ORIGINAL ARTICLE Factors influencing breastfeeding in children less than 2 years of age in Lao PDR Pornpai Putthakeo, 1 Moazzam Ali, 1 Chiaki Ito, 1 Panome Vilayhong 2 and Chushi Kuroiwa 1 1 Department of Health Policy and Planning, the University of Tokyo, Japan and 2 Maternal and Child Health Center, Ministry of Health, Lao PDR Aim: This study aimed to investigate the prevalence of, and factors influencing, exclusive breastfeeding (EBF) at 6 months and continued breastfeeding (CBF) at 2 years. Methods: Between January and February 2007, a cross-sectional study was conducted using a semi-structured questionnaire in 40 villages in the Vientiane capital and the Vientiane province of Lao PDR. A total of 400 mothers with children less than 2 years old were recruited by multistage random sampling. Based on the 1991 World Health Organization Breastfeeding Indicators, children were classified into three groups, 6–23-month-old children for assessing EBF at 6 months, 12–15-month-old children for CBF at 1 year and 20–23-month-old children for CBF at 2 years. Results: The prevalence of EBF at 6 months and CBF at 2 years were 19.4% (n = 283) and 18.6% (n = 43), respectively. Some of the factors influencing EBF at 6 months in a univariate logistic regression model included: location of residence, (OR: 19.19, 95% CI 6.96–57.01), ethnicity (OR: 3.15, 95% CI 1.63–6.08), encouragement of the child’s father (OR: 9.03, 95%CI 1.21–67.57) and inter-spousal communication (OR: 5.20, 95% CI 2.34–11.56). A majority of the mothers (75.0%) had watched television advertisements for infant formula from Thailand, and 48.4% reported that they wanted to buy formula milk after having watched them. Conclusion: This study showed a low prevalence of EBF at 6 months in the studied area in Lao PDR. Some of the factors that had a strong impact on EBF at 6 months included: location of residence, ethnicity, father’s involvement, early breastfeeding plan, Mother’s Card in antenatal care and television advertisement. There may be opportunities for government to review a range of policies relating to paternal involvement, antenatal care and formula advertising that could help to improve EBF rate. Key words: antenatal care; continued breastfeeding at 2 years; exclusive breastfeeding at 6 months; factors influencing; formula milk; television advertisement. Background Breast milk is widely accepted as the most complete source of nutrition for infants. 1 When compared with infant formula, breast milk provides a variety of benefits such as protection from infectious diseases 2,3 and disorders, 4,5 possible reduction of the risk of childhood and adolescent obesity, 6 and support for cog- nitive development. 7 For these reasons the World Health Orga- nization (WHO) and United Nations Children’s Fund (UNICEF), in 2002, adopted the Innocenti Declaration to Protect, Promote and Support Breastfeeding. It recommended that mothers prac- tice exclusive breastfeeding (EBF) of their infants for the first 6 months of life and continued breastfeeding (CBF) along with other foods until at least age two. 8,9 In developing countries, such as Lao PDR (K Khamseng, unpubl. data, 2002), many mothers do not breastfeed at all or they do so for only a short period of time. 10 In 2000, UNICEF conducted a Multiple Indicators Cluster Survey in Lao PDR. 11 This UNICEF household-level, cross-sectional survey of 5158 mother–child pairs revealed that only 23% of children between 6 months and 5 years of age were exclusively breastfed until they were 6 months old. Meanwhile only 47% of the children between the age of 2 and 5 years were breastfed until they were 2 years of age. 11 A Lao national health survey was conducted to determine the primary reasons for the low rates of breastfeeding in Lao PDR (National Health Survey in Lao PDR, unpubl. data, 2001). The results of the survey indicated that the low breastfeeding rates could be attributed to a short interval between pregnancies, the occupation of the mother, maternal fear of insufficient milk, sickness, absence due to death and others’ encouragement to Key Points 1 The prevalence of exclusive breastfeeding for 6 months, and continued breastfeeding up to 2 years, remains low in Lao PDR. 2 Interventions are needed to assist Lao mothers to understand the benefits of breastfeeding. 3 Fathers can play an important role in breastfeeding by providing encouragement and support for the mothers. This can promote exclusive breastfeeding for 6 months and continued breast- feeding up to 2 years. Correspondence: Associate Professor Chushi Kuroiwa, Department of Health Policy and Planning, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. Fax: +81 3 5841 3637; email: kurochu_99@yahoo.co.jp Declaration of conflict of interest: The author(s) declare that they have no competing interests. Accepted for publication 3 February 2009. doi:10.1111/j.1440-1754.2009.01547.x Journal of Paediatrics and Child Health 45 (2009) 487–492 © 2009 The Authors Journal compilation © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 487