The World Health Organization recommends a 24-h recall period to estimate breastfeeding practice of mothers of infants aged younger than six-months. Though 24-h recall was preferred for its low recall bias and for practical reasons, it can overestimate exclusive breastfeeding practice (EBF). Validating this indicator will help account for the deviation from the true estimate. This prospective cohort study measured accuracy of the 24-h recall method and validates a week recall as an alternative approach for use in a small sample population. The study was conducted from March to April 2018 involving 408 mother-infant pairs living in Butajira Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. Participants were prospectively followed for 14 consecutive days; where their breastfeeding practice in the past 24 h was measured daily. Exclusive breastfeeding prevalence estimate obtained using the 24-h recall method and recall periods spanning a varying number of days (short period recalls) was compared against the cumulative of the responses from a prospectively measured repeated 24-h recalls over the course of 14 days. McNemar statistics was used to assess statistical significance of the difference in the EBF prevalence estimates of the single 24-h recall and the reference standard. Sensitivity, specificity, positive predictive value and negative predictive values were calculated to determine the level of accuracy. Receiver Operating Characteristics curve was used to measure the difference in performance between the two methods. The highest prevalence (71.4%) of exclusive breastfeeding practice was estimated using the single 24-h recall method whereas the lowest breastfeeding practice (47.1%) was obtained from a cumulative of 14 repeated 24-h recalls. A week recall (a recall over 7 days’ period), resulted in the smallest discrepancy in estimate (7.1%) as compared to cumulative estimate of 14 repeated 24-h recalls. Comparing against our reference standard, a week recall had 96.7% sensitivity and 83.5% specificity in estimating exclusive breastfeeding practice. Using single 24-h recall method overestimated exclusive breastfeeding prevalence. However, a week recall gave an estimate close to the estimate from the standard method. A week recall has a potential to balance the tradeoff between the accuracy of EBF estimates and the resource implication of using multiple prospective measurements that have a proven superior accuracy.

中文翻译：

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在 6 个月以下的婴儿中，一周回忆期比 24 小时回忆期更准确地估计了纯母乳喂养实践

世界卫生组织建议有一个 24 小时的回忆期来估计六个月以下婴儿的母亲的母乳喂养实践。尽管 24 小时回忆因其低回忆偏差和实际原因而受到青睐，但它可能会高估纯母乳喂养实践 (EBF)。验证该指标将有助于解释与真实估计的偏差。这项前瞻性队列研究测量了 24 小时召回方法的准确性，并验证了一周召回作为在小样本人群中使用的替代方法。该研究于 2018 年 3 月至 4 月进行，涉及居住在埃塞俄比亚南部布塔吉拉健康和人口监测站点 (HDSS) 的 408 对母婴。参与者连续 14 天接受前瞻性随访；每天测量他们在过去 24 小时内的母乳喂养实践。将使用 24 小时回忆方法和跨越不同天数的回忆期（短期回忆）获得的纯母乳喂养流行率估计值与 14 天内前瞻性测量的重复 24 小时回忆的反应累积进行比较。McNemar 统计用于评估单次 24 小时回忆和参考标准的 EBF 流行率估计值差异的统计显着性。计算敏感性、特异性、阳性预测值和阴性预测值以确定准确度水平。接收者操作特征曲线用于测量两种方法之间的性能差异。患病率最高（71。4%) 的纯母乳喂养实践是使用单次 24 小时回忆方法估计的，而最低的母乳喂养实践 (47.1%) 是从 14 次重复 24 小时回忆的累积中获得的。与 14 次重复 24 小时召回的累积估计值相比，一周召回（7 天期间的召回）导致的估计差异最小 (7.1%)。与我们的参考标准相比，一周回忆在估计纯母乳喂养实践方面的敏感性为 96.7%，特异性为 83.5%。使用单次 24 小时回忆法高估了纯母乳喂养的流行率。然而，一周回忆给出的估计值接近标准方法的估计值。