Prevalence and determinants of initiation of breastfeeding within one hour of birth: An analysis of the Bangladesh Demographic and Health Survey, 2014

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.

Factors associated with early initiation of breastfeeding in central Saudi Arabia: a hospital-based survey

BACKGROUND

Early initiation of breastfeeding is central to the success of infant feeding. The World Health Organization (WHO) therefore recommends breastfeeding within the first hour of birth and has set a target to increase the rate to 70% globally by 2030. This suggests the necessity of systematic investigations to capture trends in early initiation of breastfeeding to avail health systems of up-to-date information in the interest of appropriate policy making. Hence, this study was designed to investigate the factors associated with early initiation among mothers who delivered babies in public healthcare facilities in the Al-Qassim Region, Saudi Arabia.

METHODS

The research was a hospital-based, cross-sectional study which featured the recruitment of 546 mothers from March 2021 to June 2021 in five public hospitals. A questionnaire was the tool used for data collection and this was administered via face-to-face, structured interviews. Data were analyzed using binary logistic regression including unadjusted (UOR) and adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULTS

The prevalence of early initiation of breastfeeding was 23.1% (120 of 519 respondents). Maternal and paternal socio-demographic variables, household characteristics, parity, age of the previous child, breastfeeding the previous child or otherwise and the sex of the newborn were not associated with the early initiation of breastfeeding. Mode of delivery and antenatal education about breastfeeding were significant factors. Postnatal care practices were also significant: the provision of help in positioning babies for breastfeeding (AOR 3.5; 95% CI 1.62, 7.57), 24-hour rooming-in (AOR 6.26; 95% CI 1.31, 29.8) and encouragement to practice early initiation of breastfeeding (AOR 3.05; 95% CI 1.71, 5.43) were good, better and the best factors associated with early initiation of breastfeeding respectively.

CONCLUSION

The prevalence of early initiation of breastfeeding is poor and represents a threat to child survival in the study area. Postnatal care practices are crucial factors strongly predisposing mothers to early initiation of breastfeeding and should therefore be institutionalized in health policy frameworks to promote the same in Saudi Arabia.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

Timely initiation of breastfeeding among women who gave birth by cesarean section in central Ethiopia, 2022: A cross-sectional study

BACKGROUND

Timely initiation of breastfeeding reduces the risk of neonatal mortality. However, there was paucity of literature on the timely initiation of breastfeeding among women who gave birth by cesarean section (CS) in Ethiopia. Thus, the aim of this study was to assess the magnitude of timely initiation of breastfeeding and factors associated with it among women who gave birth by CS in central Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among 403 women who gave birth by CS. Data were collected by using an interviewer-administered questionnaire and observation checklist, entered into EpiData 4.6, and exported to statistical package for the social sciences (SPSS) version 26.Descriptive and multivariate logistic regression analyses were performed and statistical significance is declared at p<0.05.

RESULTS

The magnitude of timely initiation of breastfeeding was 47.4% [95% CI: (42.5, 52.6)]. Attending four or more antenatal care visits [(AOR): 2.27, 95%CI: (1.28, 4.02)], counseling during antenatal care [AOR: 4.78, 95% CI: (2.66, 8.60)], early skin to skin contact with newborn [AOR: 2.83, 95% CI: (1.60, 5.02)], post-delivery counseling [AOR: 2.93, 95% CI: (1.56, 5.50)], and getting assistance from health professionals [AOR: 3.07, 95% CI: (1.64, 5.75)] were factors associated with timely initiation of breastfeeding.

CONCLUSIONS

The magnitude of timely initiation of breastfeeding in the study area was low. Strengthening counseling by health care practitioners during ANC and post-natal period should be prioritized to support women in initiating early skin-to-skin contact within one hour of birth is mandatory.

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.

Protective factors for early initiation of breastfeeding among Brazilian nursing mothers

Objectives

Evaluate the protective factors associated with early initiation of breastfeeding.

Methods

Cross-sectional study conducted with Brazilian nursing mothers. Breastfeeding in the first hour of life and difficulty initiating breastfeeding in the birth room were adopted as outcome variables and associated with other maternal and child information. Poisson regression was conducted to synthesize the data.

Results

Among 104 nursing mothers evaluated, 56.7% reported breastfeeding in the first hour of life and 43% had difficulty initiating breastfeeding in the birth room. There was a higher prevalence of breastfeeding in the first hour of life among mothers with previous breastfeeding experience (PR = 1.47, 95% CI 1.04-2.07). Difficulty initiating breastfeeding in the birth room was more prevalent among mothers who did not receive breastfeeding guidance during antenatal care (PR = 2.83, 95% CI 1.43-4.32) and those without previous breastfeeding experience (PR = 2.49, 95% CI 1.24-6.45).

Conclusion

These findings highlight the importance of adequate professional guidance, especially for primiparous mothers.

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.

Impact of a quality improvement program: Early initiation of breastfeeding after cesarean section in a tertiary care hospital, in Eastern India

Background

Early initiation of breastfeeding (EIBF) within 1 h of birth is crucial in preventing newborn deaths and plays a vital role in early infant nutrition. Promoting and supporting breastfeeding is an integral part of midwifery. The objective of the study was to improve the EIBF rate in neonates born through a Cesarean Section (CS) from 0% to 50% within six months through a quality improvement (QI) process and to assess the maternal experience of EIBF in operation theatre (OT).

Methods

Six Plan-Do-Study-Act (PDSA) cycles were conducted to test the change ideas proposed by the team members for a month to improve EIBF. Participants of the study were the stable term newborns delivered by CS under spinal anesthesia.

Results

The EIBF rate improved from 0% to 88% after the sixth PDSA cycle. The effect was sustained for six months. Mothers of 51 neonates (98%) who received EIBF reported that their newborns were breastfed successfully, and it was not physically tiring to feed immediately in the OT.

Conclusions

A quality improvement (QI) initiative was able to improve and sustain the improved EIBF rate after CS. Early skin-to-skin contact to be initiated with EIBF for better neonatal outcomes.

The clinical experience of early skin-to-skin contact combined with non-nutritive comfort sucking in mothers of preterm infants: a qualitative study

BACKGROUND

In most areas of China, mothers typically do not participate in early care of preterm infants in NICU. This study aims to examine the early experience of mothers of preterm infants participating in skin-to-skin contact combined with non-nutritive comfort sucking in China.

METHODS

This qualitative research study used one-on-one, face-to-face, semi-structured in-depth interviews. Eighteen mothers who participated in early skin-to-skin contact combined with non-nutritive comfort sucking were interviewed in the NICU of a tertiary children's hospital in Shanghai between July and December 2020. Their experiences were analyzed using the inductive topic analysis method.

RESULTS

Five themes about skin-to-skin contact combined with non-nutritive comfort sucking were identified, including alleviation of maternal anxiety and fear during mother infant separation, reshaping the maternal role, promotion of active breast pumping, enhances the mother's willingness to actively breast feed and building the maternal confidence in baby care.

CONCLUSION

Skin-to-skin contact combined with non-nutritive comfort sucking in the NICU can not only enhance the identity and responsibility of the mother's role, but also provide non-nutritive sucking experience for promoting the establishment of oral feeding in preterm infants.

Outbreak of diarrheal diseases causes mortality in different geographical locations of Bangladesh during the 2021 COVID-19 era

Objectives

Diarrhea is a major public health problem in low- and middle-income countries, including Bangladesh. Of the different spectrums of diarrheal diseases, cholera occurs every year, causing outbreaks and epidemics following a biannual seasonal pattern. Due to the COVID-19 pandemic, hospitalization for diarrheal diseases decreased in 2020 compared to the previous years. However, in 2021, massive outbreaks occurred in different geographical locations of the country. We described that an outbreak of diarrheal diseases causes mortality in different geographical locations in Bangladesh.

Method

In this study, we present a report of diarrhea outbreaks that were reported in 2018-2021 in different parts of Bangladesh, and data have been captured from different sources such as print and electronic media as well as from a nationwide surveillance system.

Results

Among these locations, districts of Barisal Division, Kishorganj, Noakhali, Gopalganj, Bandarban, and Chattogram were the major hotspots of the outbreaks where high morbidity due to acute watery diarrhea and even mortality, which is usually low in Bangladesh, were recorded.

Conclusion

Early detection and prevention and strengthening of the surveillance system are needed to combat the diarrheal upsurge, take immediate control, and adopt preventive strategies.

Mother and newborn skin-to-skin contact and timely initiation of breastfeeding in sub-Saharan Africa

BACKGROUND

Mother and newborn skin-to-skin contact (SSC) plays a key role in breastfeeding practices of mothers. In this study, we examined the association between mother and newborn SSC and timely initiation of breastfeeding in sub-Saharan Africa (SSA).

METHODS

This cross-sectional study utilized nationally representative data from the Demographic and Health Surveys of 17 countries in SSA from 2015 to 2020. Multilevel binary logistic regression analysis was performed to examine the association between mother and newborn SSC and timely initiation of breastfeeding. The results are presented using adjusted odds ratios (aOR), with 95% confidence interval (CI).

RESULTS

The pooled prevalences of mother and newborn SSC and timely initiation of breastfeeding were 45.68% (95% CI = 34.12-57.23) and 62.89% (95% CI = 55.67-70.11), respectively. Mothers who practiced newborn SSC were more likely to practice timely initiation of breastfeeding compared to those who did not practice SSC [aOR = 1.68, 95% CI = 1.58, 1.78] and this persisted after controlling for all the covariates [aOR = 1.38, 95% CI = 1.29, 1.47]. At the country level, mother and newborn SSC increased the odds of timely initiation of breastfeeding in Angola [aOR = 1.99, 95% CI = 1.44, 2.76], Cameroon [aOR = 1.43, 95% CI = 1.02, 1.99], Ethiopia [aOR = 1.62, 95% CI = 1.16, 2.28], Guinea [aOR = 1.69, 95% CI = 1.10, 2.60], Liberia [aOR = 2.03, 95% CI = 1.33, 3.12], Malawi [aOR = 1.47, 95% CI = 1.02, 2.12], Mali [aOR = 1.42, 95% CI = 1.10, 1.84], Sierra Leone [aOR = 1.87, 95% CI = 1.23, 2.83], South Africa [aOR = 2.59, 95% CI = 1.41, 4.76], Tanzania [aOR = 1.60, 95% CI = 1.27, 2.01], Uganda [aOR = 1.43, 95% CI = 1.02, 1.99], Zambia [aOR = 1.86, 95% CI = 1.50, 2.30], and Zimbabwe [aOR = 1.65, 95% CI = 1.24, 2.21].

CONCLUSION

The prevalence of SCC was relatively low but timely initiation of breastfeeding was high. Mother and newborn SSC is a strong predictor of timely initiation of breastfeeding in SSA. To enhance timely initiation of breastfeeding after birth, this study recommends that more child and maternal healthcare interventions focused on improving mother and newborn SSC should be implemented.

Trends and predictors of early initiation, exclusive and continued breast-feeding in Bangladesh (2004-2018): a multilevel analysis of demographic and health survey data

The early initiation of breast-feeding (EIBF) within 1 h of birth, exclusive breast-feeding (EBF) to 6 months and continued breast-feeding (CBF) to 2 years are key infant and young child feeding guidelines promoted globally for optimal child health and development. Using publicly available national survey data from the five most recent, consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014 and 2017-2018), we assessed the trends in these key breast-feeding indicators. Multiple multilevel logistic regression models were built to assess socio-demographic predictors of breast-feeding using the latest 2017-2018 data set. Both EIBF and EBF have increased significantly between 2004 and 2017-2018, from 26 % to 60 % and 36 % to 68 %, respectively, and CBF decreased from 94 % to 85 %. Caesarean section delivery conferred lower EIBF practice (OR = 0·34, 95 % CI 0·27, 0·42) compared with vaginal delivery. Women who were currently working had 32 % lower odds of EBF (OR = 0·68, 95 % CI 0·48, 0·95). Compared with delivery at home, women who delivered in a health facility had 81 % higher odds of EBF (OR = 1·81, 95 % CI 1·25, 2·34). Larger family size (≥5) also predicted EBF (OR = 1·70, 95 % CI 1·21, 2·40). Rural residency was associated with 2·39 (95 % CI 1·32, 4·31) times of higher odds of CBF. Regional variation was also predictive of the various breast-feeding indicators. Although Bangladesh currently exceeds the 2019 global prevalence rates for these three breast-feeding indicators, efforts should be made to continue improving EIBF and EBF and to prevent future decreases in CBF.

Association between Skin-to-Skin Contact Duration after Caesarean Section and Breastfeeding Outcomes

We aimed to explore the association between skin-to-skin contact (SSC) duration after caesarean sections (CSs) and breastfeeding outcomes. A prospective study was conducted in four hospitals in China during January and August 2021. A total of 679 participants with singleton pregnancy who delivered by elective CS after 37 gestational weeks using epidural or spinal anesthesia were included. Logistic regression was applied to assess the association between SSC duration and early initiation of breastfeeding (EIBF), as well as the promoting factors for exclusive breastfeeding (EBF) at hospital discharge. Immediate SSC after CSs was strongly associated with higher rates of EIBF (p < 0.001) and EBF at hospital discharge (p = 0.002). The EIBF rates increased with longer duration of SSC, with the at least 90 min SSC group having the highest EIBF rate (74.5%). Skin-to-skin contact durations of at least 90 min, 60−89 min and 30−59 min were significantly associated with 8.53 times (OR = 8.53, 95%CI: 4.94−14.72, Padj < 0.001), 8.04 times (95%CI: 4.68−13.80, Padj < 0.001) and 6.28 times (95%CI: 3.75−10.51, Padj < 0.001), respectively, higher EIBF rates compared to those without immediate SSC. After multiple-testing correction, the rates of EBF at hospital discharge were found to be independent of the duration of SSC (Padj = 0.12). Early initiation of breastfeeding was not a significant predictor of EBF. Our results suggested that SSC is important for EIBF in Chinese baby-friendly hospitals. Skin-to-skin contact should be practiced after CS to promote breastfeeding and providing SSC with longer duration is encouraged to obtain the full benefit; if it is not feasible, a minimum of 30 min SSC could achieve improved EIBF and EBF at discharge.

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.

Health care services use, stillbirth, and neonatal and infant survival following implementation of the Maternal Health Voucher Scheme in Bangladesh: A difference-in-differences analysis of Bangladesh Demographic and Health Survey data, 2000 to 2016

BACKGROUND

Starting in 2006 to 2007, the Government of Bangladesh implemented the Maternal Health Voucher Scheme (MHVS). This program provides pregnant women with vouchers that can be exchanged for health services from eligible public and private sector providers. In this study, we examined whether access to the MHVS was associated with maternal health services utilization, stillbirth, and neonatal and infant mortality.

METHODS AND FINDINGS

We used information on pregnancies and live births between 2000 to 2016 reported by women 15 to 49 years of age surveyed as part of the Bangladesh Demographic and Health Surveys. Our analytic sample included 23,275 pregnancies lasting at least 7 months for analyses of stillbirth and between 15,125 and 21,668 live births for analyses of health services use, neonatal, and infant mortality. With respect to live births occurring prior to the introduction of the MHVS, 31.3%, 14.1%, and 18.0% of women, respectively, reported receiving at least 3 antenatal care visits, delivering in a health institution, and having a skilled birth attendant at delivery. Rates of neonatal and infant mortality during this period were 40 and 63 per 1,000 live births, respectively, and there were 32 stillbirths per 1,000 pregnancies lasting at least 7 months. We applied a difference-in-differences design to estimate the effect of providing subdistrict-level access to the MHVS program, with inverse probability of treatment weights to address selection into the program. The introduction of the MHVS program was associated with a lagged improvement in the probability of delivering in a health facility, one of the primary targets of the program, although associations with other health services were less evident. After 6 years of access to the MHVS, the probabilities of reporting at least 3 antenatal care visits, delivering in a health facility, and having a skilled birth attendant present increased by 3.0 [95% confidence interval (95% CI) = -4.8, 10.7], 6.5 (95% CI = -0.6, 13.6), and 5.8 (95% CI = -1.8, 13.3) percentage points, respectively. We did not observe evidence consistent with the program improving health outcomes, with probabilities of stillbirth, neonatal mortality, and infant mortality decreasing by 0.7 (95% CI = -1.3, 2.6), 0.8 (95% CI = -1.7, 3.4), and 1.3 (95% CI = -2.5, 5.1) percentage points, respectively, after 6 years of access to the MHVS. The sample size was insufficient to detect smaller associations with adequate precision. Additionally, we cannot rule out the possibility of measurement error, although it was likely nondifferential by treatment group, or unmeasured confounding by concomitant interventions that were implemented differentially in treated and control areas.

CONCLUSIONS

In this study, we found that the introduction of the MHVS was positively associated with the probability of delivering in a health facility, but despite a longer period of follow-up than most extant evaluations, we did not observe attendant reductions in stillbirth, neonatal mortality, or infant mortality. Further work and engagement with stakeholders is needed to assess if the MHVS has affected the quality of care and health inequalities and whether the design and eligibility of the program should be modified to improve maternal and neonatal health outcomes.

Determinants of Exclusive Breastfeeding and Mixed Feeding Among Mothers of Infants in Dubai and Sharjah, United Arab Emirates

Background

Breastfeeding (BF) is considered the ultimate method of infant feeding for at least the first 6 months of life. Exclusive breastfeeding (EBF) is one of the most effective interventions to improve child survival. The main objective of this study was to assess the prevalence and duration of exclusive breastfeeding and the associated factors among women in Dubai and Sharjah, UAE.

Methods

A cross-sectional study was conducted in four hospitals and four healthcare centers in Dubai and Sharjah between September 2017 and December 2017. Hospitals and centers are governmental and provide maternal and child health services. A convenience sample of 858 Arab and Emirati mothers with children under the age of 2 years participated in the study. Face-to-face interviews were conducted by using structured questionnaires. The study was approved by the University Ethical Committee and the UAE Ministry of Health before data collection. Descriptive statistics were computed to describe all the questionnaire items. The chi-square test was used to compare the study's categorical variables. A binary logistic regression analysis was used to predict the relationship between BF and its associated factors. Statistical tests with P-values < 0.05 were considered statistically significant.

Results

The mean age of the participating mothers was 30.6 (SD 5.5) years. Results showed that the prevalence of exclusive breastfeeding among the study participants was 24.4% (31.1% in Sharjah and 22% in Dubai; P = 0.003). The binary logistic regression reported that mother's and father's education, skin-to-skin period, number of children, mothers' health, and place of living were significantly associated with exclusive breastfeeding (P < 0.05). The results reported a significant association between EB and duration of breastfeeding (OR = 6.9, P = 0.002), husband education (OR = 2.1, P = 0.015), mother education (OR = 1.3, P = 0.027), number of children (OR = 7.9, P = 0.045), having any health problem (OR = 1.2, P = 0.045), and living place (OR = 1.4, P = 0.033), and a non-significant positive effect of family size and family income. Furthermore, the result reported a significant association between mixed breastfeeding and duration of breastfeeding (OR = 0.1, P = 0.000), skin-to-skin period (OR = 0.3, P = 0.002), underweight (OR = 4.7, P = 0.034), last infant's sex (OR = 1.6, P = 0.010), having maid at home (OR = 2.1, P = 0.000), number of children (OR = 0.2, P = 0.013), and living place (OR =1.1, P = 0.014), and a non-significant association with family size and family income.

Conclusions

Therefore, a health promotion program for exclusive breastfeeding during antenatal health visits, together with initiating health policies in maternal hospitals to encourage the initiation of breastfeeding during the first hour of birth and the introduction of skin-to-skin contact during the first 5 min of birth are highly recommended.

Sex inequality in early initiation of breastfeeding in 24 sub-Saharan African countries: A multi-country analysis of Demographic and Health Surveys

Background

The Sustainable Development Goal (SDG) 3 aims at reducing neonatal and under-5 mortality to below 12 per 1000 and 25 per 1000 live births, respectively, globally by 2030. Studies have found that initiation of breastfeeding within one hour of birth and continuous breastfeeding for over 12 months can positively impact neonatal and infant health. However, there is evidence that the sex of a child may influence the breastfeeding practices of a mother. Thus, we examined sex inequality in early breastfeeding initiation in sub-Saharan Africa.

Materials and methods

Data from Demographic and Health Surveys conducted in 24 sub-Saharan African countries between January 2010 and December 2019 were pooled and analysed. A total of 137,677 women of reproductive age (15–49 years) were considered in this study. Bivariate and multivariable regression analyses were performed, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) with statistical significance at a p-value less than 0.05.

Results

The highest inequality in early initiation of breastfeeding was reported in Togo with a difference of 5.21% between the female and male children, while the lowest inequality was reported in Guinea with 0.48% difference between the female and male children. A higher odds of breastfeeding within 1 hour was observed among female children [cOR = 1.05; 95%(CI = 1.02–1.09)] compared to male children, and this persisted after controlling for the confounders included in this study [aOR = 1.05; 95%(CI = 1.02–1.08)].

Conclusion

We found higher odds for early breastfeeding initiation of female children compared to male children in sub-Saharan Africa. To reduce breastfeeding initiation inequalities, programmes that educate and encourage early initiation of breastfeeding irrespective of the child sex should be promoted among mothers.

Maternal and neonatal peripartum factors associated with late initiation of breast feeding in Bangladesh: a secondary analysis

OBJECTIVES

Late initiation of breast feeding (LIBF) is associated with increased neonatal mortality and morbidity. This study aimed to assess the association between intrapartum, early postpartum and neonatal factors, and LIBF in Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

In this analysis, we used data from the mothers participating in a cluster-randomised controlled trial (Rang-Din Nutrition Study) conducted in rural northwest Bangladesh. Mothers (n=3594) were interviewed about the time of initiation of breast feeding, and peripartum maternal and neonatal complications within the first 72 hours of delivery. LIBF was defined as initiation of breast feeding 1 hour after birth. Factors associated with LIBF were identified by multivariable logistic regression analysis.

MAIN OUTCOME MEASURES

Prevalence and associated factors of LIBF.

RESULTS

The prevalence of LIBF was 18.5%. Factors significantly associated with LIBF in multivariable logistic regression were assisted vaginal delivery (adjusted OR (AOR) 2.17, 95% CI 1.44 to 3.27); delivery by caesarean section (AOR 9.67, 95% CI 7.21 to 12.96); maternal health problems during childbirth (AOR 1.61, 95% CI 1.30 to 2.00); preterm newborns (AOR 1.39, 95% CI 1.09 to 1.78); newborns moved slowly immediately after birth (AOR 1.43, 95% CI 1.05 to 1.94); and sick newborns (AOR 1.60, 95% CI 1.12 to 2.29).

CONCLUSIONS

Findings from this study suggest that to reduce LIBF, peripartum maternal and neonatal complications should be prevented and treated.

TRIAL REGISTRATION NUMBER

NCT01715038.

Association between Mother's Education and Infant and Young Child Feeding Practices in South Asia

The association between mother’s education and the World Health Organization’s (WHO’s) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother’s education and the WHO’s eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)—Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother’s education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.

Prevalence of Infant and Young Child Feeding Practices and Differences in Estimates of Minimum Dietary Diversity Using 2008 and 2021 Definitions: Evidence from Bangladesh

Background

Infant and young child feeding (IYCF) practices directly impact the health of <2-y-old children. Minimum dietary diversity (MDD) is an IYCF indicator to assess feeding practices of children aged 6-23 mo. The definition of MDD has recently been updated by the WHO and UNICEF, substituting "≥4 out of 7 food groups" (MDD-7FG) with "≥5 out of 8 food groups" (MDD-8FG).

Objectives

The goals of this study were to estimate the prevalence of IYCF indicators and identify the implications of the change in the prevalence of MDD at the national and regional levels of Bangladesh.

Methods

This study used data from the National Food Security and Nutrition Surveillance 2018-2019 round. A total of 1992 children aged 0-23 mo were included in this analysis. IYCF indicators and MDD were calculated according to the WHO-UNICEF guidelines. The difference between the prevalence of MDD-7FG and MDD-8FG is presented as percentage points.

Results

The prevalence of early initiation of breastfeeding was 43.8%, and exclusive breastfeeding was 56.2%. Approximately 55% of children maintained MDD (MDD-7FG), 48% received minimum meal frequency, and 28% received a minimum acceptable diet. Compared with MDD-7FG, the prevalence of MDD-8FG was lower among 6-23-mo-old children. The difference between MDD prevalence (MDD-8FG vs. MDD-7FG) was high for boys (44.0% vs. 53.2%), children aged 12-23 mo (53.4% vs. 63.4%), in urban areas (30.2% vs. 42.4%), in the Dhaka administrative division (42.0% vs. 56.3%), among uneducated mothers (37.1% vs. 47.1%), in households with ≤4 members (44.3% vs. 55%), and for middle-class households (40.3% vs. 57.6%).

Conclusions

The new method led to a decrease in the prevalence of MDD in Bangladesh. As the country prepares to implement the new indicator, it is critical to disseminate the new knowledge and its positive implication for improved child feeding and nutrition.

Determinants of optimal breastfeeding practices in Indonesia: findings from the 2017 Indonesia Demographic Health Survey

Objectives

Understanding the factors influencing mothers’ decision to breastfeed their infants is essential to formulate effective breastfeeding interventions. This study explored the determinants of optimal breastfeeding indicators in Indonesia.

Methods

We used the 2017 Indonesia Demographic and Health Survey to analyze factors associated with early initiation of breastfeeding, exclusive breastfeeding (EBF), and continued breastfeeding at 1 year (CBF-1) and 2 years (CBF-2). Multivariate logistic regression models were used to examine bio-demographic, socio-cultural, and behavioral characteristics associated with breastfeeding after considering the survey design effect.

Results

The risk of delayed breastfeeding initiation was higher among infants who were born smaller, first-born children, were delivered via cesarean delivery, and did not have immediate skin-to-skin contact (p<0.01). Infant’s age, birth pattern, household wealth index, and the mother’s occupation and smoking status were predictors of EBF (p<0.05). CBF-1 was less common among first-time mothers and those working in the non-agricultural sector, mothers from wealthier families, and mothers who had cesarean deliveries (p<0.01). Infant’s age was negatively associated with CBF-2 (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.74 to 0.99). Mothers attending college were less likely to practice CBF-2 than those with no education or primary education (aOR, 0.45; 95% CI, 0.26 to 0.77). The absence of postnatal visits was a risk factor for CBF-1 and CBF-2 (p<0.05).

Conclusions

Breastfeeding interventions in Indonesia should pay particular attention to at-risk groups such as women from wealthier families, working outside the agricultural sector, and with a higher education level. Nutrition-sensitive programs (e.g., postnatal care and smoking cessation) should also be encouraged.

Child Feeding Practices of Childbearing Mothers and Their Household Food Insecurity in a Coastal Region of Bangladesh

The current condition of ensuring WHO-recommended newborn and young child feeding practice is becoming a challenge in many developing nations, particularly in places where family food security is threatened. Because many households in underdeveloped nations frequently face acute food shortage due to poverty, optimal child nutrition is jeopardized. The purpose of this study was to analyze the child feeding behaviors of mothers with children aged 0-24 months and to investigate their household food insecurity in a coastal region of Bangladesh, Suborno Char (one of Noakhali District’s coastal neighbourhoods) was studied from October 2019 to April 2020. In this study, a cross-sectional survey with multistage sampling technique was employed, and Suborno Char of Noakhlai district was purposely sampled of 400 women and their children aged 0-24 months. Data were obtained using a standard questionnaire and were analyzed using statistical functions in SPSS 20.0.0. Exclusive breastfeeding 53.5%, timely supplemental feeding 75.5%, and feeding children meals from homemade, canned/formula/fortified, both homemade and canned, milk these 4 food groups were at 22.2%. The moms' education level was strongly associated with their child feeding practices. Mothers from food insecure homes were less likely to exclusively breastfeed than mothers from food secure households after drawing interpretation of univariate & multivariate analysis of variables crude odds ratio (COR) and adjusted odds ratio (AOR) and confidence interval (CI) (COR .233 at 95% CI 0.083, .655 and AOR .478 at 95% CI 0.133, 1.713). Similar outcomes were seen for early complementary feeding and minimal dietary diversification of children. In conclusion, this study discovered a less dietary inclusion trend of child feeding practices among moms (0-24 months childbearing) in Bangladesh’s coastal region.

Predicting Risk for Early Breastfeeding Cessation in Israel

OBJECTIVES

This study aimed to 1) Examine factors associated with cessation of exclusive breastfeeding in Israel and 2) Develop predictive models to identify women at risk for early exclusive breastfeeding cessation.

METHODS

The study used data from longitudinal national representative infant nutrition survey in Israel (n = 2119 participants). Logistic regression was used to identify risk factors and build predictive models.

RESULTS

The rate of exclusive breastfeeding cessation increased from 45.4% at 2 months to 85.7% at 6 months. Five factors were significantly associated with higher odds of exclusive breastfeeding cessation at 2 months: being a primapara, low educational level, lack of previous breastfeeding experience, negative attitude towards birth, and lack of intention to breastfeed. Six factors were significantly associated with higher odds of exclusive breastfeeding cessation at 6 months: younger age, being in a relationship with a partner, lower religiosity level, cesarean delivery, not taking folic acid during pregnancy, and negative attitude towards birth. Both 2 and 6-months models had good predictive performance (C-statistic of .72 and .68, accordingly).

CONCLUSIONS FOR PRACTICE

This nationwide study successfully identified several predictors of exclusive breastfeeding cessation and created breastfeeding cessation prediction tools for two time periods (2 and 6 months). The resulting tools can be applied to identify women at risk for stopping exclusive breastfeeding in hospitals or at community clinics. Further studies should examine practical aspects of applying these tools in practice and explore whether applying those tools can lead to higher exclusive breastfeeding rates.

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Impact of cesarean section on timely initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis

Background

Timely initiation of breastfeeding is feeding of breast milk within one hour of birth, however, three in five babies were not breastfed in the first hour of birth globally. There is evidence that cesarean section is the major constraint for this low prevalence, but the impact of cesarean section on timely initiation of breastfeeding in Ethiopia is limited. Therefore, this meta-analysis aimed to provide evidence for policy makers, health professionals and program implementers.

Methods

This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic bibliographic databases such as PubMed/Medline, EMBASE, PsycINFO, CINHAL, Scopus, Google Scholar, Science Direct and Cochrane Library were used to search relevant studies and was conducted up to February 2021. Random effects model meta-analysis was applied to estimate the pooled impact of cesarean section on timely initiation of breastfeeding with 95% confidence intervals (CI). I² statistical test and, funnel plot and Egger’s test were used to check heterogeneity and publication bias across included studies respectively.

Results

According to meta-analysis of 17 studies, the pooled estimate of timely initiation of breastfeeding among women who had cesarean section in Ethiopia was 40.1% (95% CI 33.29, 46.92). The meta-analysis of 29,919 study participants showed that cesarean section was associated with a 79% lower odds of timely initiation of breastfeeding compared with vaginal birth (OR 0.21; 95% CI 0.16, 0.28).

Conclusions

In Ethiopia, almost only one-third of mothers who gave birth by cesarean section initiate breastfeeding within one hour of birth, much lower than the pooled prevalence among general population. Special health promotion, intervention and healthcare provider support during immediate or early skin to skin contact, and having focused breastfeeding guidelines for post-operative patient and trained health professionals should be considered for mothers who give birth through cesarean section.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00399-9.

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.

Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.

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.

Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.

Breastfeeding Practices among Adolescent Mothers and Associated Factors in Bangladesh (2004-2014)

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0-23 months of adolescent mothers aged 12-19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2-3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12-18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0-5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.

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.

Determinants of early initiation of breastfeeding in Papua New Guinea: a population-based study using the 2016-2018 demographic and health survey data

Background

Initiation of breastfeeding after birth comes with a wide range of benefits to the child. For example, it provides the child with all essential nutrients needed for survival within the first six months of birth. This study sought to determine the prevalence and factors associated with early initiation of breastfeeding (EIB) in Papua New Guinea.

Methods

We utilized the Demographic and Health Survey data of 3198 childbearing women in Papua New Guinea. We employed descriptive and binary logistic regression analyses. We presented the results as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR), with 95% confidence intervals (CI) signifying level of precision. Level of statistical significance was set at p < 0.05.

Results

Women aged 20–29 [AOR = 1.583, CI = 1.147–2.185] and those aged 30+ [AOR = 1.631, CI = 1.140–2.335] had higher odds of EIB, compared to those aged 15–19. Women from the Islands region had lower odds [AOR = 0.690, CI = 0.565–0.842] of EIB, compared to those in Southern region. Women who delivered through caesarean section had lower odds of EIB, compared to those who delivered via vaginal delivery [AOR = 0.286, CI = 0.182–0.451]. Relatedly, women who delivered in hospitals had lower odds of EIB [AOR = 0.752, CI = 0.624–0.905], compared to those who delivered at home. Women who practiced skin-to-skin contact with the baby [AOR = 1.640, CI = 1.385–1.942] had higher odds of EIB, compared to those who did not. Women who read newspaper or magazine at least once a week had lower odds of EIB [AOR = 0.781, CI = 0.619–0.986], compared to those who did not read newspaper at all.

Conclusion

The prevalence of EIB in Papua New Guinea was relatively high (60%). The factors associated with EIB are age of the women, region of residence, mode of delivery, place of delivery, practice of skin-to-skin contact with the baby, and exposure to mass media (newspaper). To increase EIB in Papua New Guinea, these factors ought to be considered in the implementation of policies and measures to strengthen existing policies. Health providers should educate mothers on the importance of EIB.

Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh?

BACKGROUND

Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh.

METHOD

We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders.

RESULTS

The prevalence of EIBF practices were 69.6%(95% CI:67.8-71.3); 72.2%(95% CI:67.8-71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3-75.6) mother's in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35-0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12-0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding.

DISCUSSIONS

This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.

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 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 15,305 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 51.3% (95% CI 48.1, 54.6%). Mothers who received antenatal care were twice as likely to timely initiate breastfeeding compared to mothers who did not receive antenatal care (Adjusted prevalence odds ratios [aPOR] 2.01, 95% CI 1.03, 3.95). Mothers who were assisted by a skilled attendant at birth had 90% higher odds of timely initiation of breastfeeding compared to mothers who were not assisted by a skilled attendant (aPOR 1.90, 95% CI 1.41, 2.55). Mothers who delivered by caesarean section had 76% lower odds of timely initiation of breastfeeding compared to mothers who had a vaginal delivery (aPOR 0.24, 95, 95% CI 0.16, 0.36). Mothers who had planned their pregnancy had 45% higher odds of timely initiation of breastfeeding compared to mothers who had an unplanned pregnancy (aPOR 1.45, 95% CI 1.09, 1.92). There were also 84% and 55% higher odds of timely initiation of breastfeeding among mothers who perceived their baby was large (aPOR 1.84, 95% CI 1.32, 2.58), and of average size (aPOR 1.55, 95% CI 1.11, 2.17) 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 or small sized babies, prevent unplanned pregnancies, and promote antenatal care attendance among pregnant women.

Birth Patterns and Delayed Breastfeeding Initiation in Indonesia

Objectives

This study was conducted to examine the association between birth patterns (defined in terms of birth order and interval) with delayed breastfeeding initiation in Indonesia.

Methods

A cross-sectional study was carried out using data from the Indonesian Demographic and Health Survey 2017. The weighted number of respondents was 5693 women aged 15-49 years whose youngest living child was less than 2 years old. Multivariable logistic regression was conducted to evaluate associations between birth patterns and delayed breastfeeding initiation after adjusting for other covariates.

Results

This study found that 40.2% of newborns in Indonesia did not receive timely breastfeeding initiation. Birth patterns were significantly associated with delayed breastfeeding initiation. Firstborn children had 77% higher odds of experiencing delayed breastfeeding initiation (adjusted odds ratio, 1.77; 95% confidence interval, 1.02 to 3.04; p<0.05) than children with a birth order of 4 or higher and a birth interval ≤ 2 years after adjusting for other variables.

Conclusions

Firstborn children had higher odds of experiencing delayed breastfeeding initiation. Steps to provide a robust support system for mothers, especially first-time mothers, such as sufficient access to breastfeeding information, support from family and healthcare providers, and national policy enforcement, will be effective strategies to ensure better practices regarding breastfeeding initiation.

Determinants of breastfeeding practices in Myanmar: Results from the latest nationally representative survey

Optimal breastfeeding practices can ensure healthy growth and development of infants, which in the long term can impact the country's economic development. Nevertheless, Myanmar has yet to achieve the WHO's target of 70% for early initiation of breastfeeding, and the country's target of 90% for exclusive breastfeeding. The purpose of this study was to assess the associations between early initiation of breastfeeding and exclusive breastfeeding and bio-demographic, socio-economic and behavioral factors in Myanmar. Using the 2015-2016 Myanmar Demographic and Health Survey, the analysis of early initiation of breastfeeding was based on a sample of 1,506 under-2 children and the analysis of exclusive breastfeeding was based on a sample of 376 children aged 0-5 months. Multiple logistic modeling, with heteroskedasticity-adjusted standard errors, was used. The prevalence rates of early initiation of breastfeeding and exclusive breastfeeding in the study were 67.9% and 52.2% respectively. Having a vaginal delivery (AOR = 2.5; 95% CI = 1.7-3.7) and having frequent (≥ 4) antenatal visits (AOR = 2.4; 95% CI = 1.5-3.8) were associated with higher odds of early initiation of breastfeeding. Having a postnatal checkup (AOR = 0.5; 95% CI = 0.3-0.9) and having an infant that was perceived to be small at birth (AOR = 2.5; 95% CI = 1.1-5.7, for infants perceived to be large at birth) were significantly associated with decreased odds of exclusive breastfeeding. In order to promote optimal breastfeeding practices, this study suggested that delivery and quality of health services during pregnancy need to be strengthened in Myanmar.

Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey

Introduction

Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women.

Methods

This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women’s individual, household and community level characteristics.

Results

Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women’s non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman’s husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28–3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40–0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65–2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women’s age, education or rural-urban residence display no statistically significant relationship with EIBF.

Conclusion

Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.

Determinants of Early Initiation of Breastfeeding among Mothers of Children Aged Less than 24 Months in Northwestern Romania

Early initiation of breastfeeding (EIBF), defined as putting newborns to the breast within 1 h of birth, may have important benefits for both infant and mother. The aim of this study was to assess EIBF practices and its determinants in northwestern Romania. This cross-sectional study was conducted from March to June 2019, based on a sample of 1399 mothers of children aged less than 24 months. The sample was recruited from the community, from 29 cities and 41 communes distributed across the six counties of the northwestern region of Romania. Mothers responded by face-to-face interviews to a structured questionnaire. Multivariate logistic regression was used to identify factors independently associated with EIBF. Only 24.3% of the mothers initiated breastfeeding within 1 h of birth. Delivering at a private hospital (adjusted odds ratio (AOR): 5.17, 95% confidence interval (CI) 3.87, 6.91), vaginal delivery (AOR: 4.39, 95% CI 3.29, 5.88), mother–newborn skin-to-skin contact for 1 h or more (AOR: 55.6, 95% CI 23.0, 134.2), and breastfeeding counseling during antenatal visits (AOR: 1.48, 95% CI 1.12, 1.97) were factors associated with increased likelihood of EIBF. Overall, the practice of EIBF was poor. Targeting modifiable factors associated with EIBF may be used to improve early initiation practice.

Exclusive breastfeeding among Saudi mothers: Exposing the substantial gap between knowledge and practice

Background:

Rates of exclusive breastfeeding are exceedingly low in the Arabic world. This study aims to estimate the local prevalence of, and knowledge about, exclusive breastfeeding in Saudi Arabia.

Method:

This is a cross-sectional survey of mothers of infants aged 6–12 months who attended Taif-based “well-baby clinic.” A structured questionnaire was developed to explore predictors of, and participants’ knowledge about, exclusive breastfeeding.

Results:

Participants in the study were 202 mothers. The rate for initiation of breastfeeding in the first hour after childbirth was 13.9%. The prevalence of exclusive breastfeeding was 16.3%. Knowledge level was great among participating mothers as 65.3% of mothers scored over 75% of the total knowledge score and 95% got more than half of the questions right. Only having 3–6 children (P = 0.023) and 1-year interpregnancy interval (P = 0.005) were associated with the positive likelihood of exclusive breastfeeding. Baby age (P = 0.0218), birth in a private facility (P = 0.00843), and university education (P = 0.0131) were associated with better knowledge.

Discussion and Conclusion:

Rates of exclusive breastfeeding practice are low in Saudi Arabia despite adequate knowledge about its benefits and necessity.