Coulibaly Nadine Mireille Josepha Danielle^1,, Somda Manutuo Aymard Serges², Sawadogo Amadé³, Compaoré Yves Daniel³, Sorgho Hermann³, Yerbanga Rakiswendé Serges^{3, 4}, Ouedraogo Césaire Tania⁵, Zeba Augustin Nawidimbasba¹, Ouedraogo Jean-Bosco⁴

Exclusive breastfeeding (EBF) for the first 6 months is recommended by WHO and UNICEF as feeding practice in early infancy. This implies the choice of a robust method to ascertain that the mothers have really observed the recommendation. By analyzing secondary data from a breastfeeding study we conducted in Burkina Faso, we aimed to determine the accuracy of different ways to assess EBF. We examined EBF practice through maternal reports of 24 hours (24h recall) and the deuterium oxide dose-to-mother technique (DMT) cross-sectional and longitudinal measurements. We also used the DMT data to simulate the WHO indicator of EBF by cumulating the assessments from birth to 5 months. Then the different methods were compared using the McNemar test. The results showed that globally, the maternal report overestimated the EBF rate compared to the DMT with a difference of 19.17% (95% CI=11.29%-27.04%, p=0.0000, n=40). Using the DMT, there was a significant difference of 35.00% (95% CI =17.72%-52.28%, p=0.0001, n=40) between the cross-sectional measurement at 5 months and the longitudinal measurement since birth up to 5 months. Finally, the simulation of the WHO model showed a significant difference of 25.83% (95% CI = 17.17%-34.50%, p=0.0000, n=120) compared to the longitudinal assessment. Taken together, the study showed that the DMT gives a more realistic estimate of EBF practice according to the definition and the technique gives the best evaluation through a longitudinal measurement. The DMT can be used as a routine method for EBF assessment during nutritional surveys or intervention programs.

exclusive breastfeeding, maternal report, dose-to-mother technique, cross-sectional measurement, longitudinal assessment, McNemar test