Association Between Mother ’ s Age and Breastfeeding Status in the Northern Iran

Introduction: Breast milk provides the ideal nutrition for infant and it is more easily digested than infant formula. The main aim of this study is to determine breastfeeding status, exclusive breastfeeding, and their relation with mother’s age among under-five children in the north of Iran. Material and Methods: This was a descriptive, cross-sectional study, which was carried out in 1997 persons (535 = Fars-native, 773 = Turkman and 689 = Sisstani) from 20 villages in the north of Iran. The calculated sample sizes of 1800 respondents at least were needed for a 95% confidence and a maximum marginal error 0.02. Exclusive Breastfeeding Duration (EBFD) and Breastfeeding Duration (BFD) were classified based on WHO definitions. Results: BFD is 20.16 months and statistical difference is significant among three ethnic groups ( p =0.001). Post hoc test are significant between Fars-native and Turkman ( p =0.001), and between Turkman and Sisstani ( p =0.002) and between Fars-native and Sisstani ( p =0.024). EBFD is 5.77 months and statistical difference is significant among three ethnic groups ( p =0.011). Post hoc test is significant between Turkman and Sisstani ( p =0.027). As whole, duration of breastfeeding positively increased with mother’s age ( p =0.002) but statistical association was not significant between exclusive breastfeeding duration and mother’s age. Conclusion: In rural area in the north of Iran, the EBFD and BFD were 5.74 and 20.16 months, respectively and they were in Turkman group more than in others. Mother’s age have a rising role for EBFD and BFD whereas in all of ethnic groups it was not the same. J Nepal Paediatr Soc 2015;35(1):1-5


Introduction
B reast milk provides the ideal nutri on for infant and it is more easily digested than infant formula 1 .Breast milk contains an bodies and lowered the risk of having asthma or allergies and diarrhea 2 .
According to the Health and Disease Study in Iran (2000), breas eeding rate and exclusive breas eeding rates were established 90% and 45% of children, respec vely.Exclusive breas eeding rate decreased from 44% in 2000 to 27% in 2004 3 .
Breas eeding is well established in Iran, and the history of it can be traced back to the fourth century AH in the Canon Medicine Text book wri en by Avicenna 4 .Iran is a Muslim country and Islam emphasizes on the importance of breas eeding 5 .
Factors thought to infl uence the Exclusive Breas eeding Dura on (EBFD) and Breas eeding Dura on (BFD) include; ethnicity, mother's age, mother's job, parent's educa onal level, social-economic status, insuffi cient milk supply, infant health problems, mother's obesity, smoking, parity, method of delivery, maternal interest and other related factors 6 .
Of 1,7 million popula ons in the Golestan province (north of Iran and southeast of Caspian Sea), 586640 person are living in Gorgan and Aq-Qala districts.The propor on of rural residence in two areas is 25.6% and 69.3%, respec vely.Agriculture is the main occupa on in rural areas and diff erent ethnic groups such as Fars-na ve, Turkman and Sisstani are living in this region 7 .
Due to the restric on in execu ng epidemiological projects, there was not any study on the associa on between breas eeding and maternal age in the north of Iran, up ll now; therefore it was necessary to design a research project to determine the breas eeding status, exclusive breas eeding, and their rela on with mother's age.This idea was implemented in a research inves ga on which comprehensively studied on the under-fi ve children nutri onal status in rural area in the north of Iran.

Material and Methods
This was a descrip ve, cross-sec onal study, which was carried out on 1997 children (535=Fars-na ve, 773=Turkman and 689=Sisstani) from 20 villages in the north of Iran in 2013.Villages and children have been chosen by simple sampling.The calculated sample sizes of 1800 respondents at least were needed for a 95% confi dence and a maximum marginal error 0.02.For all of cases, a ques onnaire with contain ques ons on the social-demographic condi on of families of children same as loca on area and ethnicity was completed by a learned team.
The ethnic groups were divided into three groups: 1) Fars -na ve: The natural inhabitant of this province, which they are recognized with same name in the society 2) Turkman: The inter marriage of this ethnic group with other ethnic groups were rare therefore this ethnic group can be recognized as pure race.
3) Sisstani and Bluch ethnic group: This ethnic group were immigrated from Sisstan and Bluchestan province from the east of Iran far earlier.Mother's age has been recorded as quan es and classifi ed by three groups: 1) <25 years, 2) 25-34 years and 3) 35≥ years.
EBFD was classifi ed based on WHO 8 defi ni on.WHO defi ned exclusive breas eeding as; "the infant has received only breast milk from his /her mother or a wet nurse, or expressed breast milk, and on other liquids or solids with the excep on of drops or syrups consis ng of vitamins, mineral supplements or medicines."SPSS 18.0 so ware was used for sta s cal data analysis.Chi-2 test was used for quali es groups and p. value under 0.05 included signifi ca ons.The mothers who did not like to par cipate in our study, has been excluded.

Results
Nutri on of breas eeding is 20.16 months and sta s cal diff erence is signifi cant among three ethnic groups (p=0.001).Post hoc test are signifi cant between Fars-na ve and Turkman (p=0.001), and between Turkman and Sisstani (p=0.002) and between Farsna ve and Sisstani (p=0.024).
Dura on of exclusive breas eeding is 5.77 months and sta s cal diff erence is signifi cant among three ethnic groups.(p=0.011).Post hoc test is signifi cant between Turkman and Sisstani (p=0.027).Table 1.
As whole, dura on of breas eeding posi vely increased with mother's age (p=0.002)but sta s cal associa on was not signifi cant between exclusive breas eeding dura on and mother's age.In Turkman group, dura on of breas eeding signifi cantly increased with mother's age (p=0.012)but it was not signifi cant in other ethnic groups.In spite of dura on of breas eeding was increased in older mothers in Sisstanish group but sta s cal diff erence was not signifi cant Table 2.
Pearson's correla on was showed a posi ve correla on between breas eeding dura on and mother's age (r=0.097,p=0.001).

Discussion
Dura on of breas eeding (DBF) and exclusive breas eeding dura on (EBFD) and their associa on with mother's age among ethnic groups will be discussed.
In our study, DBF and EBFD were 20.16 months and 5.77 months, respec vely.Based on previous study in the north of Iran 9 , 57.4% of children were in breas eed at 18-24 months and it was more in Turkman group.In another study 10 in this area, BFD and EBFD were 20.6 months and 5.59 months, respec vely.Average DBF in south-east Asian countries such as Bangladesh, 11 India 12 and Sri Lanka 13   EBFD has being decreased in Iran during recent years in Iran 14 .In Ethiopian northwest children 15 , EBFD was seen in 57.1% before 6 months, 37.0% up to 6 months and 5.9% over 6 months.In Brazil 16 , EBFD averagely was 89 days.
We found the BFD approximately equal to previous study in this area 10 and in India but it was less than in Bangladesh 11 .Regards to diff erent defi ni on of EBFD, we saw a li le promo on compared to previous study 10 and in Brazil in our study 16 .
The varia on of BFD and EBFD among ethnic groups was seen in our study, so they were more in Turkman ethnic group.Other studies 9,17 in this area, approved the BFD dissimilarity among ethnic groups.Superiority of nutri onal status and BFD in Turkman children compare to other ethnic groups in north of Iran has been approved in previous studies 4,18 .Forste 19 and Liu 20 reported the low interest in BF in black women compared to non-black women and Jevi 21 was seen the BFD in black women less than in white women and Spanish women in USA.Several studies 22,23 approved the infl uence of immigra on on BFD.BFD varia on among ethnic groups in present study probably related to diff erences in health, nutri on and socio-demographic factors that should be studied in a comprehensive survey in future.
In present study we found a posi ve associa on between mother's age and BFD while it was not set up in EBFD.The associa on between mother's age and BFD was not similar in studies.In China 24 , mother's age was a risk factor for BFD and EBFD but Thang 25 observed the low BFD in under-25 years aged mothers compared to older.Dos 26 believed that mother's age and good economic status were the protec ve factors for early weaning.In another study 27 mother's age have not a signifi cant eff ect on BFD.It seems the role of mother's age on BFD is related to their socio-demographic status.In that way, we found diff erent associa on between mother's age and BFD in Turkman group compared with the other ethnic groups.
This study is not a longitud inal research and we didn't assessment all of socio-demographic factors that related to breas eeding.They are our limi ng study.

Conclusion
In rural area in the north of Iran, the EBFD and BFD were 5.74 and 20.16 months, respec vely and they were in Turkman group more than in others.Mother's age have a rising role for EBFD and BFD whereas in all of ethnic groups it was not the same.

Recommendation
Public health programs that aim to promote breas eeding should primary focus on the younger mothers.To establish a comprehensive study for determining the substan al factors contributed to early weaning based on ethnic characteris cs is necessary in future.

Table 2 :
The comparison of Exclusive Breas eeding Dura on (EBFD) and Breas eeding Dura on (BFD) among ethnic groups based on mother's age.