Monitoring of the Main Reasons for Early Abandonment of Breastfeeding during the First Six Months of Life: A Secondary Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Line 28 - delete "up"

Line 49 - Rephrase to "continue breastfeeding with complementary foods."

Line 55 - revise the sentence

Line 57 - delete "however"

Line 59 - replace of after "life" with of

Line 60 - change aims to aimed

Line 64 - change in to from

Line 73 - remove Therefore and rephrase to "A combined sample..."

Line 74 - remove "on the one hand" and capitalize The

Line 79 - replace database with "cohorts"

Line 93 - delete "abandonment that had led to a"

Line 148 - delete "as for the reasons for the change in feeding. Capitalize "during"

Line 154 - delete "On the other hand". Capitalize from

Lines 165 & 166 - Rephase this sentence

Line 170 - delete "Specifically" and put "It was"

Line 185 - delete "high"

Line 197 - rephrase sentence as "This" is not descriptive ... what is being supported?

The term "This" is used in several places in the discussion. Please rephrase these sentences for better clarity.

Update your references. Forty-two percent of the references are older than 5 years. Newer references will better support your conclusions. 

Comments on the Quality of English Language

Some places in the manuscript need revision as listed in the suggestions for authors.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

no

Author Response

Please see the improved manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

Type of manuscript: Article
Title: Monitoring of the main reasons for early abandonment of breastfeeding
during the first six months of life.
Journal: Nursing ReportsNursep-3076221

Thank you for the opportunity to review this manuscript. The evaluation of breastfeeding during the first year of life is very important, as its maintenance is a great challenge in our society nowadays. It is of utmost importance to understand the barriers faced by those involved in the care of these women and their babies, trying to achieve exclusive, or at least some breastfeeding, up to six months of life.

I read carefully this manuscript, and my comments are stated below.

Abstract:

1. Lines 29-30: The description of the sample is confusing: “314 participants, of whom  77.1% (232) were Spanish, 51% (160), and 55.4% (174) reached six months of exclusive breastfeeding...”. Which is the percentage of exclusive breastfeeding? What is the meaning of these two frequencies? It seems that is something missing.

Introduction:

The background and the objective of the study was clearly stated. The authors wanted to identify, in a longitudinal study, the reasons of weaning in a sample of mothers willing to exclusively breastfeed their babies.

Methods:

1. Looking at the dates of recruitment, the sample included mothers inthe periods of December 2018-May 2019 and April 2022 – March 2023. What is the explanation for these two periods?

2. Regarding the mathematical calculation of the prevalence and the possibility of change in type of feeding: I think it should be better explained. Which is the denominator of the formula as it is written “n SBF previous”? Are the authors comparing the prevalence of one period with the period immediately precedent?

I understood that if all women desired to exclusive breastfeed their babies, the denominator would be the number of women enrolled in the begining of the study, or the number of women breastfeeding exclusively in the period immediately precedent. I was confused.

Also, the authors should explain how the results of the calculations of the probability of change in feeding should be interpreted.

3. I missed in Methods the description of the support given to these women in hospital or after discharge for encouraging and maintaining breastfeeding.  Or there is no support available?

4. In Methods the authors present 8 categories of possible responses of discontinuation of breastfeeding. But I lacked the explanation of the meaning of “lack of support”. From the professional team in hospital or in the follow-up? From their families? From their partners? Were these women single mothers or did these women have a partner? Lack of support is one of the more important factors envolving the weaning. And it can occur in conjunction with other factors. All these factors are not excludent.

Results:

1. In the results the authors do not present the frequency of the answers for discontinuation of breastfeeding received. I missed this information.

2. Figure 1: I thought that this figure was difficult to read and to understand; I had to read more than once to really understand it. I really do not know if it adds information to what is already written in the text. The meaning or the importance of this “probability” is to indicate that the greater change from EBF to SBF occurred between discharge and first month and between the fourth and sixth month of life. I think that the display of the probabilities would be more informative than the prevalences, but the numbers are very small. But this is displayed in this figure in a very confusing way, or at least I thought so. Perhaps they could choose which information they want to show.

Discussion:

I don’t know if it is correct to affirm that this is the first study to describe the changes in type of feeding during the first year, or even the first six months of life.

Nowadays breastfeeding support is discussed and available in many institutions around the world. There are many programs designed to promote breastfeeding, as WHO Friendly Hospital Program, The Kangoroo Method to incentivate breastfeeding and mother-infant holding. And I missed that all these iniciatives weren’t cited,

I think this discussion should be revised, as well as the limitation of this study.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Type of manuscript: Article

Title: Monitoring of the main reasons for early abandonment of breastfeeding
during the first six months of life.

Journal: Nursing ReportsNursep-3076221

I received the revised manuscript, and I appreciate the modifications made by the authors.

Abstract:

The authors have adjusted the abstract with the missed informations.

Methods:

1. Looking at the dates of recruitment, the sample included mothers inthe periods of December 2018-May 2019 and April 2022 – March 2023. What is the explanation for these two periods?

Reviwer: The authors answered my questions. They added the explanation in Methods, which cleared the text.

2. Regarding the mathematical calculation of the prevalence and the possibility of change in type of feeding: I think it should be better explained. Which is the denominator of the formula as it is written “n SBF previous”? Are the authors comparing the prevalence of one period with the period immediately precedent? Also, the authors should explain how the results of the calculations of the probability of change in feeding should be interpreted.

Reviwer: Now there is na explanation of the components of the Equations. But I think they should revise the english writing in this frase: “the denominator contains all the cases that, at the follow-up point immediately 142 above, they were the previous type of feeding, per 100 participants:”. Is it correct to write the pronoum “they” in “cases that, at the follow-up point immediately 142 above, they were”?

3. I missed in Methods the description of the support given to these women in hospital or after discharge for encouraging and maintaining breastfeeding. 

Reviwer: I found this description in Methods in lines 89-96.

4. In Methods the authors present 8 categories of possible responses of discontinuation of breastfeeding. But I lacked the explanation of the meaning of “lack of support”. From the professional team in hospital or in the follow-up? From their families? From their partners? Were these women single mothers or did these women have a partner? Lack of support is one of the more important factors envolving the weaning. And it can occur in conjunction with other factors. All these factors are not excludent.

Reviwer: The authors answered my questions and recognized the limitations of these points.

Results:

1. In the results the authors do not present the frequency of the answers for discontinuation of breastfeeding received. I missed this information.

Reviwer: Now they present this frequency, it clarified the table.

2. Figure 1: I thought that this figure was difficult to read and to understand; I had to read more than once to really understand it. I really do not know if it adds information to what is already written in the text. The meaning or the importance of this “probability” is to indicate that the greater change from EBF to SBF occurred between discharge and first month and between the fourth and sixth month of life. I think that the display of the probabilities would be more informative than the prevalences, but the numbers are very small. But this is displayed in this figure in a very confusing way, or at least I thought so. Perhaps they could choose which information they want to show.

Reviwer: It improved with the adjustments and the informations supplied by the authors. But it is still a very difficult figure, as there are many informations displayed. But I understand that the authors wanted to present a summary of their results.

Discussion:

I don’t know if it is correct to affirm that this is the first study to describe the changes in type of feeding during the first year, or even the first six months of life.

Reviwer: I appreciate the corrections made by the authors.

Nowadays breastfeeding support is discussed and available in many institutions around the world. There are many programs designed to promote breastfeeding, as WHO Friendly Hospital Program, The Kangoroo Method to incentivate breastfeeding and mother-infant holding. And I missed that all these iniciatives weren’t cited,

I think this discussion should be revised, as well as the limitation of this study.

Reviwer: It improved after the authors revision, and the addition of informations on the programs to promote breastfeeding.

 Type of manuscript: Article

Title: Monitoring of the main reasons for early abandonment of breastfeeding
during the first six months of life.

Journal: Nursing ReportsNursep-3076221

I received the revised manuscript, and I appreciate the modifications made by the authors.

Abstract:

The authors have adjusted the abstract with the missed informations.

Methods:

1. Looking at the dates of recruitment, the sample included mothers inthe periods of December 2018-May 2019 and April 2022 – March 2023. What is the explanation for these two periods?

Reviwer: The authors answered my questions. They added the explanation in Methods, which cleared the text.

2. Regarding the mathematical calculation of the prevalence and the possibility of change in type of feeding: I think it should be better explained. Which is the denominator of the formula as it is written “n SBF previous”? Are the authors comparing the prevalence of one period with the period immediately precedent? Also, the authors should explain how the results of the calculations of the probability of change in feeding should be interpreted.

Reviwer: Now there is na explanation of the components of the Equations. But I think they should revise the english writing in this frase: “the denominator contains all the cases that, at the follow-up point immediately 142 above, they were the previous type of feeding, per 100 participants:”. Is it correct to write the pronoum “they” in “cases that, at the follow-up point immediately 142 above, they were”?

3. I missed in Methods the description of the support given to these women in hospital or after discharge for encouraging and maintaining breastfeeding. 

Reviwer: I found this description in Methods in lines 89-96.

4. In Methods the authors present 8 categories of possible responses of discontinuation of breastfeeding. But I lacked the explanation of the meaning of “lack of support”. From the professional team in hospital or in the follow-up? From their families? From their partners? Were these women single mothers or did these women have a partner? Lack of support is one of the more important factors envolving the weaning. And it can occur in conjunction with other factors. All these factors are not excludent.

Reviwer: The authors answered my questions and recognized the limitations of these points.

Results:

1. In the results the authors do not present the frequency of the answers for discontinuation of breastfeeding received. I missed this information.

Reviwer: Now they present this frequency, it clarified the table.

2. Figure 1: I thought that this figure was difficult to read and to understand; I had to read more than once to really understand it. I really do not know if it adds information to what is already written in the text. The meaning or the importance of this “probability” is to indicate that the greater change from EBF to SBF occurred between discharge and first month and between the fourth and sixth month of life. I think that the display of the probabilities would be more informative than the prevalences, but the numbers are very small. But this is displayed in this figure in a very confusing way, or at least I thought so. Perhaps they could choose which information they want to show.

Reviwer: It improved with the adjustments and the informations supplied by the authors. But it is still a very difficult figure, as there are many informations displayed. But I understand that the authors wanted to present a summary of their results.

Discussion:

I don’t know if it is correct to affirm that this is the first study to describe the changes in type of feeding during the first year, or even the first six months of life.

Reviwer: I appreciate the corrections made by the authors.

Nowadays breastfeeding support is discussed and available in many institutions around the world. There are many programs designed to promote breastfeeding, as WHO Friendly Hospital Program, The Kangoroo Method to incentivate breastfeeding and mother-infant holding. And I missed that all these iniciatives weren’t cited,

I think this discussion should be revised, as well as the limitation of this study.

Reviwer: It improved after the authors revision, and the addition of informations on the programs to promote breastfeeding.

Author Response

The reviewer performs a detailed analysis of the changes made based on the reviewer input from Round 1. In the current Round 2, the reviewer points out a comment pending review.

2. Regarding the mathematical calculation of the prevalence and the possibility of change in type of feeding: I think it should be better explained. Which is the denominator of the formula as it is written “n SBF previous”? Are the authors comparing the prevalence of one period with the period immediately precedent? Also, the authors should explain how the results of the calculations of the probability of change in feeding should be interpreted.

Reviwer: Now there is na explanation of the components of the Equations. But I think they should revise the english writing in this frase: “the denominator contains all the cases that, at the follow-up point immediately 142 above, they were the previous type of feeding, per 100 participants:”. Is it correct to write the pronoum “they” in “cases that, at the follow-up point immediately 142 above, they were”?

[response] Thanks for the comment. The explanation of the calculation has been revised and expanded (Lines 144-154). We hope it is better understood now.