Determinants of early initiation of breastfeeding in Nigeria: a population-based study using the 2013 demograhic and health survey data

Prevalence and contributing factors of early initiation of breastfeeding (EIBF) in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Even though the National Infant and Young Child (IYC) Feeding guideline was launched in Ethiopia in 2016, early initiation of breastfeeding is not consistently measured among studies which limit evidence for the development of promotion strategies.

METHODS

A weighted inverse-variance random effects model was used to estimate the pooled prevalence and contributing factors of early initiation of breastfeeding (EIBF). Heterogeneity was assessed using the I² statistic, forest plot, and Egger's test. Data from 22 primary studies across all regional states in Ethiopia were analyzed, including 39,316 mother-infant pairs who had given birth and breastfed within the last two years, from December 11, 2023, to January 16, 2024.

RESULTS

The pooled prevalence of EIBF was 67.44% (95% CI: 61.31-73.56, I² = 99.40%, P = 0.001). Factors contributing to EIBF included urban residency (OR = 2.7, 95% CI: 2.11-3.30), regular antenatal care (OR = 2.44, 95% CI: 1.72-3.15), absence of prelacteal feeding (OR = 4.26, 95% CI: 2.93-5.60), secondary or higher education (OR = 2.53, 95% CI: 1.39-3.68), highest maternal wealth index (OR = 2.36, 95% CI: 1.62-3.09), health facility delivery (OR = 3.60, 95% CI: 2.58-4.62), receiving health education during antenatal care (OR = 1.62, 95% CI: 1.40-1.84), and breastfeeding support (OR = 3.56, 95% CI: 2.38-4.73).

CONCLUSION

The prevalence of early breastfeeding initiation (EIBF) remains below WHO targets. Factors like urban residence, higher education, and access to antenatal care and hospital-based delivery services are positively linked to EIBF. To improve rates, health services should enhance community outreach, promote antenatal care, provide early breastfeeding education, and offer professional support immediately after birth.

PROSPERO ID

CRD42024498671.

Comparison of Breastfeeding Behaviors of Mothers Toward Infants by Ethnic Groups: An Example of a Multicultural City

Introduction: Breastfeeding practices vary widely among different ethnic groups and are influenced by cultural, social, economic, and educational factors. The aim of this study was to compare the breastfeeding behaviors of mothers toward infants in different ethnic groups. Methods: This descriptive cross-sectional study included women of four ethnic groups (Assyrian, Turkish, Arab, and Kurdish) living in Mardin, Turkey. The study was completed with 180 Assyrian, 184 Turkish, 175 Arab, and 169 Kurdish women. In total, 708 women participated in this study. Data were collected between August 12, 2024, and September 22, 2024. Results: The highest rate of traditional breastfeeding practices was seen in Kurdish (99.4%), whereas this rate was 97.3% in Turkish, 96% in Arab, and 84.4% in Assyrian. The highest rate of giving breast milk immediately after birth was in Assyrian (71.7%), while this rate was 69.3% in Turkish, 61.9% in Kurdish, and 47% in Arab (p = 0.000). The rate of those who waited for three calls to prayer to feed the baby was 13.1% in Kurdish, 11.3% in Arab, 9.5% in Turkish, and 7.9% in Assyrian. The rate of those who did not give the first milk (colostrum) to the baby was 15.8% in Assyrian, 11.7% in Turkish, 6.5% in Kurdish, and 6% in Arab. The rate of those who give sugared water as the baby's first nutrient was 37.5% in Arab, 20.8% in Kurdish, 11.7% in Turkish, and 9.2% in Assyrian. Increased education levels were associated with decreased rates of the presence of traditional practices. Conclusion: This study provides novel results regarding the comparison of breastfeeding behaviors among ethnic groups living in the same city. Comparing breastfeeding practices across the four ethnic groups allowed us to better understand different breastfeeding practices, which could lead to the development of culturally sensitive interventions to improve the health of children and mothers. Educating the community about the benefits of breastfeeding and the risks associated with some traditional practices could contribute to public health.

Early Initiation of Breastfeeding and Exclusive Breastfeeding in Anglophone and Francophone West African Countries: Systematic Review and Meta-Analysis of Prevalence

Early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are highly effective forms of preventive medicine in many low- and middle-income countries, including Anglophone and Francophone West African countries. Despite the proven benefits of EIBF and EBF in reducing mortality and morbidity, there is limited systematic evidence from West African countries. Hence, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of EIBF and EBF in Anglophone and Francophone West African countries. Six databases were searched for eligible studies based on inclusion criteria and a systematic review and a further meta-analysis were done. The weighted prevalence of EIBF was 51.7% (95% CI: 48.8, 54.6) in Anglophone West African countries and 45.5% (95% CI: 42.0, 48.9) in Francophone West African countries. The pooled prevalence of EBF was 41.2% (95% CI: 36.9, 45.5) in Anglophone West African countries and 30.1% (95% CI: 26.7, 33.5) in Francophone West African countries. Our study showed that the weighted average EIBF and EBF prevalence tended to be higher from studies in Anglophone West African countries than in Francophone West African countries. Despite these findings, EIBF and EBF rates overall in West African countries were suboptimal. A substantial improvement is necessary in promoting EIBF and EBF in West African countries. Programmes should target all mothers in the region no matter their colonial allegiance to achieve Sustainable Development Goals 2 and 3 by 2030.

Individual- and community-level factors associated with early initiation of breastfeeding in Mozambique: evidence from the 2022-2023 Demographic and Health Survey

BACKGROUND

Early initiation of breastfeeding is defined as giving breast milk to the newborn within one hour of birth. It strengthens the link between mother and child, promotes cognitive development, and lowers the chance of obesity and non-communicable diseases during the prime years of life. Nowadays, only 50% of newborns worldwide receive breast milk within their first hour of life. This study examined the prevalence and individual- and community-level factors associated with early initiation of breastfeeding using the Demographic and Health Survey data and offers suggestions that can enhance the practice in Mozambique.

METHODS

Data from the nationally representative Mozambique Demographic and Health Survey were used in this cross-sectional analysis. The study included a weighted sample of 3,548 children born in the two years prior to the survey. Software for statistical analysis, STATA/SE version 14.0, was used to clean, recode, and analyze the data. Utilizing multilevel logistic regression, the factors associated with the outcome variable were identified. Statistical significance was attained by variables having a p-value less than 0.05.

RESULTS

The prevalence of early initiation of breastfeeding in Mozambique was 75.03% (95% CI: 73.58%, 76.43%). Factors like non-working [AOR = 0.62; 95% CI (0.50, 0.78)], wanted last pregnancy [AOR = 1.68; 95% CI (1.33, 2.12)], antenatal care attendance [AOR = 0.63; 95% CI (0.43, 0.93)], vaginal birth [AOR = 2.30; 95% CI (1.58, 3.36)], size of the child at birth [AOR = 1.77; 95% CI (1.26, 2.48)], urban residence [AOR = 2.99; 95% CI (1.90, 4.72)], community-level antenatal care utilization [AOR = 0.52; 95% CI (0.35, 0.77)], and community poverty level [AOR = 0.34; 95% CI (0.20, 0.58)] were significantly associated with early initiation of breastfeeding.

CONCLUSIONS

About three out of four newborn babies in Mozambique have an early initiation of breastfeeding. It is critical to concentrate on developing policies that support the early initiation of breastfeeding, particularly for mothers who have small children, unplanned pregnancies, non-vaginal deliveries, and reside in rural areas.

Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study

BACKGROUND

Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them.

OBJECTIVE

We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery.

METHODS

This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression-based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26.

RESULTS

The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ≥36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation.

CONCLUSIONS

Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation.

Prevalence and barriers to early initiation of breastfeeding among urban poor full-time readymade garments working mothers: a mixed-methods study in Bangladesh

BACKGROUND

Early initiation of breastfeeding is the initiation of breastfeeding within one hour of birth, which plays a significant role in a born baby's growth and survival, however its prevalence and predictors among urban full-time readymade garments (RMG) working mothers are not investigated. The purpose of this study is to determine the prevalence and factors affecting early initiation of breastfeeding among urban RMG working mothers.

METHODS

A sequential explanatory mixed-methods study was conducted between March 2023 and December 2023 in Dhaka, Bangladesh. A total of 452 full-time female RMG workers were included for the quantitative study. Qualitative study was carried out among 30 full-time female RMG workers, four female physicians who were employed in the RMGs, four RMG factory managers, and four local pediatricians.

RESULTS

The prevalence of early initiation of breastfeeding was 40% among the women. It was significantly associated with various factors, including socio-cultural barriers, the advanced age of the mother (AOR 3.93, 95%CI 1.18, 13.04), lack of education (AOR 6.86, 95%CI 1.11, 42.49), lack of awareness, and cultural practices such as initiating goat milk and honey instead of breast milk. The absence of colostrum feeding (AOR 8.96, 95%CI 4.30, 18.70) and pre-lacteal feeding (AOR 0.06, 95%CI 0.03, 0.11) were significant baby feeding practice-related barriers to early initiation of breastfeeding. Maternal health factors, notably post-delivery sickness, cesarean delivery, and lack of breastmilk production, were revealed as a significant hindrance to the early initiation of breastfeeding explored from qualitative analysis. In addition, RMG factory-related factors that significantly affect early initiation of breastfeeding include a strong focus on production, a busy schedule, and a lack of initiative regarding the early initiation of breastfeeding.

CONCLUSIONS

The prevalence of early initiation of breastfeeding among RMG working women is poor. This study emphasizes the need for interventions that address specific challenges of early initiation of breastfeeding faced by working mothers in RMG sectors, including improved lactation education, increased awareness to mitigate cultural barriers, RMG factory-based initiatives to empower female workers early initiation of breastfeeding, and preparing early initiation of breastfeeding -friendly post-cesarean unit at the health care facility.

A perinatal social nutrition approach to improve breastfeeding in a culturally diverse group of low-income women

Alima, Perinatal Social Nutrition Centre, is an established community organization that adopts a perinatal social nutrition approach to provide multidimensional support to women living in vulnerable conditions, particularly those with a precarious migratory status. This study aims to (i) determine which maternal characteristics, pregnancy-related variables, and structural features of the Alima intervention are associated with breastfeeding; and (ii) examine whether the association between attending breastfeeding workshops and breastfeeding characteristics differ according to maternal factors. The Alima digital database was used to analyze data from women who received the perinatal intervention between 2013 and 2020. Infant feeding data were retrieved at 2 weeks postpartum (T0, n = 2925), 2 months postpartum (T2, n = 1475), and 4 months postpartum (T4, n = 890). Logistic regressions were used to estimate the odds of overall and exclusive breastfeeding depending on sociodemographic characteristics, pregnancy-related variables, and features of the intervention. The prevalence of overall and exclusive breastfeeding was, respectively, 96.1% and 60.7% at T0; 93.0% and 58.5% at T2; 83.0% and 48.4% at T4. Higher education, previous breastfeeding experience, and recent immigration were associated with a higher likelihood of breastfeeding at each time point. Breastfeeding workshop attendance was associated with a greater likelihood of overall and exclusive breastfeeding at T2 and T4, with a stronger effect among women aged 35 or less, those with lower education, and those with excessive gestational weight gain. In conclusion, the Alima intervention is associated with positive breastfeeding outcomes, especially among vulnerable women living with precarious migratory status in Canada.

Infant and young child feeding practice among mothers-child pair in irrigated and non-irrigated areas of Dangila district, Northwest Ethiopia, 2020: a community based comparative cross-sectional study

BACKGROUND

The issue of Infant and Young Child Feeding practices was widespread; it was estimated that infants were not exclusively breastfed in the first six months of life. Complementary foods were frequently provided too soon or too late, and they were often nutritionally deficient. Even, there are nutrition-sensitive activities like irrigation schemes, evidence on infant and young child feeding practices between irrigated and non-irrigated areas is scarce or limited.

OBJECTIVE

To assess the prevalence of infant and young child feeding practices among 0-23 months of age children in irrigated and non-irrigated areas of Dangila District, North-west Ethiopia, 2020.

METHODS

A community based comparative cross-sectional study was conducted from Dec 1, 2020, to Jun 1, 2020. A stratified sampling technique was implemented to select 823 mothers with children age 0-23 months from irrigated (411) and non-irrigated (412) kebeles. Data were collected using structured questionnaires. Multivariable logistic regression was used to identify the associated factors of infant and young child feeding practice. Adjusted odds ratios with a 95% CI were used to determine the degree of association between the independent and outcome variables. A p-value < 0.05 was used as a cutoff point to declare statistically significant variables with the outcome variable.

RESULTS

Among 823 households visited, 802 respondents with a response rate of 97.8% in irrigated and 96.11% in non-irrigated areas gave complete responses. The overall prevalence of good IYCF practice was 62.5% (95% CI: 34.2, 41.3), and it shows a significant difference between irrigated (72.2%) and non-irrigated areas (52.8%). Moreover, the study identified that education primary and above (AOR = 1.889, 95% CI: 1.38, 2.648) knowledge above mean (AOR = 2.347, 95% CI: 1.555, 3.542), positive attitude (AOR = 1.716, 95% CI: 1.139, 2.587), PNC follow-up (AOR = 1.606, 95% CI: 1.154, 2.360), women's decision-making power (AOR = 1.840, 95% CI: 1.226, 2.763), and multiple delivery (AOR = 0.352, 95% CI: 0.213, 0.583) were significant factors for IYCF among 0-23 month-old children.

CONCLUSION AND RECOMMENDATIONS

The infant and young child feeding practice among 0-23 month-old children was better in an irrigated area than in a non-irrigated area. Promoting irrigation practices, empowering women, and strengthening postnatal care are recommended interventions to increase infant, young, and child feeding practices in the study area.

Predictors of late initiation of breastfeeding practice in Ethiopia: a multilevel mixed-effects analysis of recent evidence from EDHS 2019

OBJECTIVES

To identify the predictors of late initiation of breastfeeding practice in Ethiopia.

DESIGN

Cross-sectional study design.

SETTING

Ethiopia.

PARTICIPANTS

A total of 1982 weighted samples of mothers with children aged under 24 months were included.

OUTCOME MEASURE

Late initiation of breastfeeding practice.

RESULTS

The prevalence of late breastfeeding initiation practice is 26.4% (95 CI 24.4 to 28.3). Being a young mother (15-24 years) (adjusted odds ratio (AOR) =1.66; 95 CI 1.06 to 2.62), no antenatal care (ANC) visit (AOR=1.45; 95 CI 1.04 to 2.02), caesarean section (AOR=4.79; 95 CI 3.19 to 7.21) and home delivery (AOR=1.53; 95 CI 1.14 to 2.06) were found to be the determinants of late initiation of breast feeding.

CONCLUSION

More than one-fourth of newborn children do not start breast feeding within the WHO-recommended time (first hour). Programmes should focus on promoting the health facility birth and increasing the ANC visits. Further emphasis should be placed on young mothers and those who deliver via caesarean section to improve the timely initiation of breast feeding.

Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review

Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.

Self-reported sexually transmitted infections among men and women in Papua New Guinea: A cross-sectional study

Background and Aims

Sexually transmitted infections (STIs) pose a considerable concern for global healthcare systems. We examined the prevalence and correlates of self-reported STIs (SR-STIs) among men and women in Papua New Guinea.

Methods

A total of 7,195 women and 4,069 men from Papua New Guinea who participated in the 2016-2018 Demographic and Health Survey were included in this study. Percentages were used to summarize the prevalence of SR-STIs among men and women. A multivariable multilevel binary logistic regression was used to examine the correlates of SR-STIs in men and women.

Results

An overall 5.9% and 4.6% prevalence of SR-STIs were recorded among women and men, respectively, in Papua New Guinea. The odds of SR-STIs were higher among women who ever tested for HIV (aOR = 2.47, CI: 1.80-3.39), those who had first sex below 20 years (aOR = 1.76, CI: 1.10-2.80), those who watched television less than once a week (aOR = 1.83, CI: 1.13-2.95) and those from the Highlands and Momase regions (aOR = 5.55, CI: 3.30-9.33) compared to their counterparts who never tested for HIV, who had their first sexual intercourse when they were 20 years and above, who did not watch television at all, and those from the Southern Region. For men, the odds of SR-STIs were high among those who ever tested for HIV (aOR = 1.65, CI: 1.11-2.45), those with one (aOR= 2.08, CI: 1.05-4.14) and two or more (aOR = 3.77, CI: 1.49, 9.52) sexual partners excluding spouse in the 12 months preceding the survey, those living in the Highlands region (aOR = 2.52, CI: 1.48-4.29), and those living in communities with medium literacy level (aOR = 2.33, CI: 1.38-3.94) compared to their counterparts who had never tested for HIV, those with zero sexual partners excluding their spouse in the 12 months preceding the survey, those living in the Southern region, and those living in communities with low literacy levels.

Conclusion

We recommend that the National AIDS Council of Papua New Guinea through the National HIV and STI 2018-2022 Strategy program should be realigned to address these correlates and ensure that more sexual and reproductive health resources are provided to men and women in the Highlands and Momase regions.

Spatial variation and determinants of delayed breastfeeding initiation in Ethiopia: spatial and multilevel analysis of recent evidence from EDHS 2019

BACKGROUND

Despite the World Health Organization's firm recommendation to start breastfeeding during the first hour after delivery, nearly 54% of children in low- and middle-income countries are unable to initiate breastfeeding within the recommended time frame. Understanding the initiation of breastfeeding is essential for optimal child health and maternal well-being.

METHODS

This study was conducted using the recent Ethiopian Demographic and Health Survey (EDHS) data (2019) on a weighted sample of 1982 Ethiopian mothers of children aged under 24 months. The data extraction was conducted between August 1 and 30, 2023. Delayed' initiation of breastfeeding is defined as failure to initiate breastfeeding within one hour after birth. STATA version 17 was used for non-spatial analysis. ArcGIS Pro and Sat Scan version 9.6 were used to map the visual presentation of delayed breastfeeding initiation. Global Moran's I was computed to determine whether delayed breastfeeding initiation is randomly distributed, clustered, or dispersed. Getis-Ord Gi* Spatial Statistics was done to identify significant spatial clusters of cold and hot spot areas. Multilevel mixed-effect logistic regression analysis was computed to identify determinants of delayed breastfeeding initiation.

RESULTS

The prevalence of delayed breastfeeding initiation is 26.4% (95% CI 24.4, 28.3). Significant clustering of delayed initiation of breastfeeding practice was found in the Somali region. Less clustering was identified in Northern Amhara, Addis Ababa and Dire Dawa. Being a young mother (15-24 years) (AOR 1.66; 95% CI 1.06, 2.62), no antenatal care (AOR 1.45; 95% CI 1.04, 2.02), cesarean section (AOR 4.79; 95% CI 3.19, 7.21) and home birth (AOR 1.53; 95% CI 1.14, 2.06) were found to be determinants of delayed initiation of breastfeeding.

CONCLUSIONS

In Ethiopia, delayed breastfeeding initiation is distributed non-randomly. Significant hotspot areas were identified in the eastern part of Ethiopia. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on promoting health facility birth and increasing antenatal care visits. Further emphasis should be considered on supporting young mothers and those giving birth via cesarean section to improve timely breastfeeding initiation.

Magnitude and determinants of early initiation and exclusive breastfeeding at six weeks postpartum: evidence from the PMA Ethiopia longitudinal survey

BACKGROUND

Early initiation and exclusive breastfeeding are crucial in preventing child morbidity and mortality. Despite the importance of these practices, rates of timely initiation of breastfeeding and exclusive breastfeeding remain suboptimal in many sub-Saharan countries, including Ethiopia. This paper aimed to estimate the prevalence and identify determinants of breastfeeding initiation within the first hour after birth and exclusive breastfeeding in Ethiopia.

METHODS

Data from the Performance Monitoring for Action Ethiopia project, a national survey conducted from August 2019 to September 2020, were used. The analytical sample comprises 2564 postpartum women and their children; data reported at baseline during enrollment and six weeks postpartum were used in this analysis. A multi-level binary logistic regression model was employed to identify determinant factors linked with initiation breastfeeding and exclusive breastfeeding.

RESULTS

Of the 2564 mothers, 77.8% of infants breastfed within the first hour of birth and 68.4% of women practiced exclusive breastfeeding at six weeks postpartum with significant variation across regions. In the multivariate analysis, mothers who had cesarean delivery were less likely to initiate early breastfeeding as compared to mothers with vaginal delivery (AOR 0.27; 95% CI 0.17, 0.41). The odds of early initiation of breastfeeding were higher for mothers whose baby cried immediately after birth (AOR 3.31; 95% CI 1.95, 5.62) and who had skilled assisted delivery (AOR 2.13; 95% CI 1.01, 4.48). Other factors that were significantly associated with early initiation of breastfeeding were obstetric complication(s), parity, immediate mother-to-baby skin-to-skin contact, immediate postnatal care and the region. Similarly, mothers whose babies had a good neonatal birth status (AOR 1.81; 95% CI 1.09, 2.99) were more likely to exclusively breastfeed their child at six weeks postpartum.

CONCLUSIONS

Early initiation of breastfeeding and exclusive breastfeeding is sub-optimal in Ethiopia. Nutrition programmers should consider regional variations in designing intervention programs to enhance breastfeeding practices. Healthcare providers should give special attention to women at risk such as those giving birth through cesarean section and having obstetric complications during delivery.

Correlates of non-institutional delivery to delayed initiation of breastfeeding in Nigeria: logit-decomposition and subnational analysis of population-based survey

BACKGROUND

Studies have connected newborn delivery settings and modality to optimal breastfeeding, but how it influences untimely initiation, mostly prevalent in sub-Saharan Africa is unknown. Hence, the role of home delivery on delay initiation of breastfeeding (DIBF) in Nigeria was investigated to inform evidence-based strategy for improved breastfeeding practice.

METHODOLOGY

This is a secondary analysis of births (11,469 home and 7632 facility delivery) by 19,101 reproductive age women in the 2018 NDHS. DIBF is the outcome, home birth is the exposure, and explanatory variables were classified as: socio-demographics, obstetrics and economic factors. Descriptive statistics (frequencies and percentages) were reported, and bivariate (chi-square) analysis was carried out at 20% (p < 0.20) cutoff point. Multivariable logistic regression assessed the probability and significance of the outcome per place of birth. Multivariate decomposition further evaluated the endowment and coefficient effect contribution by independent factors to the outcome. Analysis was carried out at p < 0.05 (95% confidence level) on Stata.

RESULTS

56.6% of mothers DIBF, with 37.1% and 19.5% from home and facility delivery, respectively. Home delivery (AOR = 1.34, 95% CI 1.17-1.52) increase the chance of DIBF by 34%, while DIBF probability reduces by 26% in facility delivery (AOR = 0.74, 95% CI 0.65-0.85). DIBF is 5 times more likely in caesarian section delivery (AOR = 5.10, 95% CI 4.08-6.38) compared to virginal birth in facility delivery. Skilled antenatal provider, parity and wealth are negatively associated with DIBF in home birth, while undesired pregnancy, rural residency, partial/no skin-to-skin contact and large child size positively influence DIBF in both home and facility delivery. Skilled antenatal provider (C =  - 66.3%, p < 0.01) and skin-to-skin contact (C =  - 60.6%, p < 0.001) contributed most to reducing the negative DIBF effect with 69% and 31% overall characteristics and coefficient effect component, respectively. DIBF is more likely in Bauchi and Sokoto but less likely in Bayelsa.

CONCLUSIONS

High DIBF prevalent in Nigeria was largely due to elevated rate of home birth, positively associated with DIBF. Caesarian section delivery though heightens the chance of DIBF in facility delivery. Strengthening utilization of skilled provider and skin-to-skin contact can eliminate two-third of the adverse DIBF effect and improve early initiation rate. Adopting this strategy will bridge home-facility delivery gap to achieve optimal breastfeeding practice.

Effect of caesarian section delivery on breastfeeding initiation in Nigeria: logit-based decomposition and subnational analysis of cross-sectional survey

OBJECTIVES

This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice.

DESIGN AND SETTINGS

A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria.

PARTICIPANTS

Complete responses from reproductive-age women (15-49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey.

MAIN OUTCOME MEASURES

TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics.

METHODS

Descriptive statistics were reported and graphically presented. Bivariate χ2 analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors' contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17.

RESULTS

44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR 'AOR'=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR 'COR'=63.9: 95% CI=28.2 to 144.9).

CONCLUSIONS

CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother-child contact peculiar to CS women is critical for improved breastfeeding practice.

Inequalities in early initiation of breastfeeding in Bangladesh: an estimation of relative and absolute measures of inequality

BACKGROUND

Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality.

METHODS

We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO's Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported.

RESULTS

An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child.

CONCLUSIONS

The highest attention should be placed in Bangladesh to attain the WHO's 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations.

Examining the prevalence and determinants of early initiation of breastfeeding: Evidence from the 2017/2018 Benin demographic and health survey

Early initiation of breastfeeding has been noted as one of the well-known and successful interventions that contributes to the reduction of early childhood mortality and morbidity. The Government of Benin has established multi-sectoral institutions and policies to increase the prevalence of early initiation of breastfeeding. However, there is little information on the prevalence and the determinants of early initiation of breastfeeding in Benin. This study therefore sought to examine the prevalence and determinants of early initiation of breastfeeding among women in Benin. This is a secondary data analysis of the 2017/2018 Benin demographic and health survey. The study included weighted sample of 7,223 women between the ages of 15 and 49. STATA was used for the data analysis. We used a multilevel logistic regression to investigate the factors of early breastfeeding initiation in Benin. To determine the significant relationships, the data were reported as odds ratios (ORs) with 95% confidence intervals (CIs) and p-value 0.05. The prevalence of early initiation of breastfeeding among mothers was 56.0%. Early initiation of breastfeeding was lower among employed women (aOR = 0.80, 95% CI = 0.69-0.94), women who had caesarean section (aOR = 0.21, 95% CI = 0.16-0.28), those exposed to mass media (aOR = 0.85, 95% CI = 0.75-0.96) and women who received assistance at birth from skilled worker (aOR = 0.57, 95% CI = 0.46-0.71). The findings of this study showed that four in ten children miss early initiation of breastfeeding in Benin. The findings, therefore, call for the need for policymakers to shape existing programs and consider new programs and policies to help improve early initiation of breastfeeding practices in Benin. It is, therefore, recommended that information, education and communication programs targeting mothers who are less likely to practice early initiation of breastfeeding be formulated, implemented, and monitored accordingly by the Ministry of Health.

Efficacy of the Standard Breast Crawl Technique on Maternal and Newborn Outcomes After Term Vaginal Birth: A Randomized Controlled Trial

INTRODUCTION

The breast crawl technique is a strategy for initiating breastfeeding during the first hour of life, an important goal with long-lasting effects on newborn health and development. However, there is a lack of research to back up the benefits of the standard breast crawl technique over routine skin-to-skin care.

METHODS

A single-center single-masked randomized controlled trial was conducted among 132 women who had given birth vaginally to a full-term newborn. The study group had received the standard breast crawl (SBC) technique and the control group had received skin-to-skin contact (SSC). The outcome measures included time to initiation of breast crawl and breastfeeding, LATCH score, newborn breastfeeding behavior, time to expulsion of placenta, episiotomy suturing pain, amount of blood loss, and uterine involution.

RESULTS

Outcomes were analyzed for 60 women in each group who remained eligible. Compared with those in the SSC group, women in the SBC group had shorter time to initiation of the breast crawl (7.40 minutes vs 10.42 minutes, P = .001), shorter time to initiation of breast feeding (23.18 minutes vs 30.58 minutes, P = .003), higher LATCH scores (7.57 vs 5.35, P = .001), and higher newborn breastfeeding behavior scores (11.38 vs 9.08, P = .001). Women in the SBC group also had decreased mean time to birth of the placenta (4.67 minutes vs 6.58 minutes, P =.001), lower episiotomy suturing pain scores (2.72 vs 4.50, P =.001), and decreased maternal blood loss (16.66% vs 53.33%, P = .001); were more likely to involute the uterus below the umbilicus after 24 hours of birth (77% vs 10%, P = .001); and had higher maternal birth satisfaction score (7.15 vs 2.0, P = .001).

DISCUSSION

The study demonstrates improvement of newborn and maternal short-term outcomes with use of the SBC technique. Findings support the use of SBC technique as a routine labor room practice to improve immediate maternal and newborn outcomes.

Changes in moderately low birthweight infant feeding, care, and health outcomes before compared to during the COVID-19 pandemic in Malawi

Background

The coronavirus disease 2019 (COVID-19) and the measures taken to minimise its spread have significantly impacted mother- and infant-related healthcare. We describe the changes in newborn feeding, lactation support, and growth outcomes before compared to during the COVID-19 pandemic among moderately low birthweight infants (LBW) (1.5 to <2.5kg) in Malawi.

Methods

The data presented here are part of the Low Birthweight Infant Feeding Exploration (LIFE) study, a formative, multisite, mixed methods observational cohort study. In this analysis, we included infants born at two public hospitals in Lilongwe, Malawi between 18 October 2019 and 29 July 2020. We categorised births as "pre-COVID-19 period" (before 1 April 2020) and "during COVID-19 period" (on or after 2 April 2020) and used descriptive statistics and mixed effects models to examine differences in birth complications, lactation support, feeding, and growth outcomes between the two time periods.

Results

We included 300 infants and their mothers (n = 273) in the analysis. Most infants (n = 240) were born during the pre-COVID-19 period; 60 were born during the pandemic period. The latter group had a lower prevalence of uncomplicated births (35.8%) compared to pre-pandemic period group (16.7%) (P = 0.004). Fewer mothers reported early initiation of breastfeeding in the pandemic period (27.2%) compared to the pre-pandemic period (14.6%) (P = 0.053), along with significantly less breastfeeding support, particularly in view of discussion of proper latching (44.9% during COVID-19 vs 72.7% pre-COVID-19; P < 0.001) and physical support with positioning (14.3% vs 45.5% pre-COVID-19 P < 0.001). At 10 weeks of age, the prevalence of stunting was 51.0% pre-COVID-19 vs 45.1% during COVID-19 (P = 0.46), the prevalence of underweight was 22.5% pre-COVID-19 vs 30.4% during COVID-19 (P = 0.27), and the prevalence of wasting was 0% pre-COVID-19 vs 2.5% during COVID-19 (P = 0.27).

Conclusions

Our findings highlight the continued need to optimise early initiation of breastfeeding and lactation support for infants during COVID-19 and future pandemics. More studies are needed to evaluate the long-term outcomes of moderately LBW born during the COVID-19 pandemic (including growth outcomes) and determine the impact of restrictive measures on access to lactation support and promotion of early initiation of breastfeeding.

Early initiation of breastfeeding up to six months among mothers after cesarean section or vaginal birth: A scoping review

Background

Early initiation of breastfeeding is important for establishing continued breastfeeding. However, previous research report that cesarean section (C-section) may hinder early initiation of breastfeeding. Despite this, there is currently a lack of literature that examines the rates of breastfeeding after both cesarean section and vaginal birth globally.

Research aims

The objective of this scoping review was to systematically assess the available literature on the rate of early initiation of breastfeeding within the first hour and exclusive breastfeeding up to 6 months after C-section and vaginal birth, as well as any other factors associated with initiation and exclusive breastfeeding.

Methods

We adhered to the PRISMA extension guidelines for scoping reviews in conducting our review. In August 2022, we carried out an electronic database search on CINALH, PubMed, EMBASE, and Cochrane Library, and also manually searched the reference list.

Results

A total of 55 articles were included in the scoping review. The majority of these studies found that mothers who delivered vaginally had higher rates of breastfeeding compared to those who underwent a C-section, at various time points such as breastfeeding initiation, hospital discharge, one month, three months, and six months postpartum. Notably, there was a significant difference in the rate of early initiation of breastfeeding between the two groups. However, at 3 and 6 months after delivery the gap of exclusive breastfeeding rate between C-section and vaginal delivery is narrow. Breastfeeding education, health care providers support, and mother and baby bonding are other factors associate with initiation and exclusive breastfeeding.

Conclusions

The rate of breastfeeding initiation after C-section has remained low to date. This is due in part to insufficient knowledge about and support for breastfeeding from healthcare providers.

Current findings and gaps in early initiation of breastfeeding practices in sub-Saharan African countries: A scoping review

Background

Early initiation of breastfeeding (EIBF) plays an important role in reducing neonatal and infant mortality. Sub-Saharan African countries have high rates of neonatal and infant mortality, as well as a low prevalence of EIBF. By conducting a scoping review, we aimed to determine the gaps and current understandings of EIBF in Sub-Saharan Africa.

Methods

We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, focusing on primary studies published from 2008 to 2021. We reviewed their titles and abstracts against the eligibility criteria, selecting the relevant ones to this study's criteria for a further full-text review.

Results

The identified determinants can be categorized into household, maternal, and health service characteristics. Regarding health service characteristics, many studies reported that cesarean section was strongly associated with the delayed initiation of breastfeeding. Institutional delivery and delivery by skilled birth attendants were also reported to be associated with the early initiation of breastfeeding. Others pointed out that place of residence and wealth index as two household characteristics that were strongly associated with EIBF, as well as maternal characteristics such as older maternal age and higher education status.

Conclusions

We found that only eleven studies on the early initiation of breastfeeding have been conducted in Central and West Africa. Household, maternal, and health service factors have been reported to be associated with the early initiation of breastfeeding across many countries. More studies are needed to fill the current geographic gaps and investigate determinants that have not been examined. Future research should also cover interventions that have been effective in improving EIBF for women after caesarean sections in sub-Saharan Africa. Interventions that promote institutional delivery and deliveries by skilled attendants have the potential to improve the practice.

Amamentação na primeira hora de vida em município do interior do Rio de Janeiro: fatores associados

Resumo Objetivo analisar a amamentação na primeira hora de vida e os fatores associados em um município do interior do Rio de Janeiro. Método estudo online transversal, realizado entre maio de 2021 e agosto de 2022, com 97 parturientes do município de Rio das Ostras. Na associação entre variáveis, adotaram-se o Teste Qui-Quadrado e regressão logística. Resultados entre as participantes, 77,3% pariram na maternidade pública e 22,7% na maternidade privada. A prevalência da amamentação na primeira hora de vida na sala de parto e no alojamento conjunto foi, respectivamente, de 21,6% e 58,3%, com diferenças significativas entre as maternidades. Puérperas da maternidade pública tiveram mais chances de não amamentar na primeira hora de vida. Ter ensino básico aumentou as chances de o bebê não ser amamentado na sala de parto e não realizar contato pele a pele precoce, além de não ser amamentado no alojamento conjunto. Conclusão e implicações para a prática a amamentação na primeira hora de vida não atingiu níveis preconizados, e distintos fatores associados à sua ocorrência foram identificados, como nível de instrução, local do parto e contato pele a pele. Recomenda-se que maternidades implementem as práticas humanizadas no cuidado ao recém-nascido, para elevar as taxas da amamentação na primeira hora de vida.

Breastfeeding in the first hour of life in a city in the countryside of Rio de Janeiro: associated factors

Abstract Objective to analyze breastfeeding in the first hour of life and associated factors in a city in the countryside of Rio de Janeiro. Method a cross-sectional online study, carried out between May 2021 and August 2022, with 97 parturient women in the municipality of Rio das Ostras. In the association between variables, the chi-square test and logistic regression were used. Results among the participants, 77.3% gave birth in the public maternity hospital and 22.7% in the private maternity hospital. The prevalence of breastfeeding in the first hour of life in the delivery room and in rooming-in was, respectively, 21.6% and 58.3%, with significant differences between maternity hospitals. Postpartum women from the public maternity hospital were more likely to not breastfeed in the first hour of life. Having basic education increased the chances of the baby not being breastfed in the delivery room and not having early skin-to-skin contact and not breastfeeding breastfed in rooming-in. Conclusion and implications for practice breastfeeding in the first hour of life did not reach recommended levels and different factors associated with its occurrence were identified, such as education level, place of childbirth and skin-to-skin contact. It is recommended that maternity hospitals implement humanized practices in newborn care to increase breastfeeding rates in the first hour of life.

Mother's perception of size at birth is a weak predictor of low birth weight: Evidence from Nepal Demographic and Health Survey

Birth weight is a consistent predictor of morbidity and survivability in infancy and later life. This study aims to assess the accuracy of the mother's perception of size at birth to predict low birth weight(LBW). This study used data from Nepal Demographic and Health Survey (NDHS 2016). Information about 5060 mother pairs was obtained from the NDHS dataset. However, birth weight data were available for 3095 children, and therefore they were only included in the further analysis. The predictive accuracy of the mother's perception of size at birth to predict LBW was measured by sensitivity, specificity, positive predictive value, and negative predictive value. Factors associated with the discordance among the mother's perception of birth size and birth weight were calculated using multinomial logistic regression analysis. The mother's perception of birth size had low sensitivity (62%) and positive predictive value (46.7%) but high specificity (90.1%) and negative predictive value (94.4%) to predict the LBW. The overall agreement between birth weight(<2500gram vs > = 2500 grams) and the mother's perceived size at birth (small vs average or above average) was 86% (Kappa = 0.45, 95%CI: 0.40-0.51), which is composed of a higher share of the agreement to identify non-LBW babies(79%) and a low share to identify LBW babies (7%). Among the five categories of mothers' perception of size at birth and birth weight, the agreement was 67.2% (Kappa = 0.29, 95% CI: 0.26-0.33). Education status, ethnicity, multiple births, and sex of the newborn child were significantly associated with the discordance between the mother's perceived size at birth and birth weight. A moderate agreement was found among the mother's perception of birth size and birth weight. Mothers were more likely to correctly identify non-LBW babies compared to LBW babies based on their perception of size at birth. Efforts should be intensified to promote the practice of weighing the baby at birth.

Prevalence and associated factors of stunting, wasting and underweight of children below five using quintile regression analysis (PDHS 2017-2018)

The objective of the current study is to identify the risk factors for malnutrition among the age of under-five children's in Pakistan. This is secondary data analysis for the data taken from Pakistan Demographic and Health Survey (PDHS 2017-18) and was analyzed by implementing quantile regression analysis. The sample size included 12,708 alive children in the study, for which the data collection period was from November 22, 2017, to April 30, 2018. The prevalence of malnutrition among boys is high (51.2%). Older age mother's children have more prevalence of malnutrition (20.7%). A child born with small body size (underweight: Q_0.25: - 0.625; Q_0.50: - 0.623; Q_0.75: - 0.426 and wasting: Q_0.50: - 0.513); having uneducated mother (underweight: Q_0.25: - 0.387; Q_0.50: - 0.247; Q_0.75: - 0.328), belonged to a poor household (underweight: Q_0.50: - 0.251),residing in rural areas (underweight: Q_0.25: - 0.443), not following properly breastfeeding practices (underweight: Q_0.50: - 0.439; Q_0.75: - 0.438) have negative effect on different measures of malnutrition and this effect is significantly raises across different quantiles of stunting , wasting and underweight (at p value < 0.01 and < 0.05). Older age mother (stunting: Q_0.50: 0.777; Q_0.75: 1.078; underweight Q_0.20: 0.568; Q_0.50: 0.429; Q_0.75: 0.524) and higher birth order number (stunting: Q_0.50: 0.415; Q_0.75: 0.535), have a positive effect on three measures of under-nutrition and this effect is gradual raises at different quantile of stunting, wasting and underweight. Elder and smoker mothers were proved associated risk factors of both stunting and being underweight in Pakistan. Moreover, Proper breastfeeding practices, better economic status, average or above the average birth weight of the child, and milk consumption are found protective factors against stunting, wasting, and underweight children in Pakistan.

The role of maternal ideations on breastfeeding practices in northwestern Nigeria: a cross-section study

Background

Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices.

Methods

A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September–October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables.

Results

Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0–5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices.

Conclusion

Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women’s breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria.

Prevalence of and factors associated with early initiation of breastfeeding in Bangladesh: a multilevel modelling

BACKGROUND

Early initiation breastfeeding (EIBF) is a sign of good health for both the mother and the newborn baby. The objective of this study was to estimate the prevalence of EIBF among mothers in Bangladesh and to identify its associated factors.

METHODS

The study used the most recent Bangladesh Demographic and Health Survey 2017-2018 data. A total of 4776 (weighted) respondents were included in the final analysis. The association between the outcome and the independent variables was determined using multilevel (mixed effects) logistic regression analysis.

RESULTS

The overall weighted prevalence of EIBF among Bangladeshi mothers was 61.19% (confidence interval [CI] 59.80 to 62.56). The study shows that non-poor wealth status (adjusted odds ratio [AOR] 0.81 [95% CI 0.68 to 0.95]), institutional delivery (AOR 0.77 [95% CI 0.61 to 0.96]) and caesarean delivery (AOR 0.31 [95% CI 0.26 to 0.38]) were associated with the lower odds of EIBF. Mother's secondary education (AOR 1.34 [95% CI 1.01 to 1.83]), at least four antenatal care visits (AOR 1.36 [95% CI 1.04 to 1.53]), normal birthweight (AOR 1.42 [95% CI 1.09 to 1.85]) and placed on mother's chest and bare skin after birth (AOR 1.33 [95% CI 1.11 to 1.60]) were associated with higher odds of EIBF.

CONCLUSION

In order to enhance EIBF in Bangladesh, health professionals should emphasise skin-to-skin contact after delivery.

A prospective follow-up study on how long newborns are fasting in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020

Background

At birth, continuous flow of nutrients to the fetus in utero interrupted due to cut of the route /umbilical cord/. Instead of the cord, breast-mouth connection will be the next route in the extra uterine life. Nevertheless, limited data in our locality show the duration for how long immediate newborns are fasting.

Objective

This study aimed to assess time to initiation of breastfeeding and its predictors among postnatal mothers within 12 hours of birth in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2020.

Methods

A Facility based prospective follow-up study was conducted among 475 participants who were selected using systematic random sampling techniques. To collect the data, techniques including interview, chart review and observation were used. Data was entered to Epi-data version 3.1 and analyzed by STATA 14 software. A cox proportional hazards regression model was fitted to identify predictors for survival time. Results of the final model were expressed in terms of adjusted hazard ratio (AHR) with 95% confidence interval, statistical significance was declared with P-value is less than 0.05.

Results

Newborns were fasting breast-milk for the median time of 2 hours. In this study, 25% of participants initiated breastfeeding within 1 hour, pre-lacteal while 75% initiated within 3 hours. Gave birth to multiple babies (AHR 0.37, 95% CI (0.19, 0.69)), operative delivery (AHR 0.77, 95% CI (0.62, 0.96)), got advice on timely initiation of breastfeeding immediately after delivery (AHR 0.79, 95% CI (0.63, 0.97)), pre-lacteal feeding initiation (AHR 10.41, 95% CI (2.82, 38.47)) and neonatal sickness (AHR 0.08, 95% CI (0.03–0.19)) were statistically significant predictors for time to initiation of breastfeeding.

Conclusion

Fifty percent of mothers initiated breastfeeding within 2 hours. Most of them didn’t initiate breastfeeding based on world health organization’s recommendation, within one hour after delivery. Multiple birth, operative delivery, getting advice on timely initiation of breastfeeding immediately after delivery, giving pre-lacteal feeding and neonatal sickness were found to be predictors of time to initiation of breastfeeding.

Female Genital Mutilation/Cutting and Breastfeeding Outcomes: The Modifying Effects of Healthcare Access and Women’s Attitudes to FGM/C

The prevalence of female genital mutilation/cutting (FGM/C) in Nigeria is on the rise, although the practice has no known medical/health benefits. This study aims to assess FGM/C’s effect on breastfeeding outcomes and to identify the role of women’s attitudes and their access to healthcare services on these relationships. Associations between FGM/C and breastfeeding outcomes were measured using multi-logistic regression. About 32% of women underwent FGM/C, and 23% believed FGM/C should continue. Women exposed to FGM/C were less likely to initiate early breastfeeding (OR = 0.56, [95% CI = 0.47–0.66]) or to breastfeed exclusively (0.64, [0.57–0.73]). FGM/C acceptance reduced odds of early initiation of breastfeeding (0.57, [0.45–0.73]) (p for interaction < 0.001) and exclusive breastfeeding (0.65, [0.59–0.78]) (p for interaction < 0.001). Four or more antenatal care visits while pregnant modified the associations between FGM/C and early initiation (1.55, [1.26–1.90) (p for interaction < 0.001) or exclusive breastfeeding (2.01, [1.73–2.330]) (p for interaction < 0.001), respectively. FGM/C is associated with breastfeeding outcomes, but this association may be improved with healthcare access and attitudinal changes towards FGM/C. Targeted public health education interventions raising awareness about FGM/C and breastfeeding and policy changes increasing access to prenatal healthcare services in underserved areas are recommended.

Effect of maternal nutrition education on early initiation and exclusive breast-feeding practices in south Ethiopia: a cluster randomised control trial

Introduction: Optimal breast-feeding practices make a major contribution to the promotion of healthy growth and development through much prevention of diarrheal and respiratory diseases which majorly cause morbidity and mortality in under-five children. However, breast-feeding practices remain suboptimality in Ethiopia. Objective: The study objective was to determine the effect of maternal nutrition education on early initiation and exclusive breast-feeding practice in the Hawela Tulla sub-city. Methods: A cluster randomised, parallel-group, single-blinded trial was used. About 310 pregnant women (155 for the intervention group and 155 for the control group) were included. Result: An early initiation of breast-feeding was significantly higher among women who received breast-feeding education than those who did not receive (104(72·7 %) v. 85(59·9 %), P = 0·022) and exclusive breast-feeding practice was also significantly higher among women who received breast-feeding education than those who did not receive (106(74·1 %) v. 86(60·6 %), P = 0·015). Breast-feeding education [AORs 1·55, 95 % CI (1·02, 2·36)], institutional delivery [AOR 2·29, 95 % CI (1·21, 4·35)], vaginal delivery [AOR 2·85, 95 % CI (1·61, 5·41)] and pre-lacteal feeding [AOR 0·47, 95 % CI (0·25, 0·85)] were predictors of early initiation of breast-feeding. Breast-feeding education [AOR 1·72, 95 % CI (1·12, 2·64)] and institutional delivery [AOR 2·36, 95 % CI (1·28, 4·33)] were also determinants of exclusive breast-feeding practices. Conclusion: Breast-feeding education improved early initiation of breast-feeding and exclusive breast-feeding practices. Providing sustained education to women regarding early initiation and exclusive breast-feeding practice should be strengthened.

Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria

BACKGROUND

Although most health facilities in urban Nigeria are privately owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented.

OBJECTIVES

We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria.

METHODS

The intervention included training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging. We used logistic regression models adjusted for clustering to measure intervention impact in a cohort of women (n = 1200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum.

RESULTS

The intervention significantly increased the percentage of infants who were exclusively breastfed at 6 weeks (83% intervention; 76% comparison; P = 0.02) and 24 weeks (66% intervention; 52% comparison; P < 0.001), but had no impact on early initiation of breastfeeding (35% intervention; 33% comparison; P = 0.65). Among infants who were exclusively breastfed at 6 weeks, the odds of continued exclusive breastfeeding at 24 weeks were higher in the intervention arm than in the comparison arm (OR, 1.6; 95% CI: 1.2-2.1). Infants had increased odds of being exclusively breastfed at 6 weeks if their mothers discussed breastfeeding with a private health provider (OR, 2.3; 95% CI: 1.5-3.4), received text or WhatsApp messages about breastfeeding (OR, 1.7; 95% CI: 1.0-2.7), or heard breastfeeding radio spots (OR, 4.2; 95% CI: 1.2-14.7). Infants had increased odds of exclusive breastfeeding at 24 weeks if their mothers participated in a WhatsApp breastfeeding support group (OR, 1.5; 95% CI: 1.0-2.2).

CONCLUSIONS

A breastfeeding intervention in private health facilities in Lagos increased exclusive breastfeeding. Implementation of breastfeeding interventions in private facilities could extend the reach of breastfeeding promotion programs in urban Nigeria. This trial was registered at clinicaltrials.gov as NCT04835051.

Determinants of Early Initiation of Breastfeeding in West Belessa District, Northwest Ethiopia

BACKGROUND

The world is now suffering from malnutrition and remains one of the leading causes of death for under 5 children. Children from developing countries, including Ethiopia also suffer from undernutrition due to suboptimal breastfeeding practice. Therefore, the aim of this study was to assess the EIBF practices and determinants among children aged less than 24 months in West Belessa district, Northwest Ethiopia, 2019.

METHODS

A community-based cross-sectional study was conducted from January 2 to February 28, 2019 in the West Belessa district. A total of 569 mother-children pairs were participated in the study. Study particnapants were selected by using simple random sampling technique. The data were collected by an interviewer-administered structured questionnaire. Data were entered and analyzed by using Epi-Info version 7 and SPPS version 20, respectively. Bi-variable and Multivariable logistic regression analysis were done. Odds ratio with 95% confidence was done to determine the level of significance value less than .05 considered as significant with the outcome variable.

RESULT

The prevalence of early initiation of breastfeeding (EIBF) was found to be 77.7 % (95%CI, 74.3-81.0). Age of the mother (AOR = 2.76, 95%CI [1.21, 6.27]), antenatal care (ANC) (AOR = 3.79, 95%CI [2.58, 9.94]), and number of antenatal care visit (AOR = 1.85, 95%CI [1.03, 3.85]) were significantly associated with early initiation of breastfeeding.

CONCLUSION AND RECOMMENDATION

In this study, more than three fourth of children were received early initiation of breastfeeding within 1 hour after delivery. Age of the mother, antenatal, and number of antenatal care were associated with EIBF. Therefore, during this contact period, improve antenatal services by increasing accessibility and providing counseling is important to improve EIBF utilization.

Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities

BACKGROUND

The effects of breastfeeding practices on children's health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria.

METHODS

Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC.

RESULTS

The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers' education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment.

CONCLUSION

Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators.

Timely initiation of breastfeeding and its associated factors among Turkish mothers: a mixed model research

Exploring the determinants of timely initiation of breastfeeding is necessary for planning efficient breastfeeding promotion programmes. The present study aimed to investigate the frequency and related factors of timely initiation of breastfeeding among Turkish mothers. This study was a cross-sectional, descriptive, mixed model study, which was carried out on mothers with healthy children up to 3 years old who presented to the paediatric clinic between 01 November 2019 and 30 December 2019 in a university hospital. Of the 307 participant mothers, the mean age was 28.3 ± 3.9 years. The frequency of timely initiation of breastfeeding was 70.7%. Significant associations were found between timely initiation of breastfeeding status and residence, type of delivery, type of anaesthesia, birth weight of babies, counselling on timely initiation of breastfeeding during antenatal care and consultant medical staff. In order to increase the breastfeeding rate in the first hour, spontaneous vaginal delivery should be supported and spinal/epidural anaesthesia method should be preferred in cases where caesarean delivery is indicated. Other important steps to increase the ratio of timely initiation of breastfeeding are strengthening breastfeeding counselling services and the midwifery system.

Effect of antenatal depression on the initiation of breastfeeding in South Gondar zone, Northwest Ethiopia: A population-based prospective cohort study

BACKGROUND

Delayed initiation of breastfeeding has been found to increase early neonatal morbidity, mortality, and impaired mother-infant bonding. However, there is no study that revealed the effect of antenatal depression on breastfeeding initiation in Ethiopia. This study aimed to see the effect of antenatal depression on the practice of initiation of breastfeeding among women in urban Ethiopia.

METHODS

The Edinburgh Postnatal Depression Scale (EPDS) was administered to 970 women in the second and third trimesters of pregnancy to screen for antenatal depression. Information was collected on initiation of breastfeeding of newborns and mother's socio-demographic, obstetric, clinical, psychosocial, and behavioral factors. A logistic regression model was used to adjust for the confounders and determine association between antenatal depression and initiation of breastfeeding.

RESULTS

The cumulative incidence of late initiation of breastfeeding (LIBF) was found to be 166 (18.34%). The cumulative incidence of LIBF in those born from depressed pregnant women was 37% as compared to 8.4% in nondepressed. Antenatal depression at the second and third trimester of pregnancy remained a potential predictor of late initiation of breastfeeding after adjusting for potential confounders (AOR = 6.42: (95% CI 3.72, 11.05)). A significant association was also seen between infants who were born by cesarean section, a complication of current pregnancy, inadequate ANC follow-up, lack of advice about the importance of early initiation of breastfeeding (EIBF), home delivery, and low quartile of wealth index and late initiation of breastfeeding.

CONCLUSIONS

These findings suggest that screening for antenatal depression can help to identify women at risk for late initiation of breastfeeding. Health care providers shall have to give emphasis on the treatment of antenatal depression to benefit both the mother and the physical health, growth, and development of the fetus.

Prevalence and determinants of early initiation of breastfeeding (EIBF) and prelacteal feeding in Northern Ghana: A cross-sectional survey

BACKGROUND

There is suboptimal early initiation of breastfeeding (EIBF) with widespread prelacteal feeding in Ghana. However, studies exploring the determinants of EIBF and prelacteal feeding are limited in Ghana. The study was conducted to assess the prevalence and determinants of EIBF and prelacteal feeding in Northern Ghana.

METHODS

This cross-sectional study was conducted among 508 mothers with infants aged 0-24 months in the Sagnarigu Municipality of Northern Ghana. The quantitative data were collected using a structured questionnaire adapted from Ghana's demographic and health survey. Multivariate logistic regression was used to identify the independent determinants of EIBF and prelacteal feeding.

RESULTS

The prevalence of EIBF and prelacteal feeding was 72% and 21%, respectively. The independent positive determinants of EIBF were partner support to breastfeed [adjusted Odds ratio (AOR): 1.86, 95% Confidence interval (CI): 1.09-3.17] and exposure to breastfeeding information during pregnancy (AOR = 1.63 (95% CI: 1.01-2.64). Lower odds of EIBF were observed among mothers from extended family (AOR = 0.62, 95% CI: 0.41-0.95). Regarding prelacteal feeding, negative determinants were having a normal weight baby (AOR: 0.50, 95% CI: 0.27-0.90), exposure to breastfeeding information during pregnancy (AOR: 0.54, 95% CI: 0.31-0.92), while experiencing delayed onset of lactation was a risk factor for prelacteal feeding practice (AOR: 2.35, 95% CI: 1.41-3.94).

CONCLUSION

In this study, EIBF was slightly higher than the 2030 global target on EIBF with widespread prelacteal feeding practice. Health programs aimed at improving EIBF should focus on the women partners, nutrition counselling, and support to mothers from the extended family. In the same vein, programs aimed at discouraging prelacteal feeding practice should also target women at risk, such as those with low birthweight babies and women experiencing delayed lactation onset.

Maternal and child factors associated with early initiation of breastfeeding in Chad: evidence from nationally representative cross-sectional data

Background

Early initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad.

Methods

We used data from the children's recode file of the 2014–2015 Chad Demographic and Health Survey. A total of 3991 women ages 15–49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

We found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB.

Conclusions

Maternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.

Socioeconomic inequality in exclusive breastfeeding behavior and ideation factors for social behavioral change in three north-western Nigerian states: a cross-sectional study

Background

Socioeconomic inequalities could mitigate the impact of social and behavior change (SBC) interventions aimed at improving positive ideation towards the practice of exclusive breastfeeding. This study explores the empirical evidence of inequalities in the practice of exclusive breastfeeding (EBF) and associated ideational dimensions and domains of the theory of Strategic Communication and Behavior Change in three north-western Nigeria states.

Methods

We used cross-sectional data from 3007 randomly selected women with under-two-year-old children; the convenient regression method was applied to estimate the concentration indexes (CIxs) of exclusive breastfeeding behavior, ranked by household wealth index. Inequality was decomposed to associated ideational factors and sociodemographic determinants. Avoidable inequalities and the proportion of linear redistribution to achieve zero inequality were estimated.

Results

Women from wealthier households were more likely to practice exclusive breastfeeding CIx = 0.1236, p-value = 0.00). Attendance of at least four antenatal clinic visits (ANC 4+) was the most significant contributor to the inequality, contributing CIx = 0.0307 (p-value = 0.00) to the estimated inequality in exclusive breastfeeding practice. The elasticity of exclusive breastfeeding behavior with respect to partners influencing decision to breastfeed and ANC4+, were 0.1484 (p-value = 0.00) and 0.0825 (p-value = 0.00) respectively. Inequality in the regular attendance at community meetings (CIx = 0.1887, p-value =0.00); ANC 4+) (CIx = 0.3722, p-value = 0.00); and maternal age (CIx = 0.0161, p-value = 0.00) were pro-rich. A 10.7% redistribution of exclusive breastfeeding behavior from the wealthier half to the poorer half of the population could eliminate the inequality (line of zero inequality). Inequalities were mainly in the cognitive and social norms dimension and were all pro-poor.

Conclusion

Socioeconomic inequalities exist in exclusive breastfeeding behaviors and in associated ideation factors in the three states but are mostly avoidable. A 10.7% redistribution from wealthier to the poorer half of the population will achieve elimination. Messaging for SBC communication interventions to improve breastfeeding practices could be more effective by targeting the mitigation of these inequalities.

Timing of initiation of breastfeeding and its determinants at a tertiary hospital in Ghana: a cross-sectional study

BACKGROUND

Early initiation of breastfeeding (EIBF), breastfeeding within first hour after birth, is known to have major benefits for both the mother and newborn. EIBF rates, however, tends to vary between and within countries. This study set out to determine the prevalence of EIBF at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, and to evaluate the determinants of EIBF and time to initiation of breastfeeding.

METHODS

A cross-sectional study was conducted at the KATH postnatal wards between August and October 2014. Three hundred and eighty-two mothers delivering at KATH were recruited and data on time to initiation of breastfeeding, antenatal, delivery and immediate postnatal periods were collected. Data analyses using both binary and ordinal logistic regressions with stepwise elimination were used to determine the relationship between EIBF and time to initiation of breastfeeding on one side, and the maternal, pregnancy, delivery and neonatal associated factors.

RESULTS

EIBF was done in 39.4% (95%CI: 34.3-44.5) of the newborns with breastfeeding initiated between 1 to 6 h for 19.7%, 6 to 11 h in 4.8%, 11 to 16 h in 4.8% and after 16 h in 28.5% of the deliveries. A higher number of antenatal care visits (AOR = 1.14, 95%CI: 1.04-1.25, p = 0.006), delivery by caesarean section (AOR = 0.07, 95%CI: 0.01-0.79, p = 0.031) and infant rooming-in with mother (AOR: 31.67, 95%CI: 5.59-179.43, p <  0.001) were significantly and independently associated with EIBF. Factors independently associated with longer time to initiation of breastfeeding were older maternal age (AOR = 1.04, 95%CI: 1.00-1.09, p = 0.039), Akan ethnicity (AOR = 1.92, 95%CI: 1.14-3.22, p = 0.014), first-born child (AOR = 2.06, 95%CI: 1.18-3.58, p = 0.011), mother rooming-in with newborn (AOR = 0.01. 95%CI: 0.00-0.02, p <  0.001), increasing fifth minute APGAR score (AOR = 0.73, 95%CI: 0.58-0.93, p = 0.010) and using prelacteals (AOR = 2.42, 95%CI: 1.34-4.40, p = 0.004).

CONCLUSIONS

The low EIBF rate and prolonged time to initiation of breastfeeding at a major tertiary health facility is a major concern. Key interventions will need to be implemented at KATH and possibly other tertiary healthcare facilities in Ghana and beyond to improve EIBF rate and time to breastfeeding.

Time trends and determinants of breastfeeding practices among adolescents and young women in Nigeria, 2003-2018

Introduction

Optimal breastfeeding practices have far-reaching health and economic benefits. Evidence suggests disparities in breastfeeding practices by maternal age-groups, with younger mothers often having lower rates of breastfeeding initiation, continuation and exclusivity compared with older mothers. There is limited knowledge of trends and factors associated with breastfeeding practices, particularly among adolescent and younger mothers in Nigeria. We examine key breastfeeding practices in Nigeria over a 15-year period, comparing adolescent mothers to young women.

Methods

We used four Nigeria Demographic and Health Surveys collected between 2003 and 2018. We constructed six key breastfeeding indicators to cover the time period of breastfeeding from initiation to child age 24 months in women of three maternal age groups at the time of birth: young adolescents (<18 years), older adolescents (18–19.9 years) and young women (20–24.9 years). We used logistic regression to examine the association between maternal age group and select breastfeeding behaviours on the 2018 survey.

Results

Analysis showed an increase in optimal breastfeeding practices across the four surveys and among all maternal age groups examined. Adolescent mothers had consistently lower prevalence for three of the six key breastfeeding indicators: early initiation of breastfeeding, exclusive breastfeeding <6 months and no prelacteal feed. Compared with young women, adolescent mothers had a higher prevalence of continued breastfeeding at 1 and 2 years. In multivariate analysis, we found that maternal age group was not associated with early breastfeeding initiation or with exclusive breastfeeding <6 months. However, several sociodemographic (ethnicity, region of residence) and healthcare-related (mode of delivery, antenatal care, postnatal breastfeeding counselling) factors were strongly associated with these two practices.

Conclusions

In Nigeria, there is need to better support breastfeeding and nutritional practices in adolescents and young women focusing on ethnic groups (Hausa, Fulani, Kanuri/Beriberi) and geographic regions (South East) that are lagging behind.

Delayed Initiation of Breastfeeding and Role of Mode and Place of Childbirth: Evidence from Health Surveys in 58 Low- and Middle- Income Countries (2012-2017)

Background: Timely initiation of breastfeeding is the first step towards achieving recommended breastfeeding behaviours. Delayed breastfeeding initiation harms neonatal health and survival, including infection associated neonatal mortality. Eighty percent of neonatal deaths occur in the low-and middle-income countries (LMICs), where delayed breastfeeding initiation is the highest. Place and mode of childbirth are important factors determining the time of initiation of breastfeeding. In this study, we report the prevalence of delayed breastfeeding initiation from 58 LMICs and investigate the relationship between place and mode of childbirth and delayed breastfeeding initiation in each country. Methods: We analysed data from the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) collected between 2012 and 2017 and reported by 2019. The study sample comprised all women who had a live birth in the 24 months preceding the survey. ‘Delayed’ initiation of breastfeeding was defined using WHO recommendations as starting breastfeeding after one hour of birth. We coded the stratifying variable for the place and mode of childbirth as “vaginal birth at a facility (VBF)”, “caesarean section birth (CSB) “, and “vaginal birth at home (VBH)”. We used respondent-level sampling weights to account for individual surveys and de-normalised the standard survey weights to ensure the appropriate contribution of data from each country. We report the prevalence and population attributable fractions with robust standard errors. The population attributable risk identifies the proportion of delayed initiation that we could avert among VBH and CSB if everyone had the same risk of delaying breastfeeding as in VBF. Results: The overall prevalence of delayed initiation of breastfeeding was 53.8% (95% CI 53.3, 54.3), ranging from 15.0% (95% CI 13.8, 16.2) in Burundi to 83.4% (95% CI 80.6, 86.0) in Guinea. The prevalence of delayed initiation of breastfeeding was consistently high among women who experienced caesarean section births; however, there was no direct association with each country’s national caesarean section rates. The prevalence of delayed initiation among women who experienced VBF was high in Sub-Saharan Africa and South Asia, even though the CSB rates were low. In some countries, women who give birth vaginally in health facilities were more likely to delay breastfeeding initiation than women who did not. In many places, women who give birth by caesarean section were less likely to delay breastfeeding initiation. Population attributable risk percent for VBH ranged from −28.5% in Ukraine to 22.9% in Moldova, and for CSB, from 10.3% in Guinea to 54.8% in Burundi. On average, across all 58 countries, 24.4% of delayed initiation could be prevented if all women had the same risk of delaying breastfeeding initiation as in VBF. Discussion: In general, women who give birth in a health facility were less likely to experience delayed initiation of breastfeeding. Programs could avert much of the delayed breastfeeding initiation in LMICs if the prevalence of delayed initiation amongst women who experience CSB were the same as amongst women who experience VBF. Crucial reforms of health facilities are required to ensure early breastfeeding practices and to create pro-breastfeeding supportive environments as recommended in intervention packages like the Baby-friendly hospital initiative and Early essential newborn care. The findings from this study will guide program managers to identify countries at varying levels of preparedness to establish and maintain a breastfeeding-friendly environment at health facilities. Thus, governments should prioritise intervention strategies to improve coverage and settings surrounding early initiation of breastfeeding while considering the complex role of place and mode of childbirth.

Consistency of the determinants of early initiation of breastfeeding in Ghana: insights from four Demographic and Health Survey datasets

BACKGROUND

Early initiation of breastfeeding (EIBF) is a key strategy in averting neonatal deaths. However, studies on the facilitators and risk factors for EIBF are rare in Ghana. We examined trends in EIBF and its major facilitators and risk factors in Ghana using data from Demographic and Health Surveys from 1998 to 2014.

METHODS

We used complete weighted data of 3194, 3639, 2909 and 5695 pairs of mothers ages 15-49 y and their children ages 0-5 y in the 1998, 2003, 2008 and 2014 surveys, respectively. We accounted for the complex sampling used in the surveys for both descriptive statistics and multiple variable risk ratio analysis.

RESULTS

The proportion of children who achieved EIBF increased by about 2.5 times from 1998 to 2003 and there was a marginal increase in the proportion of children who achieved EIBF between 2003 and 2014. Children born by caesarean section were at higher risk of being breastfed later than 1 h across all four surveys. Being born in the Upper East Region (compared with the Western Region) of Ghana facilitated EIBF in 2003 and 2008.

CONCLUSIONS

The study revealed that the current estimate of the proportion of children achieving EIBF in Ghana was 55.1%, and delivery by caesarean section and region of residence consistently predicted the practice of EIBF in Ghana.

Individual and community-level factors influencing optimal breastfeeding: A multilevel analysis from a national survey study of Ethiopia

BACKGROUND

Optimal breastfeeding is critical for healthy growth of the child. Globally, 820,000 children and 20,000 women lost due to in appropriate breastfeeding each year. In Ethiopia, 50,000 children lost related to malnutrition with 18% were due to poor breastfeeding habit. Little is known on the determinants of breastfeeding with hierarchical level. Therefore, this study aimed to identify factors influencing optimal breastfeeding among children under six month in Ethiopia using a multilevel analysis.

METHODS

The data of this study were obtained from Ethiopian Demographic and health survey conducted from January to June 2016. A total 1,087 children aged 0-5 months were selected using two stage stratified sampling technique. Multilevel logistic regression analysis was done to identify significant explanatory variables. Akaike information criteria were used to select the best model fit. Fixed effect was done to estimate the association between the outcome and explanatory variable and also random effect to measure the variation explained by the higher level.

RESULT

Among the total of 1,087 children, 45.4% were optimally breastfeed. Children from the richest wealth index (AOR = 2.87; 95% CI: 1.53-5.43) was positively associated with optimal breastfeeding but, children aged 4-5 months (AOR = 0.19; 95%CI: 0.12-0.27), children born through cesarean section (AOR = 0.18; 955 CI: 0.07-0.51) and residing in Afar region (AOR = 0.13; 95%CI: 0.02-0.92) were found inversely associated with optimal breastfeeding. The random-effects showed that the variation between communities was statistically significant.

CONCLUSION

Individual and community level factors play a significant role in shaping optimal breastfeeding. Future strategies and health interventions should be strengthen to target individual and community level factors that enhance optimal breastfeeding.

Prevalence and predictors of timely initiation of breastfeeding in Ghana: an analysis of 2017-2018 multiple indicator cluster survey

Background

Timely initiation of breastfeeding is putting the newborn baby to the breast within 1 h of birth. Its practice can prevent neonatal and under-5 mortality. This study aims to assess the prevalence and factors associated with timely initiation of breastfeeding among mothers in Ghana.

Methods

We used data from the 2017–2018 Ghana multiple indicator cluster survey and our analysis was restricted to 3466 mothers who had a live birth within 2 years. Multivariable logistic regression was used to estimate the factors associated with timely initiation of breastfeeding whilst adjusting for potential confounders, and accounted for clustering, stratification, and sample weights.

Results

The prevalence of timely initiation of breastfeeding was 52.3% (95% CI 49.7%, 54.9%). Mothers who were assisted by a skilled attendant at birth had 65% higher odds of timely initiation of breastfeeding compared to mothers who were not assisted by a skilled attendant (adjusted prevalence odds ratio [aPOR] 1.65; 95% CI 1.28, 2.13). Mothers who delivered by Caesarean section had 74% lower odds of timely initiation of breastfeeding compared to mothers who had vaginal delivery (aPOR 0.26; 95% CI 0.18, 0.36). Mothers who had planned their pregnancy had 31% higher odds of timely initiation of breastfeeding compared to mothers who had an unplanned pregnancy (aPOR 1.31; 95% CI 1.05, 1.63). There were also 74% and 51% higher odds of timely initiation of breastfeeding among mothers who perceived their baby was large (aPOR 1.74; 95% CI 1.34, 2.26), and of average size (aPOR 1.51, 95% CI 1.16, 1.97) at birth respectively, compared to mothers who perceived their baby was small.

Conclusions

Interventions to increase timely initiation of breastfeeding should provide breastfeeding support to mothers who have had a Caesarean section, small sized babies and unplanned pregnancies, and to promote birthing by skilled birth attendants.

Timely initiation of breastfeeding and associated factors among mothers having children less than two years of age in sub-Saharan Africa: A multilevel analysis using recent Demographic and Health Surveys data

BACKGROUND

Despite the significant advantages of timely initiation of breastfeeding (TIBF), many countries particularly low- and middle-income countries have failed to initiate breastfeeding on time for their newborns. Optimal breastfeeding is one of the key components of the SDG that may help to achieve reduction of under-five mortality to 25 deaths per 1000 live births.

OBJECTIVE

To assess the pooled prevalence and associated factors of timely initiation of breastfeeding among mothers having children less than two years of age in sub-Saharan Africa.

METHODS

We used pooled data from the 35 sub-Saharan Africa (SSA) Demographic and Health Surveys (DHS). We used a total weighted sample of 101,815 women who ever breastfeed and who had living children under 2 years of age. We conducted the multilevel logistic regression and variables with p<0.05, in the multivariable analysis, were declared significantly associated with TIBF.

RESULTS

The pooled prevalence of TIBF in SSA was 58.3% [95%CI; 58.0-58.6%] with huge variation between countries, ranging from 24% in Chad to 86% in Burundi. Both individual and community level variables were associated with TIBF. Among individual-level factors; being older-aged mothers, having primary education, being from wealthier households, exposure to mass media, being multiparous, intended pregnancy, delivery at a health facility, vaginal delivery, single birth, and average size of the child at birth were associated with higher odds of TIBF. Of community-level factors, rural place of residence, higher community level of ANC utilization, and health facility delivery were associated with higher odds of TIBF.

CONCLUSION

In this study, the prevalence of TIBF in SSA was low. Both individual and community-level factors were associated with TIBF. The authors recommend interventions at both individual and community levels to increase ANC utilization as well as health facility delivery that are crucial for advertising optimal breastfeeding practices such as TIBF.

Trends in early initiation of breastfeeding in Bangladesh and a multilevel analysis approach to find its determinants

Early initiation of breastfeeding (EIBF) is an essential practice for child health as well as for maternal health. This study aims to determine trends, prevalence, and factors associated with EIBF in Bangladesh. Data for this study were extracted from Bangladesh demographic and health surveys (BDHS) 2004, 2007, 2011, and 2014. This study found an increasing trend in EIBF in Bangladesh irrespective of the different characteristics of mothers and children. Chi-square test was conducted to find the association between EIBF and different factors. Multilevel logistic regression analysis was used to consider the hierarchical structure of the data. Regression result showed that educated parents [Adjusted odds ratio (AOR) = 1.14, 95% Confidence Interval (CI) = 1.04, 1.26 ], exposure to media [AOR = 1.13, CI = 1.05, 1.21], 2nd or 3rd birth order [AOR = 1.13, CI = 1.04, 1.23], wanted child [AOR = 1.12, CI = 1.02, 1.23], antenatal visit [AOR = 1.07, CI = 1.00, 1.15], antenatal visit by medically trained provider [AOR = 1.06, CI = 1.00,1.13] and rich wealth index [AOR = 1.10, CI = 1.01, 1.20] were positively associated with EIBF. In contrast, mothers with caesarian delivery [AOR = 0.36, CI = 0.31, 0.40], delivery in private facility [AOR = 0.83, CI = 0.73, 0.95], multiple birth, and higher maternal age were less likely to EIBF.

Early Initiation of Breastfeeding and Its Associated Factors Among Mothers Who Delivered Vaginally in South Gondar Zone Hospitals, Northwest Ethiopia, 2020

Purpose

The early onset of skin-to-skin contact encourages the infant to breastfeed within one hour of birth. The aim of this study was to assess the prevalence of early onset breastfeeding and its associated factors among vaginal delivered mothers in hospitals in the South Gondar Zone of Northwest Ethiopia in 2020.

Methods

From January 12 to February 03, 2020, an institutional-based cross-sectional study was used in South Gondar Zone hospitals. A total of 356 mothers delivered by vaginal were included. Data was collected using a questionnaire administered by the interviewer and entered into version 3.1 of EpiData, and then exported to SPSS version 23.0.0. To classify factors correlated with the outcome variables, logistic regression statistical analyses were used.

Results

In the study area, the prevalence of early breastfeeding initiation among vaginally delivered mothers was 88.2%. Mothers who had unintended pregnancy [adjusted OR=6.00, 95% CI=2.8, 12.5], had professional guidance [adjusted OR=2.75, 95% CI=1.2, 5.6] and experience with breastfeeding [adjusted OR=1.79 95% CI=1.19, 2.68] among vaginal delivered mothers were positively correlated with early breastfeeding initiation.

Conclusion

The type of pregnancy and professional guidance among vaginally delivered mothers were significantly associated with early initiation of breastfeeding. Community-based education and counseling on breastfeeding for pregnant mothers and encouraging all mothers to start early breastfeeding.

Women's Empowerment and Determinants of Early Initiation of Breastfeeding: A Scoping Review

INTRODUCTION

Early initiation of breastfeeding (EIBF), the immediate provision of mothers' breast milk to infants within the first hour of life, has been recommended by the WHO. However, EIBF is not widely practiced, thereby increasing infant mortality risk. This review explored the available and published studies that identified interventions that empower mothers to practice EIBF.

METHOD

We conducted a scoping review to answer the aforementioned aims. Empowerment, Women, Breastfeed, and Initiation were used as initial keywords, which were further developed using Medical Subject Headings by the National Center for Biotechnology Information. Five databases, namely: Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature via EBSCO, ProQuest, and MedLine via PubMed, were searched for potential articles. We also searched the references in addition to the main search.

FINDINGS

We included 28 articles in this review. Education was mostly used as women's empowerment indicator in EIBF intervention. Additionally, we identified barriers (C-section and postoperative pain, lactation problems and pregnancy complications, mothers' social and demographic factors, mothers' lack of professional support, babies' condition preventing EIBF) and facilitators (mothers' positive behavior in relation to educational level, completion of antenatal care, poor economic situations of mothers, babies' size at birth) of EIBF.

DISCUSSION

Education is the widely used intervention to promote mothers' participation in improving EIBF rate. Furthermore, mothers' and babies' deferring conditions and traditional practices are barriers for EIBF. This review recommends future research and empowerment efforts that sensitively address the identified barriers.

Fatores associados às práticas assistenciais ao recém-nascido na sala de parto

RESUMO Objetivo identificar os fatores associados às práticas assistenciais ao recém-nascido adotadas na sala de parto de uma maternidade na baixada litorânea do Rio de Janeiro. Método estudo transversal, realizado em instituição pública no estado Rio de Janeiro, mediante coleta de dados em prontuários de nascimentos entre 2015 e 2017. Na associação entre variáveis, adotou-se o Teste Qui-Quadrado e a regressão logística. Resultados entre 351 (100,0%) prontuários, constituíram-se como práticas realizadas na sala de parto: contato pele a pele e aleitamento materno precoce (28,0%); secagem (92,3%); aspiração oronasofaríngea (82,1%); aspiração gástrica (52,7%); aspiração traqueal (12,2%); oxigênio inalatório (7,7%); e encaminhamento ao Alojamento Conjunto (91,1%). O contato precoce com o seio materno esteve associado ao tipo de parto (p=0,043) e às alterações no exame físico (p=0,001). Possuir alterações no exame físico ao nascimento diminuiu significativamente as chances de o bebê ser colocado nessa posição ainda na sala de parto (p=0,001) assim como os recém-nascidos de parto cesáreo (p=0,045). Nascer de cesárea aumentou duas vezes as chances de o recém-nascido ser submetido à aspiração gástrica (p=0,002). Conclusão e implicações para a prática é premente organizar as rotinas dos serviços, de modo a evitar intervenções desnecessárias visando uma atenção obstétrica e neonatal humanizada e de qualidade.

Prevalence and Determinants of Early Initiation (EI), Exclusive Breastfeeding (EBF), and Prelacteal Feeding among Children Aged 0-24 Months in Slums of Pune City, in Maharashtra

Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city.A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators.Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding.Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums.