Trends and determinants of early initiation of breastfeeding and exclusive breastfeeding in Ethiopia from 2000 to 2016

Breast feeding techniques and associated factors among lactating primipara mothers during the postpartum period in Debre Markos health institutions, North West Ethiopia

BACKGROUND

Breastfeeding technique is a combination of positioning, attachment, and breast milk suckling. Breastfeeding problems are caused by incorrect breastfeeding practices, which lead to premature discontinuation of breastfeeding. Therefore, this study aimed to determine the proportion of breastfeeding techniques and associated factors among lactating primiparous mothers during the postpartum period in the Debre Markos town health facility in 2021.

METHODS

An institutional-based cross-sectional study was conducted from November 1st to December 30, 2021. A systematic sampling technique was utilized to select study participants. An observational checklist developed by WHO and an interviewer-administered questionnaire were used to collect data from 409 mothers. The collected data were entered into Epi-Data version 4.6.0.4 statistical software and then exported to SPSS version 24.0 for cleaning and analysis. Binary and multivariable logistic regression was carried out to identify the factors associated with the practice of effective breastfeeding techniques. A variable that has a p-value of ≤0.2 was transferred to a multivariable for further analysis. The strength of association was identified using an adjusted odds ratio with a 95% confidence interval, and a p-value <0.05 was taken as statistically significant.

RESULTS

The proportion of practicing effective breastfeeding techniques among lactating primipara mothers was 29.1% (CI: 24.7, 33.3). Baby aged ≥29 days, mothers who were living in urban, mothers who attended college or higher education, mothers who have heard about BFT practices, mothers who received counseling on BFT after delivery, and mothers whose breast nipples had everted were variables that were significantly associated with the practice of effective breastfeeding techniques.

CONCLUSION

The findings of this study revealed that the practice of effective breastfeeding techniques among lactating primipara mothers was lower in the study area. Therefore, healthcare providers should have to counsel mothers on how to position and attach their infants during breastfeeding.

PRACTICE IMPLICATION

The provision of breast-feeding method counseling to nursing mothers is one way to enhance the practices of breast feeding.

The association between intimate partner violence and breastfeeding practices in Cameroon: An analysis from demographic and health survey of 2018

Intimate partner violence is a major public health concern around the world. While its degrading effects on maternal health are well documented, it is not clear establishing a link with child health outcomes, especially on breastfeeding practices. Therefore, this paper aims to analyze the association between Intimate partner violence and breastfeeding practices in Cameroon using data from the 2018 demographic and health survey. Intimate partner violence is apprehended from its three dimensions (physical, emotional and sexual violence), and the two key breastfeeding practices are considered: early initiation to breastfeeding within an hour of delivery for children under 24 months of age, and exclusive breastfeeding during 24 h preceding the mother's interview for children under 6 months. The results of descriptive statistics suggest that 51.91 % (n = 1704) of mothers whose infants between 0 and 23 months of age who acquired early initiation to breastfeeding and 39.61 % (n = 484) of mothers whose infants between 0 and 5 months of age practiced exclusive breastfeeding. The estimated results of the logistic regression model suggest that emotional violence and sexual violence were significantly associated with low chances of early initiation to breastfeeding (OR: 0.675; 95 % CI: 0.528, 0.864; p < 0.05; OR: 0.741; 95 % CI: 0.525, 1.046; p < 0.1), which is not the case with physical violence which has no significant association. No dimension of Intimate partner violence was associated with exclusive breastfeeding, independently or with control for infant, maternal and household characteristics. We further performed robustness analysis, and the findings suggest that the associations are robust to consider another measure of Intimate partner violence and the duration of maternity leave. Thus, to improve breastfeeding practices, in particular early initiation to breastfeeding, public decision-makers should strengthen the fight against domestic violence by emphasizing sexual and emotional violence. This paper provides a benchmark for several future investigations that could discuss other breastfeeding practices and the policy challenges towards the length of maternity leave.

Multilevel analysis of early initiation of breastfeeding in Ethiopia

Introduction

Breast milk is the ideal food for the infant and is associated with various public health benefits for both the infant and the mother. The recommended time for early initiation of breastfeeding is within one hour after birth. The prevalence of early initiation of breastfeeding was lower than the plan of the Ethiopian Ministry of Health Sector Development program. Thus, the main objective of this study was to identify individual and group-level factors associated with the early initiation of breastfeeding in Ethiopia.

Methods

Secondary data on children was obtained from the 2019 Ethiopia mini-demographic and health survey. The survey was a population-based cross-sectional study and was downloaded from the Measure Demographic and Health Survey website (http://www.measuredhs.com). The study included a random sample of 2,125 last-born infants who were born within 24 months before the survey. A multilevel binary logistic regression analysis was employed to identify the factors associated with the early initiation of breastfeeding in Ethiopia. Statistical data was analyzed using the Statistical Analysis System (SAS 9.4).

Results

The prevalence of early breastfeeding initiation was 72%. The higher preceding birth interval (AOR = 1.18, 95% CI: 1.1076, 1.5451), the higher gestational age of infants (AOR = 1.38, 95% CI: 1.2796, 1.4782), the higher number of antenatal care visits (AOR = 1.26, 95% CI: 1.2340, 1.2934), delivery at a health facility (AOR = 1.60, 95% CI: 1.4585, 1.7515), vaginal delivery (AOR = 1.11, 95% CI: 1.1019, 1.1123), mothers with primary education (AOR = 1.14, 95% CI: 1.0204, 1.2738), mothers with secondary education (AOR = 1.54, 95% CI: 1.4678, 1.6190), and mothers with higher education (AOR = 2.62, 95% CI: 2.2574, 3.0526) were associated with higher odds of early initiation of breastfeeding. Being a rural dweller (AOR = 0.63, 95% CI: 0.5684, 0.7038) and the age of mothers (AOR = 0.44, 95% CI: 0.3921, 0.4894) were associated with lower odds of early initiation of breastfeeding.

Conclusion

Since the prevalence of early initiation of breastfeeding was minimal among rural mothers who delivered their child by caesarean section, this study strongly suggests special supportive care for these mothers.

Socioeconomic and geographic inequalities in antenatal and postnatal care components in India, 2016-2021

Despite the well-known importance of high-quality care before and after delivery, not every mother and newborn in India receive appropriate antenatal and postnatal care (ANC/PNC). Using India's National Family Health Surveys (2015-2016 and 2019-2021), we quantified the socioeconomic and geographic inequalities in the utilization of ANC/PNC among women aged 15-49 years and their newborns (N = 161,225 in 2016; N = 150,611 in 2021). For each of the eighteen ANC/PNC components, we assessed absolute and relative inequalities by household wealth (poorest vs. richest), maternal education (no education vs. higher than secondary), and type of place of residence (rural vs. urban) and evaluated state-level heterogeneity. In 2021, the national prevalence of ANC/PNC components ranged from 19.8% for 8 + ANC visits to 91.6% for maternal weight measurement. Absolute inequalities were greatest for ultrasound test (33.3%-points by wealth, 30.3%-points by education) and 8 + ANC visits (13.2%-points by residence). Relative inequalities were greatest for 8 + ANC visits (1.8 ~ 4.4 times). All inequalities declined over time. State-specific estimates were overall consistent with national results. Socioeconomic and geographic inequalities in ANC/PNC varied significantly across components and by states. To optimize maternal and newborn health in India, future interventions should aim to achieve universal coverage of all ANC/PNC components.

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

OBJECTIVES

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

DESIGN

Cross-sectional study design.

SETTING

Ethiopia.

PARTICIPANTS

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

OUTCOME MEASURE

Late initiation of breastfeeding practice.

RESULTS

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

CONCLUSION

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

Predictors of delayed initiation of breast milk and exclusive breastfeeding in Ethiopia: A multi-level mixed-effect analysis

BACKGROUND

Despite the well-established benefits of early initiation of breastfeeding and exclusive breastfeeding for the first six months to promote optimal neonatal and child health, evidence indicates that in Ethiopia, a significant number of newborns initiate breastfeeding late, do not adhere to exclusive breastfeeding (EBF) for the recommended duration, and instead are fed with bottles.

OBJECTIVE

To determine the proportion of delayed initiation of breast milk, exclusive breastfeeding, and its individual and community-level predictors among mothers in Ethiopia.

METHODS

A secondary data analysis was done using the 2019 Ethiopian Mini Demographic Health Survey data. We examined a weighted sample of 2,012 children born within the past 24 months and 623 children aged 0-5 months at the time of the survey. The data analysis was done using STATA version 15. To understand the variation in delayed initiation and exclusive breastfeeding, statistical measures such as the Intraclass correlation coefficient, median odds ratio, and proportional change in variance were calculated. We employed a multilevel mixed-effects logistic regression model to identify predictors for each outcome variable. Statistical significance was determined with a p-value < 0.05.

RESULTS

The proportion of delayed initiation of breast milk and exclusive breastfeeding were 24.56 and 84.5%, respectively. Women aged 34-49 years old (AOR = 0.33: 95% CI; 0.15-0.72), having a television in the house (AOR = 0.74: 95%CI; 0.33-0.97), delivered by cesarean section (AOR = 3.83: 95% CI; 1.57-9.32), and resided in the Afar regional state (AOR = 1.43: 95%CI; 1.03-12.7) were significantly associated with delayed initiation of breast milk. On the other hand, attended primary education (AOR = 0.67: 95%CI; 0.35-0.99), secondary education (AOR = 0.34: 95%CI; 0.19-0.53), women whose household headed by male (AOR = 0.68; 95% CI; 0.34-0.97), and rural residents (AOR = 1.98: 95%CI; 1.09-3.43) were significantly associated with exclusive breastfeeding practice.

CONCLUSION

Health promotion efforts that encourage timely initation of breast milk and promote EBF, focused on young mothers, those who gave birth through cesarean section, and those residing in urban and the Afar regional state. Furthermore, government health policymakers and relevant stakeholders should consider these identified predictors when revising existing strategies or formulating new policies.

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The health consequences of informal employment among female workers and their children: a systematic review

BACKGROUND

Informal employment is unprotected and unregistered and it is often characterized by precarious working arrangements. Although being a global phenomenon and the most common type of employment worldwide, scholarly attention to its health effects has only recently accelerated. While there is still some debate, informal employment is generally understood to be detrimental to workers' health. However, because women are more vulnerable to informality than men, attention is required to the health consequences of female workers specifically. We conducted a systematic review with the objective to examine the global evidence on the consequences of informal employment, compared to formal employment, on the health of female workers and their children.

METHODS

We searched peer-reviewed literature in Embase, Medline, PsychInfo, Scopus and Web of Science up until November 11, 2022. No restrictions were applied in terms of year, language or country. Individual-level quantitative studies that compared women of reproductive age in informal and formal employment, or their children (≤ 5 years), were eligible for inclusion. If studies reported outcomes per subgroup level, these were included. Study quality was assessed using the Joanna Briggs Institute checklist and a narrative synthesis of the results were conducted.

RESULTS

13 articles were included in the review, looking at breastfeeding outcomes (n = 4), child nutritional status and low birthweight (n = 4), antenatal health (n = 3), and general health outcomes for women (n = 2). The overall evidence from the included studies was that compared to formal employment, there was an association between informal employment and worse health outcomes, especially on child nutritional status and antenatal health. The evidence for breastfeeding outcomes was mixed and showed that informal employment may be both protective and damaging to health.

CONCLUSION

This review showed that informal employment is a potential risk factor for health among female workers and their children. Further research on the pathways between informal employment and health is needed to strengthen the understanding of the health consequences of informal employment.

Unimproved source of drinking water and its associated factors: a spatial and multilevel analysis of Ethiopian demographic and health survey

BACKGROUND

Drinking water quality has been a major public health concern in lower and middle income countries where access to improved water supplies is limited. Ethiopia is thought to have one of the worst drinking water infrastructures in the world. This study aimed to assess the spatial variation and determinants of using unimproved sources of drinking water in Ethiopia using recent nationally representative data.

METHODS

A population-based cross-sectional study was employed with the recent EDHS data of 2019. A total of 8663 households were sampled using a stratified two-stage cluster sampling method. Kuldorff's SaTScan version 9.6 software was used to generate spatial scan statistics. ArcGIS version 10.7 software was used to visualize the spatial patterns of unimproved drinking water sources. A multilevel multivariable mixed-effect logistic regression was used to identify factors associated with the use of an unimproved drinking water source. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of using an unimproved source of drinking water.

RESULT

Around 31% (95% CI: 30%, 32%) of the population in Ethiopia uses unimproved sources of drinking water with significant spatial variation across the country. Households aged 41-60 [AOR = 0.69; 95%CI; 0.53, 0.89] as compared to the households aged 10-25, households having middle wealth index [AOR = 0.48; 95%CI; 0.40, 0.59], and households having a rich wealth index [AOR = 0.31; 95%CI; 0.25, 0.39] as compared to the poor households, living in high community literacy level [AOR = 0.36; 95%CI; 0.16, 0.80], living in high-level community poverty [AOR = 3.03; 95%CI; 1.32, 6.98], rural residence [AOR = 7.88; 95%CI; 2.74, 22.67] were significant predictors of use of unimproved source of drinking water. Hot spot areas of use of unimproved drinking water sources were observed in Amhara, Afar, and Somalia regions and some parts of SNNPR and Oromia regions in Ethiopia. The primary clusters were found in Ethiopia's Somalia and Oromia regions.

CONCLUSION

Around one third of the Ethiopian population utilizes unimproved source of drinking water and it was distributed non-randomly across regions of Ethiopia. The age of the household head, wealth status of the household, residence, community poverty level, and community literacy level were found to be significantly associated with utilizing unimproved drinking water source. State authorities, non-governmental organizations and local health administrators should work to improve the quality of drinking water particularly for high risk groups such as communities living in high poverty and low literacy, poor households, rural residents, and hot spot areas to decrease the adverse consequences of using unimproved drinking water source.

Health facility delivery and early initiation of breastfeeding: Cross-sectional survey of 11 sub-Saharan African countries

Background and Aims

Early initiation of breastfeeding (EIB) remains one of the promising interventions for preventing neonatal and child deaths. EIB is positively associated with healthcare delivery or childbirth. Meanwhile, no study in sub-Saharan Africa (SSA) appears to have investigated the relationship between health facility delivery and EIB; thus, we assessed the correlation between health facility delivery and EIB.

Methods

We used data from the Demographic and Health Survey (DHS) of 64,506 women from 11 SSA countries. The outcome variable was whether the respondent had early breastfeeding or not. Two logistic regression models were used in the inferential analysis. With a 95% confidence interval (CI), the adjusted odds ratios (aORs) for each variable were calculated. The data set was stored, managed, and analyzed using Stata version 13.

Results

The overall percentage of women who initiated early breastfeeding was 59.22%. Rwanda recorded the highest percentage of early initiation of breastfeeding (86.34%), while Gambia recorded the lowest (39.44%). The adjusted model revealed a significant association between health facility delivery and EIB (aOR = 1.80, CI = 1.73-1.87). Compared with urban women, rural women had higher likelihood of initiating early breastfeeding (aOR = 1.22, CI = 1.16-1.27). Women with a primary education (aOR = 1.26, CI = 1.20-1.32), secondary education (aOR = 1.12, CI = 1.06-1.17), and higher (aOR = 1.13, CI = 1.02-1.25), all had higher odds of initiating early breastfeeding. Women with the richest wealth status had the highest odds of initiating early breastfeeding as compared to the poorest women (aOR = 1.33, CI = 1.23-1.43).

Conclusion

Based on our findings, we strongly advocate for the integration of EIB policies and initiatives with healthcare delivery advocacy. Integration of these efforts can result in drastic reduction in infant and child mortality. Essentially, Gambia and other countries with a lower proclivity for EIB must reconsider their current breastfeeding interventions and conduct the necessary reviews and modifications that can lead to an increase in EIB.

Early initiation of breast feeding and associated factors among mother-baby dyads with immediate skin-to-skin contact: cross-sectional study based on the 2016 Ethiopian Demographic and Health Survey data

OBJECTIVE

The study aimed to assess the practice of early initiation of breast feeding (EIBF) and associated factors among mother-baby dyads who practiced immediate skin-to-skin contact in Ethiopia.

DESIGN

Cross-sectional study.

SETTING

The study was conducted nationally in nine regional states and two city administrations.

PARTICIPANTS

In the study, 1420 mother-baby dyads with last-born children (children born in the 2 years preceding the survey, children <24 months old) and children put on the mother's bare skin. The data of the study participants were extracted from the Ethiopian Demographic and Health Survey 2016.

OUTCOME MEASURES

The outcome measure of the study was the proportion of EIBF among mother-baby dyads and associations.

RESULTS

EIBF among mothers and newborns with skin-to-skin contact was 88.8% (95% CI 87.2 to 90.4). EIBF among mother-baby dyads with immediate skin-to-skin contact was more likely among mothers from wealthy families (adjusted OR (AOR)=2.37, 95% CI 1.38 to 4.08), attended secondary and above education (AOR=1.67, 95% CI 1.12 to 2.57), living in Oromia (AOR=2.87, 95% CI 1.11 to 7.46), Harari (AOR=11.60, 95% CI 2.48 to 24.34) and Dire Dawa (AOR=2.93, 95% CI 1.04 to 8.23) regions, gave birth by non-caesarean section (AOR=3.34, 95% CI 1.33 to 8.39), gave birth at hospital (AOR=2.02, 95% CI 1.02 to 4.00), and health centre (AOR=2.19, 95% CI 1.21 to 3.98), and gave birth by midwifery assistance (AOR=1.62, 95% CI 1.06 to 2.49).

CONCLUSION

Nine in ten mother-baby dyads with immediate skin-to-skin contact early initiate breast feeding. The EIBF was affected by educational status, wealth index, region, mode of delivery, place of delivery and delivery assisted by midwifery. Improving healthcare service, institutional delivery and the competency of maternal healthcare providers may aid the EIBF in Ethiopia.

Lactation prescription plus acupoint stimulation improves breastfeeding quality and alleviates breast tenderness in parturients undergoing cesarean section

PURPOSE

This retrospective study primarily discusses the influence of lactation prescription plus acupoint stimulation on breastfeeding quality and breast tenderness of parturients after cesarean section (CS).

METHODS

First, 149 parturients presented between July 2018 and July 2021 for CS were selected, including 74 cases (test group) treated with lactation prescription plus acupoint stimulation and 75 cases (control group) intervened by routine western medicine nursing intervention. The breastfeeding status, milk yield at 48 hours postpartum, breast tenderness (Visual Analogue Scale, VAS), neonatal weight at 42 days after delivery, and laboratory indexes (white blood cell count, WBC; adrenocorticotropin, ACTH; prolactin, PRL) were compared between the two cohorts. Finally, multivariate analysis was carried out using the logistic regression model to identify factors leading to low milk production in mothers 48 hours after CS.

RESULTS

The test group was observed with a higher exclusive breastfeeding rate, higher milk yield at 48 hours postpartum, and milder breast tenderness (lower VAS score) than the control group. Higher neonatal weight at 42 days postpartum was also determined in the test group versus the control group. Moreover, the PRL at 3 days postpartum in the test group was statistically higher than that prenatal and at 1 day postpartum and the control group; markedly elevated WBC and reduced ACTH were observed at 1 d and 3 d postpartum compared with the prenatal, but no significant differences were identified between the test and control groups. According to the Logistic regression analysis, breast tenderness (P=0.009) was an independent risk factor for low lactation in mothers at 48 hours after CS.

CONCLUSION

Lactation prescription plus acupoint stimulation has a positive effect on improving the breastfeeding quality of parturients after CS and relieving breast tenderness, which is worth promoting clinically.

Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project

BACKGROUND

The Baby-Friendly Hospital Initiative's Step 4 recommends: "support mothers to start breastfeeding as soon as possible after birth", thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the "Adequate Childbirth Project", a quality-of-care improvement project, and to analyze determinants of this outcome.

METHODS

Secondary analysis of data collected by the cross-sectional evaluative "Healthy Birth Study", conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns' severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model.

RESULTS

The prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6-59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528-0.782), lower economic status (aOR 0.687; CI 95% 0.504-0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529-0.797), preterm birth (aOR 0.660; CI 95% 0.460-0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559-0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102-3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065-1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791-2.525) and female newborn (aOR 1.194; CI 95% 1.008-1.415) were factors positively associated with the outcome.

CONCLUSIONS

The private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life.

Exploring spatial variations and the individual and contextual factors of uptake of measles-containing second dose vaccine among children aged 24 to 35 months in Ethiopia

BACKGROUND

To eliminate measles, which is a devastating contagious disease, Ethiopia introduced the measles-containing second dose vaccine (MCV2) that will be given in the second year of life. Despite its paramount benefit, the coverage was low worldwide and, in Ethiopia, there is scarce evidence on the geographic variations and factors associated with uptake of MCV2.

OBJECTIVE

This study aimed to explore the spatial variations and the individual and contextual factors of uptake of measles-containing second dose vaccine among children aged 24 to 35 months in Ethiopia.

METHODS

We used the 2019 Ethiopian Mini Demographic and Health Survey data. A total weighted sample of 800 children aged 24 to 35 months was used. Multilevel analysis was employed and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. Factors with a p-value<0.05 in the multivariable analysis were declared to be significant predictors of MCV2 uptake. To explore the spatial variations of MCV2 uptake, we have conducted spatial analysis using both Arc GIS version 10.7 and SaTScan version 9.6 software.

RESULTS

The proportion of MCV2 uptake was 9.84% (95% CI: 7.96%, 12.11%). Children whose mothers were aged 20-34 years (AOR = 0.19; 95%CI: 0.05, 0.69) and 35-49 years (AOR = 0.21; 95%CI: 0.04, 0.90), being the 4th-5th child (AOR = 4.02; 95%CI: 1.45, 11.14) and 6th and above child (AOR = 4.12; 95%CI: 1.42, 13.05) and children who did not receive full childhood vaccinations (AOR = 0.44; 95%CI: 0.25, 0.77) were significantly associated with MCV2 uptake. Besides, MCV2 uptake was clustered in Ethiopia (Global Moran's I = 0.074, p-value <0.01). The primary cluster spatial window was detected in the Benishangul-Gumuz region with LLR = 10.05 and p = 0.011.

CONCLUSION

The uptake of MCV2 in Ethiopia was low. Maternal age, birth order, and uptake of the other basic vaccines were associated with MCV2 uptake. Besides, MCV2 uptake was clustered in Ethiopia and the primary cluster spatial window was located in the Benishangul-Gumuz region. Therefore, special concern should be given to regions with lower MCV2 uptake such as the Benishangul-Gumuz region. Besides, it is better to give attention to basic vaccination programs.

Socioecological predictors of breastfeeding practices in rural eastern Ethiopia

BACKGROUND

Estimates by the World Health Organization indicate that over 800,000 global neonatal deaths each year are attributed to deviations from recommended best practices in infant feeding. Identifying factors promoting ideal breastfeeding practices may facilitate efforts to decrease neonatal and infant death rates and progress towards achieving the Sustainable Development Goals set for 2030. Though numerous studies have identified the benefits of breastfeeding in reducing the risk of childhood undernutrition, infection and illness, and mortality in low- and middle-income countries, no studies have explored predictors of breastfeeding practices in rural eastern Ethiopia, where undernutrition is widespread. The aim of this study is to examine predictors of infant feeding practices in Haramaya, Ethiopia, using a multi-level conceptual framework.

METHODS

This study uses data collected from household questionnaires during the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project among 102 households in the Haramaya woreda, Eastern Hararghe Zone, Eastern Ethiopia, and investigates factors influencing breastfeeding practices: early initiation, prelacteal feeding, and untimely complementary feeding.

RESULTS

Nearly half (47.9%) of infants in this study were non-exclusively breastfed (n = 96). Generalized liner mixed effects models of breastfeeding practices revealed that prelacteal feeding may be a common practice in the region (43.9%, n = 98) and characterized by gender differences (p = .03). No factors evaluated were statistically significantly predictive of early initiation and untimely complementary feeding (82% and 14%, respectively). Severely food insecure mothers had more than 72% lower odds of early breastfeeding initiation, and participants who self-reported as being illiterate had 1.53 times greater odds of untimely complementary feeding (95% CI, [0.30,7.69]) followed by male children having 1.45 greater odds of being untimely complementary fed compared to female (95% CI,[0.40,5.37]).

CONCLUSIONS

This study found high rates of prelacteal feeding and low prevalence of exclusive breastfeeding, with girls more likely to be exclusively breastfed. While no predictors evaluated in this multi-level framework were associated with prevalence of early initiation or complementary feeding, rates may be clinically meaningful in a region burdened by undernutrition. Findings raise questions about gendered breastfeeding norms, the under-examined role of khat consumption on infant feeding, and the complex factors that affect breastfeeding practices in this region. This information may be used to guide future research questions and inform intervention strategies.

Trends and factors contributing to health facility delivery among adolescent women in Ethiopia: multivariate decomposition analysis

BACKGROUND

Although an increase in health facility delivery in Ethiopia over time, adolescent women giving birth at health facilities is still low. Health facility delivery is crucial to improving the health of women and their newborns' health by providing safe delivery services. We aimed to examine the trend change and identify factors contributing to health facility delivery in Ethiopia.

METHODS

We analyzed the data on adolescent women obtained from three Ethiopian Demographic and Health Surveys. A total of weighted samples were 575 in 2005, 492 in 2011, and 378 in 2016. Data management and further statistical analysis were done using STATA 14. Trends and multivariate decomposition analysis were used to examine the trends in health facility delivery over time and the factors contributing to the change in health facility delivery.

RESULTS

This study showed that the prevalence of health facility delivery among adolescent women in Ethiopia increased significantly from 4.6% (95% CI 3.2-6.7) in 2005 to 38.7% (95% CI 33.9-43.7) in 2016. Decomposition analysis revealed that around 78.4% of the total change in health facility delivery over time was due to the changes in the composition of adolescent women and approximately 21.6% was due to the changes in their behavior. In this study, maternal age, place of residency, wealth index, maternal education, frequency of ANC visits, number of living children, and region were significant factors contributing to an increase in health facility delivery over the study periods.

CONCLUSION

The prevalence of health facility delivery for adolescent women in Ethiopia has increased significantly over time. Approximately 78.4% increase in health facility delivery was due to adolescent women's compositional changes. Public health interventions targeting rural residents and uneducated women would help to increase the prevalence of health facility delivery.

Effect of maternal employment on exclusive breastfeeding practice among mothers of infants 6–12 months old in Wolkite town, Ethiopia: a comparative cross-sectional study

Introduction

Exclusive breastfeeding (EBF) means providing only breast milk for infants for up to six months without the addition of solid or liquid matter. Even though EBF had great benefits for infants and mothers, the rate of EBF is so limited below the global target. In Ethiopia, the overall EBF practice is 59%. This low EBF practice had a great unexplained variation among employed and unemployed mothers. Therefore, this study aimed to compare EBF practice and associated factors among employed and unemployed mothers of infants aged 6–12 months in Wolkite town, Southern Ethiopia, 2020.

Methods

A community-based comparative cross-sectional study was conducted in March 2020. A total sample of 485 (241 employed and 244 unemployed) study subjects was involved in the study. A simple random sampling technique was used to recruit study subjects. A pre-tested structured interviewer-administered questionnaire was used. Multivariable logistic regression was used to identify associated factors of EBF practice for the whole study participants and then for employed and unemployed mothers independently.

Results

The pooled prevalence of exclusive breastfeeding practice was 63.9% [95% CI (59.8–68.2%)]. Exclusive breastfeeding practice was 54.8% [95% CI (48.5–61.4%)] and 73% [95% CI (66.8–78.7%)] among employed and unemployed mothers respectively. Three or more years of a birth interval [AOR = 4.03; 95% CI (1.80–8.99)], three or more ANC visits [AOR = 5.39; 95% CI (1.49–19.45)], and having PNC service [AOR = 4.56; 95% CI (2.0–9.4)] significantly associated to exclusive breastfeeding practice among employed mothers. No history of breastfeeding counseling during ANC visits [AOR = 0.15; 95% CI (0.06–0.41)], had history of breast disease [AOR = 0.28; 95% CI (0.08–0.99)], three or more ANC visits [AOR = 5.11; 95% CI (1.66–15.8)], and having social support [AOR = 3.05; 95% CI (1.23–7.6)] significantly associated to EBF practice among unemployed mothers.

Conclusion

Employment among mothers was found to discourage EBF practice. The predictors of exclusive breastfeeding practice are different for employed and unemployed. Therefore Policymakers and program planners are called to come together and create a conducive environment for lactating employees, and appropriate intervention at respective predictor variables is needed to enhance EBF practice.

Trends and Determinants of Dietary Diversity in Children Aged 6-59 Months in Ethiopia: Analysis of 2005-2016 Demographic and Health Survey

Background

Dietary diversity may be associated with health and optimum growth in children.

Objectives

In this study we analyzed the trends and determinants of minimum dietary diversity (MDD) among Ethiopian children aged 6 to 59 mo.

Methods

Ethiopian Demographic Health Survey (EDHS) data of 3 consecutive years (2005, 2011, and 2016) were analyzed. A total of n = 2396 (2005), n = 3385 (2011), and n = 3723 (2016) children aged 6 to 59 mo were included for measurement of trends and identification of the determinants of MDD. The associations between the study factors and MDD were investigated using multiple logistic regression analysis.

Results

The proportion of children who fulfilled the MDD decreased from 2.46% in 2005 to 1.57% in 2011 but sharply increased to 7.82% in 2016. Adjusted regression analysis revealed that exposure of mothers to media, particularly watching television, maternal education, and household wealth were associated with a greater likelihood of mothers providing diversified diets to their children across the 3 y of EDHS data.

Conclusions

A decrease in MDD was observed from the years 2005 to 2011, after which a sharp increase was noted in 2016. In all 3 y of the EDHS, media exposure, maternal education, and household wealth were the consistent factors positively affecting dietary diversity among children aged 6 to 59 mo. Future intervention programs to increase dietary diversity in children should emphasize improving access to media exposure, education, and antenatal care visits.

Timely Initiation of Breastfeeding and Its Associated Factors at the Public Health Facilities of Dire Dawa City, Eastern Ethiopia, 2021

Introduction

Timely initiation of breastfeeding is defined as putting the newborn baby to the breast within one hour of birth. Despite the World Health Organization and national recommendations on timely initiation of breastfeeding, delayed initiation of breastfeeding is still a common problem.

Objective

The aim of this study was to assess the timely initiation of breastfeeding and its associated factors at the public health facilities of Dire Dawa city, Eastern Ethiopia, 2021.

Methods

A health facility-based cross-sectional study was employed from February 1, 2021, to March 2, 2021, at the public health facilities of Dire Dawa city among 302 mother-child pairs. The data were collected by systematic random sampling technique, entered into Epi data 4.2, and analyzed using Statistical Package of Social Science 25.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95%, and a P value of < 0.05 was considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables.

Results

In this study, timely initiation of breastfeeding was 70.9% (95% CI: 65.6-75.8%). In a multivariable analysis, maternal age group of 25-40 years (AOR = 2.21, 95% CI = 1.09 − 4.48), multiparty (AOR = 2.58, 95% CI = 1.24 − 5.40), counselling on timely initiation of breastfeeding during antenatal care visits (AOR = 2.38, 95% CI = 1.16 − 4.88), institutional delivery (AOR = 3.29, 95% CI = 1.27 − 8.52), vaginal delivery (AOR = 3.06, 95% CI = 1.20 − 7.81), counselling on breastfeeding immediately after delivery (AOR = 2.89, 95% CI = 1.29 − 6.45), not practicing pre lacteal feeding (AOR = 6.76, 95% CI = 2.35 − 19.44), and having good practice of colostrum feeding (AOR = 4.03, 95% CI = 1.95 − 8.36) were associated with timely initiation of breastfeeding. Conclusion and Recommendation. Mothers who had practiced timely initiation of breastfeeding were low compared to the national recommendation (92%). Age of the mother, multiparity, counseling on timely initiation of breastfeeding, institutional delivery, vaginal delivery, counseling after delivery, not practicing prelacteal feeding, and having a good practice of colostrum feeding were predictors of timely initiation of breastfeeding. It indicates a need to encourage mothers to have antenatal care visits and institutional delivery.

How do the determinants of exclusive breast-feeding change over time? A multi-survey quasi-longitudinal study in Lao People's Democratic Republic

OBJECTIVE

The current study aimed to assess trends, associated factors and the changes in these factors for exclusive breast-feeding (EBF) over the past two decades in Lao People's Democratic Republic (Lao PDR).

DESIGN

The current study used a quasi-longitudinal design. Descriptive analyses were done with correction for complex survey design. Inferential analyses were done for survey years separately using multiple logistic regression. Finally, pooled logistic regression analysis was done using interaction terms to quantify the difference in association per year.

SETTING

The current study used data from all provinces of Lao PDR collected in the years 2000, 2006, 2011/2012 and 2017.

PARTICIPANTS

Children aged six months or younger from Lao PDR.

RESULTS

EBF practice was estimated at 19·03 %, 26·87 %, 40·67 % and 44·89 % in the four survey years, respectively. Factors significantly associated with EBF included: region of residence, ethnicity, wealth index and age of child. Region and ethnicity saw significant changes in association, and the South developing positively over time as well as in the Lao-Thai ethnic group. Having had any antenatal visits was not associated with EBF practice, nor did this change over time.

CONCLUSIONS

Our study shows how EBF trends, and factors associated with EBF, changed over time. We applied an easily replicable methodology to assess similar public health phenomena. We argue that such analysis is particularly relevant for transitioning countries. In such rapidly evolving settings, it is crucial to take into account changing underlying factors when assessing and developing public health policy.

Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia

BACKGROUND

World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months of life. EBF has sustainable long-term health benefits for both infants and mothers. Despite its benefits, the practice of EBF in Ethiopia is lower than the internationally recommended one. This study aimed at identifying factors influencing EBF practice among under-6 month infants in Ethiopia.

METHODS

This study used data drawn from the 2019 Ethiopian Mini Demographic and Health Survey (2019 EMDHS) data. A multivariable logistic regression model was employed to investigate factors significantly associated with EBF practice among under-6 month infants in Ethiopia. An adjusted odds ratio with 95% confidence interval was used to measure the association of factors with EBF practice.

RESULTS

A total of 566 infants under the age of 6 months were included in the study. The prevalence of exclusive breastfeeding practice was 83% (95% CI: 79.70-86%). Urban residences (AOR: 0.40, 95% CI: 0.22-0.73), mothers having secondary education (AOR: 1.54, 95% CI: 1.29-1.84) and higher education (AOR: 3.18, 95% CI: 0.68-15.02), mothers having ANC visits of 1 to 3 times (AOR: 1.52, 95% CI: 1.24-1.88) and ANC visits of 4 and more times (AOR: 4.27, 95% CI: 1.06-17.25), family size of more than 5 (AOR: 0.45, 95% CI: 0.26-0.88), caesarean births (AOR: 0.63, 95% CI: 0.42-0.95), and deliveries at health facilities (AOR: 2.51, 95% CI: 1.12-5.63) were factors significantly associated with EBF practice among under-6 month infants.

CONCLUSION

In this study, EBF practice among under-6 month infants was significantly associated with place of residence, maternal educational level, ANC visits, family size, mode of delivery, and place of delivery. Therefore, encouraging ANC visit and promotion of institutional (health facility) delivery are recommended. Furthermore, special attention has to be given to mothers with no or less education to make them better aware of the EBF and its benefits to enhance exclusive breastfeeding practice.

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.

Household Solid Fuel Use and Associated Factors in Ethiopia: A Multilevel Analysis of Data From 2016 Ethiopian Demographic and Health Survey

Solid fuels are types of fuel that comprise coal, biomass, charcoal, wood, or straw and are used for cooking, heating, lighting, boiling water, and generating revenue at home. Globally, 3 billion of the world's poorest people continue to rely on inefficient solid fuels, which produce health-damaging contaminants. In Ethiopia, more than 90% of households rely on wood as their primary source of energy. The actual and potential determinants of solid fuel use have not been fully identified, particularly at the national level in Ethiopia. Therefore, this study aimed to determine the magnitude of solid fuel use and its associated factors in Ethiopia. We used the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2016. The data was conducted using a 2-stage stratified cluster sampling approach. A total of 16 650 weighted samples were taken. Multilevel logistic regression models were fitted to identify factors associated with solid fuel use, and a cluster-level random intercept was introduced in the mixed model. An adjusted odds ratio with a 95% confidence level was reported to show the strength of the association and its significance. The goodness of fit of the model was checked using proportional change deviance (PCV). The magnitude of solid fuel use among households in Ethiopia was 94.03% (95% CI = 93.66, 94.37). Household heads completed in primary school (AOR, 3.09, 95% CI = 2.44, 3.91), outdoor cooking places (AOR, 4.13, 95% CI = 2.96, 5.76), and small peripheral regions (AOR, 14.44, 95% CI = 6.12, 34.04) were all significantly associated with solid fuel use. The intra-cluster correlation coefficient (ICC) showed that about 81% of the variations in the use of solid fuel were attributed to the difference at the 643 cluster level, but the remaining 19% were attributed to individual household factors. The PCV was 90%, which showed that the variation in solid fuel use among study households was explained by factors at both the individual and community levels. The deviation test of the fourth model had the lowest value (3528) and was chosen as the best-fitted model. Due to different influencing factors, the use of solid fuel is still high in Ethiopia. Promoting access to education and raising awareness toward solid fuel impact is very important.

Association Between Maternal Work and Exclusive Breastfeeding in Countries of Latin America and Caribbean

OBJECTIVE

The aim of this study was to estimate the association between individual and contextual characteristics related to maternal work and exclusive breastfeeding (EBF) in Latin America and the Caribbean.

METHODS

A cross-sectional study, conducted with data from the Demographic and Health Survey of Bolivia (2008), Brazil (2006), Colombia (2010), the Dominican Republic (2007), Guatemala (2015), Haiti (2017), Honduras (2011) and Peru (2011). The sample included infants who were under 6 months of age and their mothers. The outcome was EBF (yes/no), individual predictors were maternal employment status (employed/not employed), type of occupation, and type of employment (formal/informal), and contextual predictors were gross domestic product, maternity leave, and percentage of women in the labor force. The association between maternal employment status and EBF was performed using multilevel Poisson analysis adjusted for maternal education level, presence of partner, place of residence, maternal age, type of childbirth, primiparity, wealth index and breastfeeding in the first hour of life.

RESULTS

The prevalence of EBF was 58.0% in Bolivia, 41.1% in Brazil, 39.2% in Colombia, 7.6% in the Dominican Republic, 50.8% in Guatemala, 39.7% in Haiti, 31.1% in Honduras, and 68.1% in Peru. The percentage of employed women ranged from 19.1% in the Dominican Republic to 46.1% in Bolivia. Maternal employment was negatively associated with EBF (Prevalence Ratio [PR] = 0.77; 95% CI 0.73, 0.82), while the highest percentage of women in the labor force of the country was positively associated with EBF (PR = 1.03; 95% CI 1.01, 1.06), with an increase in the PR value after the inclusion of gross domestic product in the model.

CONCLUSIONS

The prevalence of EBF was lower in infants whose mothers were employed. However, the prevalence of EBF was higher in countries with a larger percentage of women in the labor force.

Trends of Inequalities in Early Initiation of Breastfeeding in Ethiopia: Evidence from Ethiopian Demographic and Health Surveys, 2000-2016

Background

Early initiation of breastfeeding (EIBF) is a costless practice with numerous neonates' survival benefits. Thus, any disparity results in an unacceptably high neonatal death rate but socioeconomic disparities on EIBF have not been well explored in Ethiopia. Therefore, this study is aimed at assessing the socioeconomic inequalities of EIBF in Ethiopia from 2000 to 2016.

Methods

The Ethiopian demographic and health survey data and the World Health Organization's Health Equity Assessment Toolkit were used to investigate the inequalities in EIBF across the wealth quintile, education, residence, and subnational region. Difference, ratio, slope index inequality (SII), relative index inequality (RII), and population attributable risk (PAR) were used as equity summary measures.

Results

In Ethiopia, EIBF practice was 47.4% in 2000, 66.2% in 2005, 51.5% in 2011, and 73.3% in 2016. Wealth-related inequality was observed in the 2000, 2005, and 2011 survey years with SII of -7.1%, -8.8%, and 8.7%, respectively, whereas educational-related inequality was observed in 2005 and 2011 with SII of -11.7% and 6.5%, respectively. However, significant change in wealth-, education-, and residence-related inequalities was detected in 2011. Regional inequality on EIBF was observed in all survey years with a difference of 35.7%, 38.0%, 29.1%, and 48.5% in the 2000, 2005, 2011, and 2016 survey years, respectively. But a significant change in regional inequality was noted in 2016 with a PAR of 17.2%.

Conclusions

In Ethiopia, the wealth-, residence-, and educational-related inequalities of EIBF increased significantly between the years 2000 and 2011. However, regional inequality persistently increased from 2000 to 2016. Overall, one-sixth of the national level EIBF was decreased due to regional disparity in 2016. The northern regions of Ethiopia (Tigray, Afar, and Amhara) poorly performed compared to the peer regions. Therefore, interventions targeting them would significantly improve the national level of EIBF.

Married women’s decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey

Introduction:

Women’s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women’s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women’s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model.

Methods:

The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15–49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women’s decision-making autonomy on contraceptive use. Akaike’s information criterion was used to select the best-fitted model.

Results:

Overall, 21.6% (95% confidence interval = 20.3%–22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67–3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52–3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36–4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32–3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34–3.87) were positively associated with women’s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29–0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12–0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23–0.87) were negatively associated with women’s independent decision on contraceptive use.

Conclusion:

Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women’s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women’s decision-making autonomy on contraceptive use. The government should promote women’s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.

Determinants of time-trends in exclusivity and continuation of breastfeeding in India: An investigation from the National Family Health Survey

Breastfeeding is an essential key factor for reducing child mortality and the risk of disease. Therefore, to ensure health and wellbeing for all (Sustainable Development Goal 03), and to reduce inequalities in child health status (SDG 10), understanding the determinants of breastfeeding is essential. Our research aims to investigate determinants of different breastfeeding practices from 2005-06 (NFHS-3) to 2015-16 (NFHS-4), and changes in different breastfeeding practices among various demographic, social, religious, and economic groups during this decade. We have used a multivariate binary logistic regression model to estimate significant determinants of different breastfeeding practices. The results show an 8.4% hike in Exclusive Breastfeeding (EBF), along with a 3.3% and 1% drop in the Continuation of Breastfeeding (CBF) up to one and two years respectively during this decade in India. Significant variation has been found in EBF, CBF1 and CBF2 among various categories of child's birth interval, place of residence, social groups, economic communities, and geographic regions. Maternal nutritional status and anemia levels had significant influence on CBF1 and CBF2, and gender of the children on EBF and CBF2 from 2005-06 to 2015-16. There was no significant variation in CBF1 and CBF2 among children born in different birth orders, whereas EBF was significantly less among higher birth orders children. A dramatic improvement in EBF was found among first birth ordered children, teenage and/or highly educated mother, rich families, and in north India, and CBF2 was significantly raised only among higher educated mothers. The estimation of determinants throughout the decade is essential for improving government policies related to supporting and encouraging breastfeeding. The study suggests more initiatives and investment for the promotion, support and improvement of CBF for one and two years, and reduction of inequality among various demographic and socio-economic groups and geographic regions.

What Mother, Midwives, and Traditional Birth Helper Said About Early Initiation of Breastfeeding in Buginese-Bajo Culture

Introduction

The aim of this study is to investigate how mothers, families, midwives, and traditional birth attendants in the Buginese-Bajo culture understanding breastfeeding and early initiation of breastfeeding (EIBF). Also to assess what support mothers receive from families, midwives, and traditional birth attendants during pregnancy, birth, and EIBF.

Methods

This qualitative study included 21 subjects (11 pregnant women, three midwives, and seven traditional birth attendants). Recorded interviews with the three groups of participants were transcribed verbatim and analyzed separately, using latent content analysis. The study started in December 2014 and ended in July 2015.

Results

Some mothers understood the meaning of EIBF, but engaged in it for different reasons. The midwives interpreted the principle of EIBF differently from a duration perspective. Traditional birth attendants explained it as a way to strengthen the relationship between mothers, and babies; they believed that prolonging breastfeeding until 2 years would change babies into caring children. According to them, this skin-to-skin contact has been practice for a century by traditional birth helpers. The philosophy of breastfeeding, according to the Buginese-Bajo, is creating “peru” relationships for mothers and babies each other for their whole lives.

Conclusion

These findings show a connection between established science and cultural beliefs. The concept of peru is the central philosophy to be achieved in EIBF. Breast-feeding's psychological value is known and passed from generation to generation; this essential fact needs to be preserved as local capital for changing breastfeeding behavior. The government should pay more attention to this opportunity to increase awareness and promote breastfeeding behavior changes.

Prevalence of exclusive breastfeeding practice and its association with maternal employment in Ethiopia: a systematic review and meta-analysis

Background

Exclusive breastfeeding is defined as the practice of providing only breast milk for an infant for the first 6 months of life without the addition of any other food or water, except for vitamins, mineral supplements, and medicines. Findings are inconsistent regarding the prevalence of exclusive breastfeeding in Ethiopia. Full-time maternal employment is an important factor contributing to the low rates of practice of exclusive breastfeeding. Empowering women to exclusively breastfeed, by enacting 6 months’ mandatory paid maternity leave can increase the rate of exclusive breastfeeding in the first 6 months of life up to 50%. The purpose of this review was to estimate the pooled prevalence of exclusive breastfeeding and its association with full-time maternal employment in the first 6 months of life for infants in the context of Ethiopia.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. All observational studies reporting the prevalence of exclusive breastfeeding and its association with maternal employment in Ethiopia were considered. The search was conducted from 6 November 2020 to 31 December 2020 and all papers published in the English language from 1 January 2015 to 31 December 2020 were included in this review.

Results

Forty-five studies were included in the final analysis after reviewing 751 studies in this meta-analysis yielding the pooled prevalence of EBF 60.42% (95% CI 55.81, 65.02) at 6 months in Ethiopia. Those full-time employed mothers in the first 6 months were 57% less likely to practice exclusive breastfeeding in comparison to mothers not in paid employment in Ethiopia (OR 0.43; 95% CI 0.31, 0.61).

Conclusions

Full-time maternal employment was negatively associated with the practice of exclusive breastfeeding in comparison to unemployed mothers. The prevalence of exclusive breastfeeding in Ethiopia is low in comparison to the global recommendation. The Ethiopian government should implement policies that empower women. The governmental and non-governmental organizations should create a conducive environment for mothers to practice exclusive breastfeeding in the workplace.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00432-x.

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

Background

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

Methods

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

Results

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

Conclusions

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

Socioeconomic inequalities in early initiation and exclusive breastfeeding practices in Bangladesh: findings from the 2018 demographic and health survey

BACKGROUND

Optimal breastfeeding practices including early initiation of breastfeeding and exclusive breastfeeding (EBF) are associated with positive health outcomes. Socioeconomic inequalities in key breastfeeding indicators may play a role in the prevalence of breastfeeding practices. The objective of this study was to examine the socioeconomic inequalities in early initiation of breastfeeding and EBF practices in Bangladesh based on the 2018 Bangladesh Demographic and Health Survey (BDHS).

METHODS

This was a secondary data analysis of the nationally representative 2018 BDHS. Data on 4950 women of reproductive age who had ever given birth and 924 children aged 0-5 months were extracted, for early initiation of breastfeeding and EBF. Early initiation of breastfeeding was determined from children who were put to the breast within the first hour of birth. Exclusive breastfeeding was estimated from children aged 0-5 months who were exclusively breastfed.

RESULTS

The weighted prevalence of early initiation of breastfeeding and EBF were 60.8% (95% CI; 59.0, 62.6%) and 66.8% (95% CI; 63.1, 70.3%), respectively. The estimated prevalence of early initiation among the poorest, poorer, middle, richer and richest households were 67.8, 66.3, 58.4, 56.3 and 54.4%, respectively. Similarly, early initiation prevalence of 64.4, 65.0, 61.1 and 52.3% were estimated among women with no formal education, primary, secondary and higher education, respectively. The estimated prevalence of EBF among the poorest, poorer, middle, richer and richest households were 63.0, 65.2, 67.7, 66.7 and 69.9%, respectively. Similarly, the estimated EBF prevalence were 62.5, 66.0, 66.3 and 68.9% among women with no formal education, primary, secondary and higher education, respectively. Early initiation of breastfeeding was higher among lower household wealth (Conc. Index = - 0.049; SE = 0.006) and lower educational attainment groups (Conc. Index = - 0.035; SE = 0.006).

CONCLUSIONS

Improving optimal breastfeeding practices in Bangladesh should be given utmost priority. A need to address the socioeconomic inequalities in breastfeeding practices was also identified.

The influence of gestational age at term on breastfeeding: a cohort study

OBJECTIVE

To identify the effect of the category gestational age at term on breastfeeding in he first hour of life, the duration of exclusive breastfeeding, and practice of breastfeeding twelve months from birth.

METHOD

Single cohort, with a one-year prospective follow-up of 541 children. A hierarchical analysis was performed, with models adjusted per Cox regression, considering critical p < 0.05.

RESULTS

During raw analysis there was a statistical difference on breastfeeding in the first hour of life (RR = 1.54; CI 95% = 1.12-2.12; p = 0.008). However, in the final analysis, there was no association between gestational age at term and breastfeeding in the first hour of life, duration of exclusive breastfeeding, and the practice of breastfeeding twelve months from birth. Secondarily, higher age and education, cesarean section, birth at private services, and the need for resuscitation were observed to have a negative influence. Duration of previous pregnancy favored breastfeeding in the first hour of life. Using baby bottle and pacifier was negative for breastfeeding in the first year of life.

CONCLUSION

There was no association between the category gestational age at term and breastfeeding. The association of outcomes pointed out by the scientific literature have been confirmed.

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

OBJECTIVE

In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia.

SOURCE OF INFORMATION

A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021.

STUDY ELIGIBILITY CRITERIA

Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included.

STUDY APPRAISAL AND SYNTHESIS

All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study.

RESULTS

Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention.

CONCLUSION

Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia.

PROTOCOL REGISTRATION NUMBER

PROSPERO, CRD42020155519.

Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review

BACKGROUND

Sub-Saharan Africa carries a disproportionate burden of under-five child deaths in the world and appropriate breastfeeding practices can support efforts to reduce child mortality rates. Health facilities are important in the promotion of early and exclusive breastfeeding. The purpose of this review was to examine facility-based barriers and facilitators to early and exclusive breastfeeding in Sub-Saharan Africa.

METHODS

A systematic search was conducted on Medline, Web of Science, CINAHL, African Journals Online and African Index Medicus from database inception to April 29, 2021 and primary research studies on breastfeeding practices in health facilities in Sub-Saharan Africa were included in the review. We assessed qualitative studies with the Critical Appraisal Skills Programme Qualitative Checklist and quantitative studies using the National Heart, Lung, and Blood Institute tool. The review protocol was registered to Prospero prior to conducting the review (CRD42020167414).

RESULTS

Of the 56 included studies, relatively few described health facility infrastructure and supplies-related issues (5, 11%) while caregiver factors were frequently described (35, 74%). Facility-based breastfeeding policies and guidelines were frequently available but challenged by implementation gaps, especially at lower health service levels. Facilitators included positive caregiver and health worker attitudes, knowledge and support during the postpartum period. Current studies have focused on caregiver factors, particularly around their knowledge and attitudes, while health facility infrastructure and supplies factors appear to be growing concerns, such as overcrowding and lack of privacy during breastfeeding counselling that lowers the openness and comfort of mothers especially those HIV-positive.

CONCLUSION

There has been a dramatic rise in rates of facility births in Sub-Saharan Africa, which must be taken into account when considering the capacities of health facilities to support breastfeeding practices. As the number of facility births rise in Sub-Saharan Africa, so does the responsibility of skilled healthcare workers to provide the necessary breastfeeding support and advice to caregivers. Our review highlighted that health facility infrastructure, supplies and staffing appears to be a neglected area in breastfeeding promotion and a need to strengthen respectful maternity care in the delivery of breastfeeding counselling, particularly in supporting HIV-positive mothers within the context of Sub-Saharan Africa.

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.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

Mapping Geographical Differences and Examining the Determinants of Childhood Stunting in Ethiopia: A Bayesian Geostatistical Analysis

Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0–59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4–74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5–48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother’s BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the “arid” geographic areas, small birth size of the child, and mother’s BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors.

Breastfeeding and employed mothers in Ethiopia: legal protection, arrangement, and support

Background

Breastfeeding is the single, most cost-effective intervention to reduce worldwide child mortality. Women empowerment interventions have positive impacts on child and maternal nutritional, and health status. Women’s employment and economic participation in Ethiopia have shown progress over the past three decades. However, consistent evidence indicated that maternal employment is often negatively associated with optimal breastfeeding in Ethiopia. The existence and enforcement of breastfeeding law, arrangement, and support in the workplace have vital roles in protecting employed mothers’ ability and right to breastfeed upon return to work from maternity leave. This commentary compared the breastfeeding laws, policies, and arrangements in Ethiopia with international standards, recommendations, and evidence-based practices.

Workplace breastfeeding policies in Ethiopia

Public legislations of Ethiopia poorly protect the breastfeeding right of most new mothers. Ethiopian revised Labor Proclamation (No.1156/2019) incorporates most of the International Labour Organization maternity protection recommendations. However, it poorly safeguards breastfeeding rights and abilities of employed women. The provided maternity leave period is also shorter than the recommended exclusive breastfeeding duration. The revised Federal Civil Servant Proclamation of Ethiopia (NO.1064/2017) mandates the establishment of a nursery in government institutions where female civil servants could breastfeed and take care of their babies in a private room. Though, it protects only a small proportion of working mothers in Ethiopia, as majority women employed in the agriculture and informal economy sectors. So far, there are no notable workplace breastfeeding arrangements and support for employed mothers by employers and other initiatives. The ILO recommendation and experience of other middle income and low-income countries can be legal and practical grounds for establishment of breastfeeding-friendly workplace in Ethiopia.

Conclusions

The lack of workplace breastfeeding laws, arrangements, and supports in Ethiopia limits mothers’ right to practice optimal breastfeeding. Policymakers, the government, and all concerned bodies should give due attention to enacting and enforcing sound laws and arrangements that will enable employed mothers to practice optimal breastfeeding upon return to work.

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

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

Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14 weeks postpartum: a cross-sectional survey in Naivasha, Kenya

BACKGROUND

In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF.

OBJECTIVES

We evaluated associations between maternal employment and breastfeeding (BF) status. We compared formally and non-formally employed mothers in Naivasha, Kenya, where commercial floriculture and hospitality industries employ many women.

METHODS

We conducted a cross-sectional survey among mothers (n = 1186) from September 2018 to October 2019 at 4 postpartum time points: at hospital discharge (n = 296) and at 6 wk (n = 298), 14 wk (n = 295), and 36 wk (to estimate BF at 24 wk; n = 297) postpartum. Mothers reported their BF status and reasons for EBF cessation. We used multivariable logistic regression models to test the association between formal maternal employment and 3 outcomes: early BF initiation (within 1 h of birth), EBF at each time point, and continued BF at 9 mo. Models were informed by a directed acyclic graph: a causal diagram used to characterize the relationship among variables that influence the independent (employment) and dependent (BF status) variables.

RESULTS

EBF did not differ by employment status at hospital discharge or at 6 wk postpartum. However, formally employed mothers were less likely than those not formally employed to report EBF at 14 wk (59.0% compared with 95.4%, respectively; AOR: 0.19; 95% CI: 0.10, 0.34) and at 24 wk (19.0% compared with 49.6%, respectively; AOR: 0.25; 95% CI: 0.14, 0.44). The prevalence of continued BF at 36 wk did not differ by group (98.1% for formally employed compared with 98.5% for non-formally employed women; AOR: 0.80; 95% CI: 0.10, 6.08). The primary reasons reported for early EBF cessation were returning to work (46.5%), introducing other foods based on the child's age (33.5%), or perceived milk insufficiency (13.7%).

CONCLUSIONS

As more women engage in formal employment in low- and middle-income countries, additional supports to help prolong the period of EBF may be beneficial for formally employed mothers and their children.

Trends and Determinants of Female Genital Mutilation in Ethiopia: Multilevel Analysis of 2000, 2005 and 2016 Ethiopian Demographic and Health Surveys

Background

Female genital mutilation (FGM) is a harmful practice that causes health-related problems in the life of the affected women and girls. Though FGM is declared as a human right violation, studies revealed it is being practiced throughout Ethiopia. Therefore, this study was conducted to assess the prevalence, trends, and predictors of FGM among reproductive-aged (1549 years) women in Ethiopia.

Methods

Trends of FGM among reproductive-age women were estimated using the three Ethiopian Demographic and Health Survey (EDHS): 2000 (n=15,367), 2005 (n=14,070) and 2016 (n=7248) data. Multilevel logistic regression analysis was conducted to identify both individual- and community-level factors of FGM using the latest (2016) EDHS. To adjust potential confounders, the analysis was conducted considering sample weighting, clustering, and stratifications using STATA-14 software.

Results

The prevalence of FGM among women of reproductive age in Ethiopia decreased from 79.91% in 2000 to 70.37% in 2016. Similarly, FGM among daughters of circumcised mothers decreased from 56.16% in 2000 to 16.76% in 2016. Being Muslim (adjusted odds ratio [AOR] 5.48; 95% confidence interval [CI]: 4.23, 7.09), attending higher education (AOR 0.40; 95% CI: 0.29, 0.54), 45–49 years old (AOR 5.06; 95% CI: 3.38, 7.57), marriage at ≥ 18 years (AOR 0.80; 95% CI: 0.66, 0.96), not working (AOR 1.20; 95% CI: 1.02, 1.41), married (AOR 1.41; 95% CI: 1.12, 1.77) and residing in peripheral region (AOR 3.0.4; 95% CI: 1.96, 4.70) were determinants of FGM.

Conclusion

Though the reduction of FGM among women of reproductive age in Ethiopia was minimal, it was encouraging among daughters of circumcised women over the last 16 years. Education, religion, age, age at marriage, occupation, marital status, and geographical regions were determinants of FGM. Combined and integrated interventions based on the identified factors are recommended to abandon FGM in Ethiopia.

The relationship between the perception of breast milk of parents with term infants and exclusive breastfeeding in the postnatal first six months

Objective

Breast milk is the ideal food that meets all kinds of nutritional contents of babies. The World Health Organization recommends that all babies be fed exclusively breastfeeding for the first 6 months. This study aimed to evaluate the relationship between the perception of breast milk of mothers and fathers with term babies and exclusively breastfeeding status in the first 6 months and to investigate the factors affecting exclusively breastfeeding status.

Material and Methods

Our longitudinal type study includes healthy/term infants and their parents born between 1 July-30 September 2018. In the postpartum period "adult's perception level of breast milk scale" was completed by the parents. The nutritional properties of the babies were recorded by reaching the families by phone when they were 2, 4, and 6 months old. Of the 341 families that participated in the study, 332 were evaluated and the study was completed with 304, 297, and 292 families at the 2^nd, 4^th, and 6^th months, respectively.

Results

Exclusively breastfeeding ratio was 85.5%, 68%, and 50% in the 2^nd, 4^th, and 6^th months, respectively. The mean score of the mothers on perception level of milk scale was significantly higher than the fathers (133.97±10.01 vs 123.91±13.41, p<0.001, respectively). The scale score of the mothers receiving breastfeeding training was significantly higher than the mothers without training (135.19±8.55 vs 130.91±12.25, respectively, p=0.008). The mode of delivery is related to the level of perception of breast milk of mothers and fathers. Mothers who had the last cesarean section had lower scale scores than those who delivered normally (131.71±12.11 vs 134.94±8.80, respectively, p=0.007). In the fathers whose spouse had a cesarean section, the scale scores were significantly higher than those whose spouses had normal delivery (126.42±12.73 vs 122.83±13.57, p=0.026, respectively). There was no correlation between exclusively breastfeeding status and breastmilk perception levels of the parents in the first 6 months. The mother's breastfeeding her previous child for ≥6 months and the use of pacifier/baby bottle were associated with exclusively breastfeeding status in the first 6 months.

Conclusion

Fathers should be included in breastmilk and breastfeeding training.

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

Purpose

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

Methods

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

Results

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

Conclusion

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

A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners' support among expectant couples in Mekelle, Ethiopia

Background

Breastfeeding is considered the biological norm and essential to reduce infant morbidity and mortality. Mothers are responsible for breastfeeding but the support of others, including their partners is an influential determinant. The aim of this study was to compare antenatal breastfeeding knowledge, attitudes, and perceived breastfeeding support of expectant couples in Mekelle, Ethiopia.

Methods

As part of a randomised controlled trial of an mHealth intervention, 128 couples in their third trimester from three selected health centres in Mekelle city were recruited to participate between September and October 2018. Couples who each had a personal mobile phone, read and spoke Tigrigna, and lived together were included. Baseline data on breastfeeding knowledge, attitudes, and perceived support (breastfeeding savvy, help, appreciation, presence and responsiveness) were collected using previously validated tools through interview by health workers.

Results

Compared to mothers, male partners were more likely to indicate their intention to provide breastfeeding appreciation (p = 0.02), breastfeeding presence (p = 0.002), and breastfeeding responsiveness (p = 0.04). The mothers’ prenatal perception of their partners’ intended breastfeeding support was lower than fathers’ perceptions to support their partners. Multiparous mothers had more positive perceptions regarding their partners’ breastfeeding savvy (p = 0.03), and breastfeeding help (p = 0.02) compared to primiparous mothers.

Conclusions

Fathers in Ethiopia are potentially strong supporters of breastfeeding practice. Future breastfeeding interventions should promote the involvement of fathers in breastfeeding and encourage mothers to increase their partners’ involvement in breastfeeding.

Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

BACKGROUND

The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia.

METHODS

In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices.

RESULTS

Overall, 17.6% (95% CI: 15.6-19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21-0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16-0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21-4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16-0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44-4.82) was the community-level factors associated with the exclusive breastfeeding practices.

CONCLUSIONS

Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother's employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

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.

Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey

Background

Early initiation of breast feeding has great importance for both mothers and newborns. Despite, recommendations for exclusive and early initiation of breast feeding within one hour of birth, Ethiopia reports that 58% of infants under six months of age are exclusively breastfed. Cesarean deliveries may affect timing of breastfeeding initiation, establishment of milk supply and infant breastfeeding interest compared to vaginal deliveries. The aim of this study was to assess the impact of cesarean delivery on breastfeeding initiation.

Methods

A cross-sectional study was conducted with a total of 7115 study participants from the 2016 Ethiopian Demographic Health Survey (EDHS). Both descriptive and analytical statistical analysis was employed. Univariable and multivariable logistic regression analyses were used to identify anyassociations between variables. Odds ratios with its corresponding 95% confidence intervals (CI) were reported. During multivariable analysis, variables with p-value < 0.05 were considered as statistically significant.

Results

The prevalence of late initiation of breast feeding among women with their last live birth was 25.03% (95%CI; 20.5–32.2). Significant factors associated with late initiation of breastfeeding were cesarean delivery [AOR = 4.06 (95%CI, 2.66–6.2)], primipara mother [AOR = 1.45(95%CI, 1.13–1.7)], and having an unplanned pregnancy [AOR = 1.35(95%CI, 1.1–1.65)]. Positively associated with early initiation of breastfeeding was the mother’s age, for women between 20–34 years-old. This association, reported as a negative association of late initiation of breast feeding was [AOR = 0.77(95%CI, 0.61–0.98)].

Conclusion

Cesarean delivery adversely affects the initiation of breast feeding. Cesarean delivery, unplanned pregnancy, and being primiparous, were associated with late initiation of breastfeeding. Women between the ages of 20–34 years of age had a reduced chance of late initiation of breastfeeding. Providing counseling regarding the strategy and importance of early initiation of breast feeding, could have crucial importance for the mother and her newborn.

Prevalence and associated factors of early initiation of breastfeeding among women delivered via Cesarean section in South Gondar zone hospitals Ethiopia, 2020

Background

Early initiation of breastfeeding is putting the newborn to breast within one hour after birth. This study was aimed to assess prevalence of early initiation of breastfeeding and its associated factors among mothers who delivered by cesarean section in South Gondar Zone hospitals Northwest Ethiopia, 2020.

Methods

An institutional based cross-sectional study was employed in South Gondar Zone hospitals from June 12 to July 03, 2020. A total of 356 cesarean delivered mothers were included. Data were collected using interviewer administered questionnaire and entered in to Epi Data version 4.2 and then exported to SPSS version 23.0. Logistic regression statistical analyses were used to identify factors associated with the outcome variables.

Results

The prevalence of early initiation of breastfeeding among mothers who delivered by cesarean section was 51.9%. Mothers who had intended pregnancy [AOR = 2.69, 95% CI (1.34–5.38)], had professional guidance [AOR = 2.68, 95% CI (1.18–6.10)], had breastfeeding experience [AOR = 2.25, 95% CI (1.35–3.75)], and had four and above antenatal care visits [AOR = 2.20, 95% CI (1.24–3.91)] were positively associated with early initiation of breastfeeding among mothers who delivered by cesarean section.

Conclusion

Type of pregnancy, professional guidance, had four or more antenatal care and breastfeeding experience were significantly associated with early initiation of breast feeding among mothers who delivered by cesarean section. Community based breastfeeding education and counseling to pregnant mothers and encouraging all mothers to follow recommended ANC visit is should be recommended.