J. Paediatr. Child Health (2005) 41, 338–343 Determinants of breast-feeding within the first 6 months post-partum in rural Vietnam Dat V Duong, Andy H Lee and Colin W Binns School of Public Health, Curtin University of Technology, Perth, Western Australia, Australia Objective: This study explored the determinants of breast-feeding practices within the first 6 months post-partum among women residing in rural Vietnam. Methods: The study was conducted in Quang Xuong district, in the Thanh Hoa Province of Vietnam. In the first phase, 463 women were prospectively studied at weeks 1, 16 and 24 post-partum. During the second phase, 16 focus group discussions were undertaken to obtain complementary information. Results: Exclusive breast-feeding dropped from 83.6% at week 1 to 43.6% at week 16 and by week 24, no infant was exclusively breast-fed. A logistic regression analysis found ‘mother’s education level’, ‘mother’s decision-making on breast- feeding’, ‘mother’s comfort to breast-feed in public places’, ‘father’s occupation’, ‘feeding preference of father’ and ‘having sufficient food for the family’ significantly influenced the exclusive breast-feeding practice. Qualitative data provided in-depth information on factors relating to mother, infant, close relatives and providers. Conclusion: Providing appropriate training and supportive supervision on breast-feeding counselling to health workers and supporting working mothers to exclusively breast-feed their infants through community mobilization were recommended to improve breast-feeding in rural Vietnam. Key words: breast-feeding; determinants; feeding patterns; longitudinal study; Vietnam. According to the World Health Organization (WHO), mal- nutrition contributes directly or indirectly to 60% of the 10.9 million deaths annually among children under 5 years of age. 1 In Vietnam, despite the recent improvement in national health indicators, malnutrition in children under 5 years of age remains a major public health concern. With 30% of children under 5 years malnourished in terms of weight-for-age and 33% undernourished in terms of height-for-age, Vietnam has one of the highest child malnutrition rates in South-East Asia. 2 Inappropriate infant feeding practice is an important factor contributing to the malnutrition of children. 3,4 In Vietnam, al- though the WHO has recommended that infants should be exclu- sively breast-fed for the first 6 months with the introduction of appropriate complementary foods and continued breast-feeding thereafter, 5 recent studies showed that only 31% of infants aged less than 2 months were exclusively breast-fed and after the fifth month, no infant was being exclusively breast-fed. There has been a decreasing trend of exclusive breast-feeding (EBF) in favour of an early introduction of complementary food. Typ- ically, the number of infants under 4 months of age who are exclusively breast-fed has reduced from 27% in 1997 to 20% in 2002. 6 Factors influencing breast-feeding have been investigated in published international reports. Mother-related factors such as employment and perceived insufficient breast milk and infant- related factors were reported. 7–9 Breast-feeding could also be influenced by health providers 10 and the marketing of infant formula. 11 In addition, cultural environment was found to affect breast-feeding practices. 12 It is known that the factors affecting breast-feeding may oper- ate differently across countries. 13 Despite the alarming decline in the rate of EBF in Vietnam, there have been few studies specifically focused on the determinants of breast-feeding. 14–17 Moreover, their applications are rather restrictive because of ei- ther small sample size 14,15 or limitations in data analysis. 16,17 Correspondence: Mr Dat Van Duong, 10 Ngo 18 Nguyen Dinh Chieu Street, Hanoi, Vietnam. Fax: +84 4 8232822; email: dat@unfpa.org.vn Accepted for publication 11 January 2005. Using a combination of qualitative and quantitative methods, this study explores factors influencing breast-feeding practices within the first 6 months post-partum among women residing in the rural northern region of central Vietnam. METHODS Location This study was conducted in Quang Xuong district in the Thanh Hoa Province, located 150 km south of Hanoi. Quang Xuong district is divided into 41 communes, of which nine are coastal and 32 lowland, with a total population of 240 000. The popu- lation growth rate for Quang Xuong was 1.6% in the national census of 1999. The district is representative of the northern region of central Vietnam according to demographic and health indicators. 18 Study design The study consisted of two phases. A longitudinal study was first conducted from August 2002 to May 2003. A sample of 463 rural women who gave birth during August–October 2002 was enrolled in the study. For the initial survey, subjects were interviewed within the first week after delivery. Research as- sistants were given information about deliveries by district and commune health authorities. For those who delivered in the dis- trict hospital (DH), research assistants interviewed them during their post-partum period in the hospital. For those who delivered either at a commune health centre (CHC) or at home attended by a traditional birth attendant (TBA), interviews were conducted at CHC or at the home of the subjects. The subjects were con- secutively selected until the required sample size for sufficient