Prevalence and factors associated with timely initiation of breastfeeding in Kilimanjaro region, northern Tanzania: a cross-sectional study

Timely initiation of breastfeeding and its associated factors among immediate postpartum mother-newborn pairs in Debre Tabor comprehensive specialized hospital, South Gondar Zone, North West, Ethiopia

BACKGROUND

Initiation of breast feeding within one hour of birth is the easiest and most cost-effective intervention to reduce the risk of neonatal morbidity and mortality. Conducting studies immediately after an hour of birth for the timely initiation of breastfeeding has the significance of initiating breastfeeding and acting immediately. However, there was a paucity of information in the region as well as in the country at large. Therefore, the aim of this study was to assess the magnitude of timely initiation of breastfeeding and its associated factors among immediate postpartum mother-newborn pairs in Debre Tabor comprehensive specialized hospital, northwest Ethiopia, in 2024.

METHOD

An institutional-based cross-sectional study was conducted from October 25, 2023, to January 25, 2024, at Debre Tabor Comprehensive Specialized Hospital. A total of 478 immediate postpartum mothers were selected at birth using systematic random sampling techniques. Data were collected using chart reviews, interviewer-administered questionnaires, and through observation. Data entry and analysis was performed by Epi-Data version 4.6.02 and Statistical Package for Social Sciences version 25(SPSS) soft war respectively. Descriptive statistics were computed to determine the frequency of variables. After doing a binary logistic regression analysis, a p-value less than 0.25 indicated a potential candidate for multivariable analysis aimed at identifying statistically relevant factors. Both crude and adjusted odds ratios (AOR) were computed, and the levels of significance were declared based on the AOR with a 95% confidence interval (CI) at a p-value < 0.05.

RESULTS

In this study, the prevalence of timely initiation of breastfeeding was 73.7% with a 95% CI (69.65%, 77.67%). Being multiparous (AOR: 2.25, 95% CI: 1.32, 3.84), receiving counseling immediately after delivery (AOR: 4.19, 95% CI: 2.20, 7.98), receiving support and guidance from health care providers (AOR: 1.95, 95% CI: 1.01, 3.77), having no obstetric complications during and immediately after delivery (AOR: 4.44, 95% CI: 2.34, 8.42), and practicing rooming-in (AOR: 3.65, 95% CI: 2.05, 6.51) were significantly associated variables with timely initiation of breast feeding.

CONCLUSION

The overall timely initiation of breastfeeding in this study was lower than the World Health Organization's recommendations. Therefore, interventions need to focus on mothers who developed obstetric complications, primiparous mothers, improper rooming-in, a lack of advice immediately after delivery, and the support and guidance of mothers on the timely initiation of breastfeeding to improve the timely initiation of breastfeeding practice.

Prediction of delayed breastfeeding initiation among mothers having children less than 2 months of age in East Africa: application of machine learning algorithms

Background

Delayed breastfeeding initiation is a significant public health concern, and reducing the proportion of delayed breastfeeding initiation in East Africa is a key strategy for lowering the Child Mortality rate. However, there is limited evidence on this public health issue assessed using advanced models. Therefore, this study aimed to assess prediction of delayed initiation of breastfeeding initiation and associated factors among women with less than 2 months of a child in East Africa using the machine learning approach.

Methods

A community-based, cross-sectional study was conducted using the most recent Demographic and Health Survey (DHS) dataset covering the years 2011 to 2021. Using statistical software (Python version 3.11), nine supervised machine learning algorithms were applied to a weighted sample of 31,640 women and assessed using performance measures. To pinpoint significant factors and predict delayed breastfeeding initiation in East Africa, this study also employed the most widely used outlines of Yufeng Guo's steps of supervised machine learning.

Results

The pooled prevalence of delayed breastfeeding initiation in East Africa was 31.33% with 95% CI (24.16-38.49). Delayed breastfeeding initiation was highest in Comoros and low in Burundi. Among the nine machine learning algorithms, the random forest model was fitted for this study. The association rule mining result revealed that home delivery, delivered by cesarean section, poor wealth status, poor access to media outlets, women aged between 35 and 49 years, and women who had distance problems accessing health facilities were associated with delayed breastfeeding initiation in East Africa.

Conclusion

The prevalence of delayed breastfeeding initiation was high. The findings highlight the multifaceted nature of breastfeeding practices and the need to consider socioeconomic, healthcare, and demographic variables when addressing breastfeeding initiation timelines in the region. Policymakers and stakeholders pay attention to the significant factors and we recommend targeted interventions to improve healthcare accessibility, enhance media outreach, and support women of lower socioeconomic status. These measures can encourage timely breastfeeding initiation and address the identified factors contributing to delays across the region.

The Impact of Mode of Delivery and Postpartum Conditions on Breastfeeding: A Cross-Sectional Study

Breast milk is the optimal and essential source of nutrients for babies. Many women, however, do not breastfeed or stop early after giving birth, often due to lack of support. For newborns delivered by caesarean section, there is often a delay, or no skin-to-skin contact after birth; thus, early breastfeeding is not achieved. Separation, complementary feeding or pacifier use also limits the mother's ability to breastfeed. A quantitative, cross-sectional study was conducted. Sociodemographic data, the mode of delivery and postpartum circumstances, information on breastfeeding, and the method and duration of feeding were collected (n = 2008). Two-thirds of children born by caesarean section did not have skin-to-skin contact after birth (p < 0.001). Lack of rooming-in placement increased the incidence of more frequent complementary feeding (p < 0.001) and shortened the duration of exclusive breastfeeding (p < 0.001). The duration of breastfeeding may also be negatively affected by scheduled feeding (p = 0.007) and pacifier utilization (p < 0.001). The mode of delivery and postpartum circumstances directly affecting the mother and the newborn can affect the feasibility of breastfeeding and the duration of exclusive and partial breastfeeding. For positive breastfeeding outcomes, skin-to-skin contact immediately after birth, rooming-in and unrestricted, demand breastfeeding, as well as the avoidance of the use of pacifiers, are recommended.

The multiple factors of suboptimal early feeding practices among infants aged 0–5 months in Indonesia

Background

Optimal early infant feeding practices are critical to ensure adequate nutrition for infants’ growth and development. This study aimed to examine the determinants of suboptimal early feeding practices (i.e., delayed initiation of breastfeeding, prelacteal feeding, and non-exclusive breastfeeding) among infants aged 0–5 months in Indonesia.

Methods

We used data collected in the 2012 and 2017 Indonesia Demographic and Health Surveys. Analyses were conducted using information from 3,198 live-born singleton infants aged 0–5 months. The primary outcomes used were: (1) delayed initiation of breastfeeding in the first hour after birth, (2) prelacteal feeding in the first 3 days, and (3) non-exclusive breastfeeding in the last 24 h preceding the survey. Potential predictors analyzed were categorized into the environmental, household, maternal, pregnancy, delivery, and child characteristics. Logistic regression analyses were performed to identify factors significantly associated with each outcome.

Results

Approximately 78,6% of infants aged 0–5 months in Indonesia had at least one of the three suboptimal early infant feeding practices. We found a strong association between the three outcome indicators analyzed. The determinants of delayed initiation of breastfeeding included infants from Sumatera region (adjusted odds ratios (aOR) = 2.02, p &lt; 0.001), infants delivered by Cesarean section (aOR = 2.78, p &lt; 0.001), and in non-health facilities (aOR = 1.53, p = 0.003). The determinants of prelacteal feeding in the first 3 days included infants living in urban areas (aOR = 1.32, p = 0.035), the first birth-ranked infants (aOR = 1.32, p = 0.019), and infants who had delayed initiation of breastfeeding in the first hour of life (aOR = 3.90, p &lt; 0.001). The determinants of non-exclusive breastfeeding in the last 24 h included infants whose mothers worked in non-agricultural fields (aOR = 1.52, p &lt; 0.001), infants delivered by Cesarean section (aOR = 1.33, p = 0.044), and the first birth-ranked infants (aOR = 1.28, p = 0.039).

Conclusion

There was a high percentage of infants aged 0–5 months who had suboptimal feeding practices in Indonesia. As we found multiple factors associated with suboptimal early feeding practices among infants, integrated approaches, including health promotion and supportive public policy, are required to ensure infants receive adequate nutrition in the early stages of life.

Early Initiation of Breastfeeding and Associated Factors Among Women of Reproductive age in Simiyu Region, Tanzania

Background

Breast milk provides infants with complete nutrition for immune development and protection against childhood diseases and associated mortality. Early initiation of breastfeeding (EIBF) aids in providing colostrum to newborns, providing protection against infection, and improving newborn and infant survival. Although Simiyu reported the lowest prevalence of EIBF in Tanzania, no study has investigated the factors associated with EIBF in this region.

Objective

The study aimed to determine early breastfeeding initiation prevalence and associated factors among women of reproductive age in the Simiyu region.

Methodology

We used data from a cross-sectional study conducted by AMREF Health Africa among 669 women of reproductive age (15-49 years) in the Simiyu region, Tanzania. An interviewer-administered questionnaire collected data on breastfeeding practices (including breastfeeding initiation) among others. A multilevel logistic regression analysis estimated the adjusted odds ratio (OR) and 95% confidence intervals (CI) for factors associated with EIBF.

Results

The mean age of 669 women analyzed was 28.3 years (SD ± 6.8). The prevalence of EIBF was 62.2%, ranging from 52.7% in Bariadi district to 73.3% in Maswa district. Lower odds of EIBF were among women who had a caesarian section (OR = 0.41; 95% CI = 0.17-0.98) and those who gave birth to male children (OR =  0.57; 95%CI = 0.39-0.82) while higher odds of EIBF were among mothers who reported skin-to-skin contact (OR =  2.40; 95%CI = 1.53-3.83) and from Maswa district (OR = 2.73; 95%CI = 1.09-6.89).

Conclusion

The prevalence of EIBF in the Simiyu region remains low (62%) relative to the global target of 70% by 2030 and varies by district. To promote EIBF in the region, good engagement and communication practices between mothers and healthcare providers should be emphasised in educating women about the importance of EIBF. Moreover, the practice of skin-to-skin contact between mother and child should be encouraged immediately after delivery.

Factors associated with early initiation of breastfeeding among children less than 24 months old: the 2019 Ethiopian mini demographic and health survey

Background

The world Health Organization recommended that all mothers be supported to initiate breastfeeding as soon as possible after birth, within the first hour. This study examined the determinants of early initiation of breastfeeding in Ethiopia by using data from the 2019 Ethiopia Mini Demographic and Health Survey.

Methods

The data for this study was extracted from the 2019 Ethiopia Mini Demographic and Health Survey. A total of 1948 children aged less than 24 months at the time of the survey were included for analysis from the nine regional states and two city administrations. The analysis was carried out in STATA Version 14.2 software using survey commands to account for the complex sample design and apply sampling weights. A manual backward stepwise elimination approach was applied.

Result

The prevalence of early initiation of breastfeeding in Ethiopia was noted to be 75.2% [95% CI (71.9, 78.5%)]. In the multivariable analysis, mothers who had vaginal deliveries [AOR = 3.02 (95% CI: 1.55, 5.88)] had 3 times higher odds practicing early initiation of breastfeeding compared to mothers who had a cesarian section. Mothers aged between 35 and 49 years [AOR = 2.40, 95% CI: 1.20, 4.49] had 2.4 times higher odds of practicing early initiation of breastfeeding compared to mothers aged below 20 years. In addition, early initiation of breastfeeding was also associated with the region where mothers resided, in particular mothers in Amhara and Somali region, had lower odds of practicing early initiation of breastfeeding as compared with mothers residing in Tigray region.

Conclusion

Early initiation of breastfeeding in Ethiopia was found to be significantly associated with mode of delivery, mother’s age, and region. As a result, raising awareness about early initiation of breastfeeding is especially important for mothers who have had a cesarean section, which could be accomplished with the help of the health extension workforce.

Magnitude and determinants of breastfeeding initiation within one hour among reproductive women in Sub-Saharan Africa; evidence from demographic and health survey data: a multilevel study

Background

Early initiation of breastfeeding is one of the most simple and essential intervention for child development and survival in the world. World Health Organization recommended to begin breast milk with one hour after delivery. The objective of this study was to determine the magnitude of early initiation of breastfeeding in Sub-Saharan Africa using DHS data set.

Methods

This study was carried out within 32 Sub-Saharan African countries from 2010–2020, a pooled study of early initiation of breastfeeding was performed. For assessing model fitness and contrast, intra-class correlation coefficient, median odds ratio, proportional change in variance, and deviance were used. In order to identify possible covariates associated with early initiation of breastfeeding in the study area, the multilevel multivariable logistic regression model was adapted. Adjusted Odds Ratio was used with 95% confidence interval to declare major breastfeeding factors.

Result

The pooled prevalence of early initiation of breastfeeding in Sub-Saharan Africa countries was 57% (95% CI; 56%—61%), the highest prevalence rate of early initiation of breastfeeding was found in Malawi while the lowest prevalence was found in Congo Brazzaville (24%). In multilevel multivariable logistic regression model; wealth index (AOR = 1.20; 95% CI 1.16 – 1.26), place of delivery (AOR = 1.97; 95% CI 1.89 – 2.05), skin-to-skin contact (AOR = 1.51; 95% CI 1.47 – 1.57), mode of delivery (AOR = 0.27; 95% CI 0.25 – 0.29), media exposure (AOR = 1.36; 95% CI 1.31 – 1.41) were significantly correlated with early initiation of breastfeeding in Sub-Saharan Africa.

Conclusion

The magnitude of early initiation of breastfeeding rate was low in Sub-Saharan Africa. Covariates significantly associated with early initiation of breastfeeding was wealth index, place of delivery, mode of delivery, women educational status, and media exposure. Structural improvements are required for women with caesarean births to achieve optimal breastfeeding practice in Sub-Saharan Africa.

Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania

Purpose

We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years.

Patients and Methods

We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother's practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding.

Results

EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had >2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age.

Conclusion

Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.

Trends and determinants of breastfeeding within one hour in Ethiopia, further analysis of Ethiopian Demographic and Health Survey: multivariate decomposition analysis

Background

Despite the substantial efforts to improve timely/early initiation of breastfeeding, avoidance of colostrum, and delayed initiation of breastfeeding remains a big challenge in developing countries. Therefore, this study aimed to analyze the trends of early breastfeeding rate over time based on the Ethiopian Demographic and Health Survey (EDHS).

Methods

Secondary data analysis was conducted based on the Ethiopian Demographic Health Surveys (EDHSs) conducted in 2005, 2011, and 2016. A total weighted sample of 9, 111, 10,106, and 8564 in 2005, 2011, and 2016 respectively were included for analysis. Trend and Logistic based decomposition analysis technique was used for analyzing the trends of early breastfeeding initiation over time and factors contributing to the change in early breastfeeding initiation rate. STATA 15 was employed for data management and analyses. All analyses presented in this paper were weighted for the sampling probabilities and non-response.

Result

Among children age less than 5 years the rate of early breastfeeding initiation rate overtime was increased from 70.5% in 2005 to 72.7% in 2016. The highest rate of improvement was seen in the second phase of the study (2011–2016) while it shows a decline in the first phase (2005–2011) from 70.5 to 55.1%. The decomposition analysis indicated that about half of the overall change in early breastfeeding initiation rate was due to the difference in women’s composition. Particularly, an increase in health facility delivery and vaginal delivery was a significant predictor of the increasing rate of early breastfeeding initiation over the surveys.

Conclusion

Early initiation of breastfeeding slightly increasing over the last 10 years in Ethiopia. Half of the overall increase in the early initiation of breastfeeding was due to the change in compositional characteristics of women over 10 years in Ethiopia. Change in the composition of women according to health facility delivery and vaginal delivery were the major source of the increase in early breastfeeding initiation over time. Public interventions including promoting health facility delivery of women for further improvements of early breastfeeding initiation should be needed.