Prevalence and predictors of delayed initiation of breastfeeding among postnatal women at a tertiary hospital in Eastern Uganda: a cross-sectional study

BACKGROUND

The rates for the delayed initiation of breastfeeding in Uganda remain unacceptably high between 30% and 80%. The reasons for this are not well understood. We aimed to determine the prevalence and predictors for the delayed initiation of breastfeeding in Eastern Uganda.

METHODS

This study employed a cross-sectional study design. A total of 404 mother-infant pairs were enrolled onto the study between July and November, 2020 at Mbale regional referral hospital (MRRH). They were interviewed on socio-demographic related, infant-related, labour and delivery characteristics using a structured questionnaire. We estimated adjusted odds ratios using multivariable logistic regression models. All variables with p < 0.25 at the bivariate level were included in the initial model at the multivariate analysis. All variables with p < 0.1 and those of biological or epidemiologic plausibility (from previous studies) were included in the second model. The variables with odds ratios greater than 1 were considered as risk factors; otherwise they were protective against the delayed initiation of breastfeeding.

RESULTS

The rate of delayed initiation of breastfeeding was 70% (n = 283/404, 95% CI: 65.3 - 74.4%). The factors that were associated with delayed initiation of breastfeeding were maternal charateristics including: being single (AOR = 0.37; 95%CI: 0.19-0.74), receiving antenatal care for less than 3 times (AOR = 1.85, 95%CI: 1.07-3.19) undergoing a caesarean section (AOR = 2.07; 95%CI: 1.3-3.19) and having a difficult labour (AOR = 2.05; 95%CI: 1.25-3.35). Infant characteristics included: having a health issue at birth (AOR = 9.8; 95%CI: 2.94-32.98).

CONCLUSIONS

The proportion of infants that do not achieve early initiation of breastfeeding in this setting remains high. Women at high risk of delaying the initiation of breastfeeding include those who: deliver by caesarean section, do not receive antenatal care and have labour difficulties. Infants at risk of not achieving early initiation of breastfeeding include those that have a health issue at birth. We recommend increased support for women who undergo caesarean section in the early initiation of breastfeeding. Breastfeeding support can be initiated in the recovery room after caesarean delivery or in the operating theatre. The importance of antenatal care attendance should be emphasized during health education classes. Infants with any form of health issue at birth should particularly be given attention to ensure breastfeeding is initiated early.