that although they generally complained about having "insufficient breast milk" various factors such as domineering grandmothers, lack of financial support by their husbands, too much housework, or disinterest contributed to their failure to breast-feed exclusively. While family support is essential for all lactating mothers, women with familial or financial problems require special attention and extra counselling sessions so that they can be helped to identify how to achieve and sustain exclusive breast-feeding.
PIP: In Bangladesh, where only a small proportion of deliveries occur in a health facility, an infant's hospitalization for diarrhea offers an opportunity to counsel mothers about the importance of exclusive breast feeding for the first 4-6 months of life. This study followed a group of 104 partially breast-fed infants admitted to the Dhaka Hospital of the International Center for Diarrheal Disease Research, Bangladesh. Mothers received intensive breast feeding counseling both during their infant's hospitalization and again at a home visit 1 week after hospital discharge. At follow-up 2 weeks after discharge, only 80 (77%) of these infants were being exclusively breast-fed. The remaining 24 infants were being partially breast-fed. There were no significant differences between fully and partially breast-fed infants in terms of average age at hospitalization (52.6 and 47.0 days, respectively) or maternal age, education, or parity. Mothers who failed to breast feed exclusively complained about insufficient milk quantity. Other significant obstacles included nonsupportive grandmothers, lack of financial support from husbands, too much housework, and lack of interest in breast feeding. These findings indicate that mothers with family or financial problems require extra counseling sessions to enable them to identify strategies for achieving and sustaining exclusive breast feeding. Participation of influential family members such as grandmothers and husbands in these counseling sessions could enhance their effectiveness. It is possible, however, that the hospital-based counseling occurred too late in the infant's life to influence maternal behavior. The use of trained peer counselors living in the community might be more effective.