Patterns and determinants of breastfeeding and complementary feeding practices over the first year of life in a rural Gambian population

Background: Although breastfeeding is common in The Gambia, high rates of undernutrition in children under five highlight the importance of understanding drivers of particular feeding patterns in this environment, especially early introduction of non-breast milk foods (NBMFs). The country’s marked seasonality, which is associated with annual food insecurity and heavy maternal workload, may influence breastfeeding patterns; however, longitudinal assessments of infant diet in relationship to such factors are limited. We aimed to characterize infant breastfeeding patterns and timing of introduction of local complementary foods in a rural Gambian population across the first twelve months of life. Potential environmental and sociodemographic predictors of exclusive breastfeeding (EBF) duration were explored in order to identify factors that may influence infant feeding decisions in this population. Methods: Data from dietary questionnaires (administered every ten days until 12 months of age) collected as a part of the Hormonal and Epigenetic Regulators of Growth study (2013-2018) were used to calculate EBF duration in a subsample of 194 mother-infant pairs. Socioeconomic questionnaires and Principal Component Analysis were used to calculate household sociodemographic position (SEP). Multiple linear regression analyses were used to investigate potential predictors of EBF duration, including seasonality, SEP, and maternal and infant factors. Results: Mean age at introduction of food or liquid other than maternal milk was five months (±1.5). At twelve months, 98.7% of infants continue to receive some maternal milk. Being born in  May significantly predicted shorter EBF duration by -1.68 months (95% CIs: -2.52, -0.84mo; P<.0001). SEP, maternal parity, and infant sex were non-significant predictors of EBF duration. Conclusions: Maternal milk is a vital component of infant diet across the first twelve months of life in this population. Earlier introduction of NBMFs coincides with the annual period where maternal agricultural workload intensifies in this region, though additional investigation is warranted.