Factors associated with Early Initiation of Breastfeeding in Western Nepal

Early Initiation of Breastfeeding (EIBF) and Its Associated Factors Among Mothers With Infants Aged 0 to 6 Months in Jashore District, Bangladesh: A Cross-Sectional Study

OBJECTIVE

Early initiation of breastfeeding (EIBF) is one of the most successful interventions for minimizing newborn morbidity and death. According to the database (Bangladesh Demographic Health Survey 2014), only around half of babies begin breastfeeding during the first hour of life in Bangladesh. The goal of this study was to determine the prevalence of EIBF in the Jashore area while also investigating its associated factors among mothers of infants aged 0 to 6 months in order to better understand the variables that impacted breastfeeding initiation.

METHOD

A cross-sectional study was conducted in the maternity wards of the 3 busiest hospitals in the Jashore district of Bangladesh from May to July 2019. Using random sampling, a total of 423 mother-infant pairs were chosen. Pearson chi-square test and bivariable and multivariable logistic regression statistical analysis were used to identify factors linked to EIBF.

RESULTS

The prevalence of EIBF was 46.3% (196/423). Mothers who had skin-to-skin contact after delivery (adjusted odds ratio [AOR], 2.25; 95% confidential interval [CI], 1.40-3.59), who did not deliver prelacteal food (AOR, 3.68; 95% CI, 1.65-8.21), and who provided colostrum (AOR, 5.89; 95% CI, 1.62-21.49) were more likely to begin breastfeeding within 1 hour than were their counterparts.

CONCLUSIONS

EIBF was found to be strongly linked with skin-to-skin contact after delivery, avoidance of prelacteal feeding, and colostrum feeding practice. As a result, we strongly urge public health officials and health care practitioners to encourage these feeding behaviors in order to increase EIBF.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Influence of breastfeeding education and support on predominant breastfeeding: Findings from a community-based prospective cohort study in Western Nepal

Background and Aims

Breastfeeding education and support have the potential to improve breastfeeding outcomes. However, there is a lack of research on the impact of breastfeeding education on predominant breastfeeding in Nepal and other South Asian countries. This study aimed to report the rate of predominant breastfeeding at the first, fourth, and sixth months of birth and examine the influence of breastfeeding promotion on predominant breastfeeding.

Methods

A community-based prospective cohort study was conducted in western Nepal. A total of 735 mother-infant pairs were recruited within 30 days of childbirth and followed up at the fourth and sixth months to collect data on infant feeding practices.

Results

The rate of predominant breastfeeding at first, fourth, and sixth months were 88.6% (N = 735), 78.2% (N = 715), and 26.3% (N = 711), respectively, showing a significant decline with infant age. Mothers who received support on breastfeeding skills (Adjusted Odds Ratio [AOR]: 2.55; 95% confidence interval [CI]: 1.73-3.75), those who received advice on keeping mother-infant together (AOR: 2.19; 95% CI: 1.14-4.22) and who had initiated breastfeeding within 1 h of childbirth (AOR: 2.55; 95% CI: 1.73-3.75), and who were educated, had higher likelihood of predominant breastfeeding at sixth month.

Conclusion

This study asserts a need for continuous and focused breastfeeding promotion programs to educate and support lactating mothers.

Dissecting antenatal care inequalities in western Nepal: insights from a community-based cohort study

BACKGROUND

Antenatal care (ANC) ensures continuity of care in maternal and foetal health. Understanding the quality and timing of antenatal care (ANC) is important to further progress maternal health in Nepal. This study aimed to investigate the proportion of and factors associated with, key ANC services in western Nepal.

METHODS

Data from a community-based cohort study were utilized to evaluate the major ANC service outcomes: (i) three or less ANC visits (underutilization) (ii) late initiation (≥ 4 months) and (iii) suboptimal ANC (< 8 quality indicators). Mothers were recruited and interviewed within 30 days of childbirth. The outcomes and the factors associated with them were reported using frequency distribution and multiple logistic regressions, respectively.

RESULTS

Only 7.5% of 735 mothers reported not attending any ANC visits. While only a quarter (23.77%) of mothers reported under-utilizing ANC, more than half of the women (55.21%) initiated ANC visits late, and one-third (33.8%) received suboptimal ANC quality. A total of seven factors were associated with the suboptimal ANC. Mothers with lower education attainment, residing in rural areas, and those who received service at home, were more likely to attain three or less ANC visits, late initiation of ANC, and report receiving suboptimal ANC. Furthermore, mothers from poor family backgrounds appeared to initiate ANC late. Mothers from disadvantaged Madhesi communities tended to receive suboptimal ANC.

CONCLUSIONS

Despite a high ANC attendance, a significant proportion of mothers had initiated ANC late and received suboptimal care. There is a need to tailor ANC services to better support women from Madhesi ethnic community, as well as those with poor and less educated backgrounds to reduce the inequalities in maternal health care.

Positive influencers for early initiation of breastfeeding

Background

The practice of newborns being put to the breasts soon after birth results in a reduction in neonatal mortality. Factors such as antenatal care attendance, delivery at the Baby Friendly Hospital Initiative (BFHI) facility, mode of delivery, number of children, and various socio-cultural practices are found to have a positive impact on the early initiation of breastfeeding. The present study was performed to determine the socio-demographic, maternal, and neonatal factors affecting the early initiation of breastfeeding.

Methodology

A hospital-based cross-sectional study was performed at the Immunization Clinic and Nursery situated in a government tertiary care hospital for assessing the pattern of breastfeeding initiation. Children born at the hospital and also those reporting to the clinic from outside were included in the study.

Results

Breastfeeding initiation within 1 hour after delivery was only 30%, and 9% did not initiate breastfeeding at all. About half of the reasons for not initiating breastfeeding were related to mothers, followed by 30% related to babies.

Conclusion

Upon regression analysis, it was found that urban residence, higher educational status of the mothers, and those mothers who were not counselled on breastfeeding during antenatal visits had higher odds of not initiating breastfeeding and that was statistically significant.

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.

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

Background

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

Methods

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

Results

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

Conclusion

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

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.

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

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

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

Background

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

Methods

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

Result

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

Conclusion

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

Determinants of Delayed Initiation of Breastfeeding: A Cross-Sectional Multicenter Study in Abu Dhabi, the United Arab Emirates

One of the best practices to reduce the risk of infant morbidity and mortality is the early initiation of breastfeeding, specifically within the first hour of birth, as the World Health Organization (WHO) recommends. Limited data exist on breastfeeding initiation and its related factors in the United Arab Emirates (U.A.E.). Therefore, the purpose of this research study was to evaluate and analyze the determinant factors associated with delayed initiation of breastfeeding among mothers with children aged <2 years old in a cross-sectional multicenter setting in Abu Dhabi, U.A.E. Seven governmental community and healthcare centers participated in the study from diverse geographic areas of Abu Dhabi. A trained female research assistant collected information from mothers with young children attending the centers. All participants were informed in detail about the purpose of the study and signed a written consent form. A total of 1610 mother−child pairs were included in the study. The mean (standard deviation) of maternal age and children’s age was 30.1 (5.1) years and 8.1 (5.9) months, respectively. Six hundred and four (604) (37.5%) reported delayed initiation of breastfeeding. Factors associated with delayed breastfeeding initiation were being of non-Arab nationality (adjusted odds ratio (A.O.R.) 1.30, 95% confidence interval (CI) 1.03, 1.63), caesarean section (AOR 2.85, 95% CI 2.26, 3.58), non-rooming-in (AOR 2.82, 95% CI 1.53, 5.21), first birth order (AOR 1.34, 95% CI 1.07, 1.69), and mothers with low-birth-weight children (AOR 3.30, 95% CI 2.18, 4.99) as was analyzed by multivariate logistic regression analysis. In conclusion, approximately four out of ten mothers delayed initiation of breastfeeding for more than one hour after delivery. The results of this study call for urgent policy changes to improve the early initiation rates of breastfeeding mothers in the U.A.E.

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

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

Gender, nutritional disparities, and child survival in Nepal

BACKGROUND

This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five.

METHODS

We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender.

RESULTS

We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged.

CONCLUSION

While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.

Infant and young child feeding practices and child linear growth in Nepal: Regression-decomposition analysis of national survey data, 1996-2016

Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and height-for-age z-score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001-2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996-2016 period. Our findings indicate that most age-appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's tool for national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle-feeding and introduction of solid, semi-solid or soft foods are rated fair. Our study also reports that a paucity of age-appropriate IYCF practices-in particular complementary feeding-are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, age-appropriate IYCF practices-in isolation-made modest statistical contributions to the rapid and sustained reduction in age-specific child linear growth faltering from 1996-2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies-integrating and advocating optimal IYCF-are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle-feeding.

Infant and young child feeding practices and its associated factors among mothers of under two years children in a western hilly region of Nepal

Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Nepal government has developed and implemented different programs to improve infant and young child feeding practice. However, the practice remains poor and is a major cause of malnutrition in Nepal. This study aims to identify infant and young child feeding practices and its associated factors among mothers of children aged less than two years in western hilly region of Nepal. A descriptive cross-sectional study was carried out among 360 mothers of under two years' children in Syangja district. A semi structural questionnaire was used. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics were used to report the feeding practices and other independent variables. Bivariate and multivariate logistic regression model was used to establish the factors associated with infant and young child feeding practices. The prevalence of breastfeeding, timely initiation of breastfeeding, exclusive breastfeeding, timely initiation of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet (MAD) were 95.6%, 69.2%, 47.6%, 53.3%, 61.5%, 67.3% and 49.9% respectively. Normal delivery (AOR 6.1, 95% CI 1.2-31.3) and higher maternal autonomy (AOR 5.2, 95% CI 1.8-14.6) were significantly associated with exclusive breastfeeding. Similarly, crop production and food security (AOR 3.8, 95% CI 1.9-7.7), maternal knowledge on MAD (AOR 2.5, 95% CI 1.0-6.2) and maternal autonomy (AOR 4.2, 95% CI 2.1-8.4) were significantly associated with minimum acceptable diet. Factors such as maternal education, maternal health services utilization, maternal knowledge, and maternal autonomy were associated with infant and young child feeding practices, which warrants further attention to these factors to reduce malnutrition.

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.

Determinant of Mother's Health Promotional Measures Practice of Infant with Age 6-12 Months in a Tertiary Hospital of Nepal

Background

Promotion of health is vital for the optimal growth and development of every infant. Globally, many infants died due to common problems such as diarrhoea and respiratory infection; most of these problems are related to inadequate breast feeding, improper complimentary feeding, lack of immunization, and home accident. Infant and child health status depends upon mothers' knowledge and practice regarding health promotional measures. This study aimed to determine practice and its determinants regarding health promotional measures of infant with 6–12 months age amongst the mothers attending Pediatrics Outpatient Department of Universal College of Medical Science and Teaching Hospital, Bhairahawa, Rupandehi, Nepal.

Methods

Hospital-based cross-sectional study was conducted in Universal College of Medical Science, Bhairahawa, Rupandehi, Nepal, among 414 mothers attending pediatrics outpatient department from September 2019–March 2020. Purposive sampling technique was used to select mothers of infants aged 6–12 months. Bivariate analysis was used primarily to assess the association between dependent and independent variables. Variables which were associated in bivariate analysis with p < 0.05 were entered into a multivariable logistic regression model to identify associated factors of health promotional measures. The goodness of fit of multivariate logistic regression was checked by Nagelkerke R square and variation inflation factor.

Results

The mean age and family size was 25.89 ± 4.81 years and 5.94 ± 2.48, respectively. A total of 71.5% mothers have good practice of health promotional measures. Mothers from Dalit caste (adjusted odds ratio = 0.04, confidence interval: 0.005–0.30), mothers with below school leaving certificate education (AOR = 0.08, CI: 0.02–0.27), fathers engaged in nonagricultural work (AOR = 7.21, CI: 2.59–20.11), birth space of index child greater than 2 years (AOR = 12.88, CI: 3.49–47.58), and family monthly income greater than 20000 Nepalese rupees (AOR = 3.29, CI: 1.16–13.32 were significantly associated with good practice of health promotional measures.

Conclusions

More than one-fourth of the mothers have poor practice of health promotional measures. Ethnicity, mothers' education, fathers' occupation, birth space of index child, and family monthly income were found to be independent determinants of practice of health promotion measures. Thus, policy makers should provide specific education regarding health promotional measures to both parents.

Factors Associated with Delayed Initiation and Cessation of Breastfeeding Among Working Mothers in Abu Dhabi, the United Arab Emirates

INTRODUCTION

Despite the enormous benefits of breastfeeding, working mothers face more challenges to meet the World Health Organization (WHO) recommendations regarding successful breastfeeding practices. Little research has been done to understand the breastfeeding practices among working mothers in the United Arab Emirates (UAE). Thus, the aim of this study was to investigate the prevalence and factors associated with delayed initiation and cessation of breastfeeding among working mothers with children under the age of two years in Abu Dhabi, the UAE.

METHODS

A cross-sectional multicenter study was conducted from March to September 2017. The study included both Emirati and non-Emirati mothers of children below the age of two years. The data were collected from seven government health care centers in Abu Dhabi as well as from the community. Mothers with young children attending the centers during the study days were approached by trained research assistants, who provided oral and written information about the study.

RESULTS

Among the 1610 mother-child pairs with complete data who were included in this study, 606 were working mothers giving an employment rate of 37.6%. The mean (standard deviation) of maternal age and children's age were 30.9 (5.1) years and 8.6 (6.1) months, respectively. Of the 606 mothers, 217 (35.8%) delayed initiation of breastfeeding, and 359 (59.2%) ceased breastfeeding. In multivariable logistic regression analysis, factors associated with delayed breastfeeding initiation among working mothers were older mother age (adjusted odds ratio [AOR] 1.04, 95% confidence interval [CI]1.01, 1.08), being of non-Arab nationality (AOR 2.24, 95% CI 1.53, 3.27), caesarean section (AOR 2.70, 95% CI 1.84, 3.96), non-rooming-in (AOR 3.85, 95% CI 1.56, 9.51) and mothers with low birth weight children (AOR 2.47, 95% CI 1.23, 4.94). The main factors associated with cessation of breastfeeding were being of non-Arab nationality (AOR 1.59, 95% CI 1.09, 2.31) and mother with high-income rating (AOR 2.79, 95% CI 1.36, 5.75).

CONCLUSION

The study highlighted the need for urgent actions to improve the working mothers' conditions in order to promote optimal breastfeeding practices, including both early initiation and continuation of breastfeeding among all mothers in the UAE regardless of employment status. Policies to improve EBF rates among professional working mothers should include maternity leave extension to enable mothers to continue breastfeeding.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Factors influencing exclusive breastfeeding rates until 6 months postpartum: the Japan Environment and Children's Study

This research aimed to examine the efficacy of the early initiation of breastfeeding within 1 h of birth, early skin-to-skin contact, and rooming-in for the continuation of exclusive breastfeeding until 6 months postpartum. The research used data from the Japan Environment and Children's Study (JECS), a nationwide government-funded birth cohort study. A total of 80,491 mothers in Japan between January 2011 and March 2014 who succeeded or failed to exclusively breastfeed to 6 months were surveyed in JECS. Multiple logistic regression model was used to analyse the data. The percentage of mothers who succeeded in exclusively breastfeeding to 6 months is 37.4%. Adjusted odds ratios were analysed for all 35 variables. Early initiation of breastfeeding (adjusted odds ratio [AOR]: 1.455 [1.401-1.512]), early skin-to-skin contact (AOR: 1.233 [1.165-1.304]), and rooming-in (AOR: 1.567 [1.454-1.690]) affected continuation of exclusive breastfeeding. Regional social capital (AOR: 1.133 [1.061-1.210]) was also discovered to support the continuation of breastfeeding. In contrast, the most influential inhibiting factors were starting childcare (AOR: 0.126 [0.113-0.141]), smoking during pregnancy (AOR: 0.557 [0.496-0.627]), and obese body type during early pregnancy (AOR: 0.667 [0.627-0.710]).

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

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

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

INTRODUCTION

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

METHOD

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

FINDINGS

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

DISCUSSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

We used data from the 2017-2018 Ghana multiple indicator cluster survey and our analysis was restricted to 15,305 mothers who had a live birth within 2 years. Multivariable logistic regression was used to estimate the factors associated with timely initiation of breastfeeding whilst adjusting for potential confounders, and accounted for clustering, stratification, and sample weights.

RESULTS

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

CONCLUSIONS

Interventions to increase timely initiation of breastfeeding should provide breastfeeding support to mothers who have had a caesarean section or small sized babies, prevent unplanned pregnancies, and promote antenatal care attendance among pregnant women.

Prevalence of and factors associated with early initiation of breastfeeding among women with children aged < 24 months in Kilimanjaro region, northern Tanzania: a community-based cross-sectional study

Background

Early initiation of breastfeeding offers nutritional and immunological benefits to the newborn, which is critical for health and survival. Understanding factors associated with timely initiation of breastfeeding is crucial for healthcare providers and policy-makers. This study aimed to assess the prevalence and factors associated with early initiation of breastfeeding among mothers with children < 24 months of age in the Kilimanjaro region, Northern Tanzania.

Methods

This study utilized secondary data from a cross-sectional survey conducted in April 2016 and April 2017 in the Kilimanjaro region. A multistage sampling technique was used to select study participants and interviewed using a questionnaire. A total of 1644 women with children aged < 24 months were analyzed. Modified Poisson regression models were used to determine factors independently associated with early initiation of breastfeeding, within first hour of life.

Results

The prevalence of early initiation of breastfeeding in the Kilimanjaro region was 70%, ranging from 64% in Same to 80% in Siha districts. The prevalence of early initiation of breastfeeding was lower among women who initiated prelacteal feeding compared to their counterparts (prevalence ratio [PR] 0.42; 95% Confidence Interval [CI] 0.34, 0.53). Likewise, women living in Same and Hai district had lower prevalence of early initiation of breastfeeding compared to women in Rombo (PR 0.8; 95% CI 0.76, 0.93) and (PR 0.89, 95% CI 0.80, 0.98) respectively. Higher prevalence of early initiation of breastfeeding was found in women with primary education compared to those with secondary education (PR 1.09; 95% CI 1.003, 1.18), and among women with two children compared to one child (PR 1.14, 95% CI 1.03, 1.26).

Conclusions

Early initiation of breastfeeding practice was suboptimal in this study. To improve early initiation of breastfeeding, healthcare providers at reproductive and child health clinics and labour wards should discourage women from prelacteal feeding, give more support to women with one child and those with secondary level of education and above. Furthermore, a qualitative study is crucial to understand the reasons for low prevalence of early initiation of breastfeeding in Same and Hai districts.

Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation

Unmet need for postpartum contraception in rural Nepal remains high and expanding access to sexual and reproductive healthcare is essential to achieving universal healthcare. We evaluated the impact of an integrated intervention that employed community health workers aided by mobile technology to deliver patient-centred, home-based antenatal and postnatal counselling on postpartum modern contraceptive use. This was a pre–post-intervention study in seven village wards in a single municipality in rural Nepal. The primary outcome was modern contraceptive use among recently postpartum women. We performed a multivariable logistic regression to examine contraceptive use among postpartum women pre- and one-year post-intervention. We conducted qualitative interviews to explore the implementation process. There were 445 postpartum women in the pre-intervention group and 508 in the post-intervention group. Modern contraceptive use increased from 29% pre-intervention to 46% post-intervention (p < 0.0001). Adjusting for age, caste, and household expenditure, time since delivery and sex of child in the index pregnancy, postpartum women one-year post-intervention had twice the odds (OR 2.3; CI 1.7, 3.1; p < 0.0001) of using a modern contraceptive method as compared to pre-intervention. Factors at the individual, family, and systems level influenced women’s contraceptive decisions. The intervention contributed to increasing contraceptive use through knowledge transfer, demand generation, referrals to healthcare facilities, and follow-up. A community-based, patient-centred contraceptive counselling intervention supported by mobile technology and integrated into longitudinal care delivered by community health workers appears to be an effective strategy for improving uptake of modern contraception among postpartum women in rural Nepal.

Gender inequality in early initiation of breastfeeding in Bangladesh: a trend analysis

Background

Early initiation of breastfeeding within 1 hour after birth is essential for newborns, because it reduces risk of neonatal mortality and hypothermia to a great extent and also helps in preventing the long-term chronic diseases and in increasing energy and immunity to newborn. In order to reach the ‘very good state’ of timely or early initiation of breastfeeding recommended by WHO, Bangladesh needs to increase the current rate of 51.24 to 100%. An attempt has been made in this study to examine how the early breastfeeding practice changes among male and female children with time controlling the factors associated with this practice.

Methods

Data from last four consecutive Bangladesh Demographic and Health Surveys (BDHS) have been used in the study. The participants were included whose child born within the last 5 years preceding the surveys of 2004, 2007 and 2011, and within the last 3 years preceding the survey of 2014 in the study and the respective selected participants were 5145, 4765, 7099 and 4370. To conduct the trend analysis, the descriptive statistics of selected variables along with prevalence of early initiation of breastfeeding have been computed by different years and a multiple logistic regression model has been fitted to the pooled dataset of 2004–2014 considering survey years as time.

Results

Rate of early initiation of breastfeeding increased as time progressed and it was faster for female child compared to male child. For example, female children were significantly 10 and 6% less likely to be initiated early than their counterparts in 2004 and 2007, respectively; whereas after 2007 both male and female children were equally treated for breastfeeding practice. It was also found that rate of early initiation significantly increased for one unit increased in survey year and this increasing rate was higher for female child compared to male child. For example, for one unit of increased in survey year, the early initiation of breastfeeding increased by 60% for male child and by 67% for female child. Besides, survey time, gender, education of parents, wanted index child, mode of delivery, antenatal care visits, wealth index, exposure to media and division were found to have potential influence on early initiation of breastfeeding.

Conclusion

Demographic and health surveys conducted in Bangladesh since 2011 have shown no evidence of gender discrimination regarding timely initiation of breastfeeding. In order to achieve the target rate of early initiation of breastfeeding recommended by WHO, it requires to take effective intervention regarding maternal and child health education.

Factors Associated with the Early Initiation of Breastfeeding in Economic Community of West African States (ECOWAS)

The early initiation of breastfeeding (EIBF) within one hour after birth enhanced mother–newborn bonding and protection against infectious diseases. This paper aimed to examine factors associated with EIBF in 13 Economic Community of West African States (ECOWAS). A weighted sample of 76,934 children aged 0–23 months from the recent Demographic and Health Survey dataset in the ECOWAS for the period 2010 to 2018 was pooled. Survey logistic regression analyses, adjusting for country-specific cluster and population-level weights, were used to determine the factors associated with EIBF. The overall combined rate of EIBF in ECOWAS was 43%. After adjusting for potential confounding factors, EIBF was significantly lower in Burkina Faso, Cote d’Ivoire, Guinea, Niger, Nigeria, and Senegal. Mothers who perceived their babies to be average and large at birth were significantly more likely to initiate breastfeeding within one hour of birth than those mothers who perceived their babies to be small at birth. Mothers who had a caesarean delivery (AOR = 0.28, 95%CI = 0.22–0.36), who did not attend antenatal visits (ANC) during pregnancy, and delivered by non-health professionals were more likely to delay initiation of breastfeeding beyond one hour after birth. Male children and mothers from poorer households were more likely to delay introduction of breastfeeding. Infant and young child feeding nutrition programs aimed at improving EIBF in ECOWAS need to target mothers who underutilize healthcare services, especially mothers from lower socioeconomic groups.

Factors associated with exclusive breast-feeding: A cross-sectional survey in Kaiyuan, Yunnan, Southwest China

Breastfeeding has a wide range of benefits for both infants and mothers. The identification of factors associated with exclusive breastfeeding (EBF) are important to increase the prevalence of EBF. The study aimed to determine the prevalence of EBF within the first six months and its associated factors in Kaiyuan, Yunnan Province, Southwest China. This cross-sectional study was conducted in Kaiyuan, a middle-sized city of Yunnan Province, Southwest China. Mothers of infants under twelve months were randomly selected for a face to face interview in four towns (two in urban areas and two in rural areas) in Kaiyuan. A structured questionnaire was applied for collection of sociodemographic information, mothers’ and infants’ health, and breastfeeding information. A 24-hour food recall survey was used to collect infant feeding information. A logistic regression analysis was performed to identify the factors independently associated with exclusive breastfeeding for infants up to six months of age. The number of 417 mothers with infants under six months was interviewed. The prevalence of EBF at six months was 27.34%. Logistic regression indicated that EBF within six months was more likely to be practiced by mothers who had higher average household income per year (OR = 2.09, 95% CI: 1.05–4.17 p = 0.037; OR = 1.85, 95% CI: 1.04–3.28 p = 0.037), and mothers who received breastfeeding information (OR = 2.46, (95%CI: 1.45–4.18, p = 0.0009). The prevalence of EBF in Kaiyuan, Southwest China is considerably lower than national and international recommendations. Yearly household income, and mothers who received breastfeeding information are associated with higher EBF prevalence. Breastfeeding information should be given to mothers in order to increase the prevalence of EBF.

Assistance for parents with unsettled infants in Central Vietnam: a qualitative investigation of health professionals' perspectives

BACKGROUND

Unsettled infant behaviours are a common concern for parents internationally, and have been associated with maternal stress, reduced parenting confidence, and postnatal mental health problems among parents. Little information currently exists regarding available support for the parents of unsettled infants in low-and-middle income countries such as Vietnam. We aimed to describe how unsettled infant behaviour was understood and investigated by Vietnamese health professionals, and what health education was provided to parents regarding infant sleep and settling.

METHODS

This qualitative study elicited the perspectives of Vietnamese health professionals working in Thua Thien Hue Province, Vietnam. A semi-structured interview guide included participant demographics, and questions about providing assistance to the parents of unsettled infants, understandings of unsettled infant behaviour, management of unsettled infant behaviour and health education. Individual interviews or small-group discussions were undertaken in Vietnamese, data were translated and analysed in English. The authors used a thematic approach to analysis, supported by Nvivo software.

RESULTS

Nine health professionals (four primary care doctors, one paediatrician and four nurses/midwives) working in urban and rural areas of Thua Thien Hue were interviewed. Four themes were created that reflected the responses to the literature-based interview questions. Health professionals described having received little formal training about infant sleep and settling, thus based their advice on personal experience. Information on infant sleep and settling was not included in health education for new mothers, which focused on breastfeeding and preventing malnutrition. Where advice was given, it was generally based on settling strategies involving high levels of caregiver intervention (holding, rocking, breastfeeding on demand and tolerating frequent overnight wakings) rather than behaviour management style strategies. Participants emphasised the importance of recognising and responding to infant behavioural cues (e.g infants cry when hungry).

CONCLUSIONS

There is an unmet need for information on infant sleep and settling for new parents and health professionals in Vietnam. Our findings suggest information for caregivers on how to respond sensitively to infant tired signs should be formally included in the training of health professionals in LALMI settings. Sleep and settling information should also be part of culturally appropriate multi-component maternal and child health interventions aimed at promoting early childhood development.

Determinants of infant breastfeeding practices in Nepal: a national study

Background

Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development.

Methods

We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering.

Results

The prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains.

Conclusions

Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy.

Electronic supplementary material

The online version of this article (10.1186/s13006-019-0208-y) contains supplementary material, which is available to authorized users.

Predictors of early initiation of breastfeeding among Zimbabwean women: secondary analysis of ZDHS 2015

Background

The World Health Organization recommends initiation of breastfeeding within the first hour of delivery. Early initiation is beneficial for both mother and baby. Previous Zimbabwe Demographic and Health Surveys (ZDHS) have shown reduction in early initiation of breast feeding from 68% (2005/06) to 58% (2015). This study sought to investigate factors associated with early initiation of breast feeding among women aged 15–49 years in Zimbabwe.

Methodology

Secondary analysis of ZDHS 2015 data was done to investigate the association between early initiation of breast feeding and maternal, provider and neonatal factors using multivariate logistic regression (n = 2192).

Results

The majority of the study sample (78%) reported having practised early initiation of breastfeeding during their most recent delivery (preceding 24 months).Children who were put on skin to skin contact (AOR = 1.51, 95% CI 1.13–2.02) and those delivered by skilled attendants (AOR = 4.36, 95% CI 1.07–17.77) had greater odds of early initiation compared to those who were not. Other factors associated with early initiation were multiparity (AOR 1.82 95% CI 1.33–2.49) and rural residence (AOR 2.10 95% 1.12–3.93). However, having an abnormal birth weight, i.e. low birth weight (AOR 0.60 95% CI 0.36–0.99) and macrosomia (AOR = 0.42, CI 0.22–0.79) as well as delivery by caesarean section (AOR 0.1195% CI 0.06–0.19) were associated with reduced odds of early initiation.

Conclusion

Early initiation of breast feeding in Zimbabwe is mainly associated with residing in the rural areas and multiparity. The 78% rate of early initiation of breastfeeding was contrary to the 58% reported in the ZDHS findings. Interventions targeting an improvement in early initiation of breastfeeding must aim at women who deliver by caesarean section, women with babies of abnormal birth weight, primi-parous women and women residing in rural areas.

Timely initiation of breastfeeding and associated factors among mothers of infants age 0-6 months old in Bahir Dar City, Northwest, Ethiopia, 2017: a community based cross-sectional study

Background

Early initiation of breastfeeding, also known as early initiation, is the provision of a mothers own breast milk to her infant within one hour of birth. In Ethiopia, there is a considerable variation in the timely initiation of breastfeeding practices. Therefore, the objective of this study was to assess the level of timely initiation of breastfeeding and associated factors among mothers of infants less than six months old in Bahir Dar, Northwest, Ethiopia.

Methods

A community-based cross-sectional study was conducted in Bahir Dar City from April 15 to May 3, 2017. A total of 472 mothers of infant age less than six months were selected by simple random sampling technique. Data were collected using an interviewer administered questionnaire. Descriptive statistics were done to know the distribution of variables. To identify predictors logistic regression was conducted.

Results

The prevalence of timely initiation of breastfeeding was 356 (75.4%). Mothers who birth by a vaginal delivery (Adjusted Odds Ratio [AOR] 6.99; 95% Confidence Interval [CI] 3.49, 14.00), mothers who gave birth at health institution (AOR 3.36; 95% CI 1.47, 7.67), and who get breastfeeding counseling during antenatal care visits (AOR 5.64; 95% CI 2.70, 11.79) were more likely to initiate breastfeeding within one hour than counterparts.

Conclusions

Practice of timely initiation of breastfeeding in this study was suboptimal. Mothers who delivered at the health institution, gave birth by a vaginal delivery, and who got breastfeeding counseling during antenatal visits were the independent predictors of the timely initiation of breastfeeding practice. Encouraging all mothers to give birth in health facilities, counsel mothers to initiate breastfeeding timely at time of Caesarean sections, reduce the indication of the Caesarean procedure and providing breastfeeding counseling during antenatal care visits were recommended. Additionally, health services must establish practices that enable timely breastfeeding whenever possible, in particular, after Caesarean section and systems need to be set up to enable skin-to-skin and timely breastfeeding.

SKIN-TO-SKIN CONTACT FOLLOWED BY BREASTFEEDING IN THE FIRST HOUR OF LIFE: ASSOCIATED FACTORS AND INFLUENCES ON EXCLUSIVE BREASTFEEDING

ABSTRACT Objective: to verify the factors associated with the practice of skin-to-skin contact with breastfeeding in the first hour of life and its influence on exclusive breastfeeding in the first month. Method: a retrospective cross-sectional study with medical records from a breastfeeding outpatient clinic in São Paulo, Brazil. The sample included all the medical records of the mother-baby dyad who had been consulted by nurses between 2004 and 2010. Data were collected from the medical records between 2014 and 2015. Results: 1,030 medical records were identified, 71 were excluded and the final sample was 959. The prevalence of skin-to-skin contact with breastfeeding in the first hour was 37.2%. The Apgar score between 8 and 10 in the first minute of life and the higher birth weight of the newborn were protective factors of contact with early breastfeeding; lower maternal age and cesarean delivery and forceps were risk factors for this practice. Exclusive breastfeeding was statistically higher in the group of newborns who had contact with breastfeeding in the first hour; however, there was no association with duration of exclusive breastfeeding. Conclusion: good birth conditions were protective factors for breastfeeding followed by skin-to-skin contact in the first hour, while younger maternal age and surgical deliveries proved to be risk factors. Exclusive breastfeeding in the baby´s first month of life was not associated with skin-to-skin contact followed by breastfeeding in the first hour of life.

Maternal Factors and Utilization of the Antenatal Care Services during Pregnancy Associated with Low Birth Weight in Rural Nepal: Analyses of the Antenatal Care and Birth Weight Records of the MATRI-SUMAN Trial

Low birth weight (LBW) remains a major public health problem in developing countries, including Nepal. This study was undertaken to examine the association between LBW and maternal factors and antenatal care service utilization, in rural Nepal, using data obtained for a capacity-building and text-messaging intervention, designed to enhance maternal and child health service utilization among pregnant women, in rural Nepal ("MATRI-SUMAN"). The study used a clustered randomized controlled design and was conducted during 2015⁻2016. We investigated maternal and antenatal care service utilization determinants of LBW, using a logistic regression model. Of the four hundred and two singleton babies, included in the present study, seventy-eight (19.4%) had an LBW (mean (SD), 2210.64 (212.47)) grams. It was found that Dalit caste/ethnicity, illiteracy, manual labor, a female baby, and having more than four family members were significantly positively associated with LBW. In addition, mothers who did not visit an antenatal care (ANC) unit, visited an ANC < 4 times, did not take iron and folic acid (IFA), de-worming tablets, and mothers that did not consume additional food, during pregnancy, were more likely to have an LBW baby, than their counterparts. The MATRI-SUMAN intervention and availability of a kitchen garden at home, were found to reduce the risk of LBW. Nepalese child survival policies and programs should pay attention to these maternal and antenatal care service utilization factors, while designating preventive strategies to improve child health outcomes.

Trends and factors associated with early initiation of breastfeeding in Namibia: analysis of the Demographic and Health Surveys 2000-2013

BACKGROUND

Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013.

METHODS

An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006-2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used to analyse respondents' demographic, socioeconomic and obstetric characteristics. Factors associated with EIBF were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis.

RESULTS

EIBF significantly decreased from 82.5% (confidence interval [CI]: 79.5-85.0) in 2000 to 74.9% (72.5-77.2) in 2013. Factors associated with EIBF in 2000 were urban residence (adjusted odds ratio 0.58, 95% CI: 0.36-0.93), poorer household wealth index (1.82, 1.05-3.17), lack of antenatal care (0.14, 0.03-0.81), small birth size (0.38, 0.24-0.63) and large birth size (0.51, 0.37-0.79). In 2013, factors associated with EIBF were maternal age of 15-19 years (2.28, 1.22-4.24), vaginal delivery (2.74, 1.90-3.93), married mothers (1.57, 1.16-2.14), delivery assistance from health professionals (3.67, 1.23-10.9) and birth order of fourth or above (1.52, 1.03-2.26).

CONCLUSIONS

Namibia has experienced a declining trend in EIBF rates from 2000 to 2013. Factors associated with EIBF differed between 2000 and 2013. The present findings highlight the importance of continued commitment to addressing neonatal health challenges and strengthening implementation of interventions to increase EIBF in Namibia.

Las semanas de gestación como factor asociado a la práctica de la lactancia materna inmediata

Introducción: iniciar la lactancia tempranamente es crucial para aprovechar el periodo sensitivo del recién nacido y la cascada hormonal materna inmediata al posparto, que en conjunto favorecen la continuidad de la lactancia durante el desarrollo del niño. Sin embargo, existen factores que pueden afectar la realización de la lactancia materna inmediata (LMI) con consecuencias que afectan la salud.Objetivo: determinar si existe relación entre la LMI y las características del control prenatal, del parto y de tipo socioeconómico.Material y métodos: estudio de casos y controles. Se aplicaron encuestas a mujeres con hijos entre 6 y 24 meses de edad. El muestreo fue no probabilístico. Se compararon las medias a través de la t de student, se buscaron asociaciones a través de correlación de Spearman y Odds ratio.Resultados: las semanas de gestación (SDG) tuvieron una media inferior en el grupo de mujeres que realizaron LMI (p=0,023). Las mujeres con mayores ingresos económicos realizaron menos LMI [Rho= -0.28 (p <0.05)] y a menos SDG aumenta la práctica de LMI [Rho= -0,35 (p <0,05)]. Nacer con más de 38 SDG se relaciona con menor realización de LMI [OR= 0.16 (IC 0,04-0,64)].Conclusiones: mientras que el menor ingreso económico y escolaridad de la madre se relacionan con menor práctica de LMI, cuando el parto se da antes de las 38 SDG la probabilidad aumenta.

Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh

This study aimed to evaluate the impact of peer counselling on early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) rates for mother-infant pairs living in urban slums, Dhaka, Bangladesh. This randomized controlled trial enrolled 350 mother-infant pairs from selected slums between September 2014 and July 2016. The women assigned to intervention group received peer counselling from locally recruited, trained community female volunteers starting in third trimester of pregnancy until 6 months after delivery; control group received no intervention. EIBF, any liquids given after birth, and EBF were compared between groups. Follow-up was scheduled at enrolment, following childbirth, and every 2 months up to 6 months after delivery. Multiple logistic regressions were used to assess the effect peer counselling and other associated factors on EIBF and EBF practices. EIBF rate was higher in the intervention group than in the control group (89.1% vs. 77.4%, p = .005). More mothers in intervention group were exclusively breastfeeding at 5 months than mothers in the control group (73% vs. 27%, p < .005). Control mothers were twice as likely to not practice EIBF compared with intervention mothers (adjusted odds risk [aOR]: 2.53, CI [1.29, 4.97], p = .007). Overall, caesarean section was associated with an 8.9-fold higher risk of not achieving EIBF (aOR: 8.90, CI [4.05, 19.55], p < .001). Intervention mothers were 5.10-fold more likely to practice EBF compared with control mothers (aOR: 5.10, CI [2.89, 9.01], p < .001) at 5 months. This study demonstrates peer counselling can positively influence both EIBF and EBF among mothers living in urban area.

Initiation of breastfeeding within one hour of birth among mothers with infants younger than or equal to 6 months of age attending public health institutions in Addis Ababa, Ethiopia

Background

Breast milk is comprised of the essential nutrients that an infant needs in the first six months of life. Timely initiation of breastfeeding guarantees that infants receive the colostrum, ‘the first breastmilk’, which contains antibodies that protect the newborn against diseases. Breastfeeding within the first hour of life prevents newborn death due to sepsis, pneumonia, diarrhea and hypothermia. Although breastfeeding is a common practice in sub-Saharan Africa, evidence show that early initiation of breastfeeding is low.

Methods

We conducted a cross-sectional study of 583 mothers with infants younger than or equal to 6 months of age attending Maternal and Child Health (MCH) clinics of public health institutions in Addis Ababa, Ethiopia from April to May 2012. A simple random sampling design was used to select the institutions included in this study. Data from mothers of infants were collected using interviewer-administered questionnaire. We analyzed the data to examine factors associated with initiation of breastfeeding within one hour of birth using logistic regression models.

Results

Of 564 (96.7%, 564/583) mothers who breastfed their infants, 58.3% (329/564) initiated breastfeeding within one hour of birth. In the adjusted analysis, mothers who had three or more infants had about twice higher odds of timely initiation of breastfeeding within one hour of birth (Adjusted Odds Ratio [aOR] 2.10; 95% Confidence Interval [CI]1.04, 4.30) compared with mothers who had one infant. Furthermore, women who started antenatal care at their fourth month of pregnancy or later had a 49.0% higher odds of initiation of breastfeeding within one hour of birth (aOR 1.49; 95% CI 1.01, 2.19) compared to mothers who started antenatal care before their fourth month of pregnancy.

Conclusions

Initiation of breastfeeding within one hour of birth was low. Initiation of breastfeeding within one hour of birth was highest among multiparous women, mothers aged 30–34 years, and women who began antenatal care at their fourth month of pregnancy or later. Public health officials and health care providers should consider interventions to promote and support early initiation of breastfeeding.

Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia

The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother’s room (OR: 2.37; 95% CI: 1.66–3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13–2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51–31.4), followed by not rooming-in infants in the mother’s room (OR: 2.2; 95% CI: 1.52–3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3–2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04–2.35), and cesarean sections (OR:1.42; 95% CI: 1.02–1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers’ awareness and promote BF practice.

Early Initiation of Breastfeeding Among Maya Mothers in the Western Highlands of Guatemala: Practices and Beliefs

BACKGROUND

Guatemala exhibits the sixth highest rate of child stunting worldwide, and stunting disproportionately affects Guatemala indigenous communities. In a country struggling to combat this result of malnutrition, early child nutrition is especially critical. Specifically, early initiation of breastfeeding is important for the development of newborn infants. Understanding beliefs and practices related to early initiation of breastfeeding in Maya Guatemala may provide an avenue to guide nutrition interventions in indigenous communities. Research aim: This study aimed to determine major beliefs and practices associated with early initiation of breastfeeding among Maya mothers in Lake Atitlán, Guatemala.

METHODS

As part of a larger study to assess child nutrition in the Lake Atitlán region, we created a series of semistructured interview questions to document breastfeeding practices and beliefs among mothers. We conducted and audio-recorded in-person interviews that were translated from Kaqchikel, the local language, to Spanish by a community assistant.

RESULTS

We conducted 178 interviews with mothers; 76% practiced early initiation. Early initiation was associated with the village and complementary feeding practices. Mothers held a variety of beliefs about the value of colostrum, and these beliefs were associated with the village. Mothers who held negative beliefs toward colostrum were more likely to delay breastfeeding initiation.

CONCLUSION

Although most Maya mothers practice early initiation, the intervillage disparity in breastfeeding practices demonstrates a need to geographically focus breastfeeding interventions. Our novel insights into the breastfeeding beliefs among Maya mothers will serve as a guide to structure culturally competent breastfeeding education interventions in indigenous communities.

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Correlates of early neonatal feeding practice in Dabat HDSS site, northwest Ethiopia

Background

Delaying the start of breastfeeding and giving prelacteal feeding leads to a significant increase in neonatal and infant deaths, particularly in a resource limited countries, like Ethiopia. Therefore, this study aimed to assess early neonatal feeding practice and its determinants in Dabat HDSS site, northwest Ethiopia.

Methods

The census for the reconciliation of the surveillance of the Dabat Health and Demographic Surveillance System (HDSS) site was conducted from October to December 2014. Data were entered into the Household Registration System (HRS) version 2.1 and analyzed using Stata version 14. A total of 6,761 mother-child pairs were included in the study. Sociodemographic factors, maternal health care and early neonatal feeding practices (early initiation of breastfeeding and prelacteal feeding) were collected by interviewing the mothers. The prevalence of early/timely initiation of breastfeeding was computed as the ratio of children put to the breast within one hour of delivery to the total number of children. Prelacteal feeding was defined as giving anything to drink other than breast milk in the first three days following birth. Binary logistic regression models were used to identify variables which were associated with the dependent variable. A multivariable logistic regression analysis was carried out to identify factors associated with early initiation of breastfeeding.

Results

The prevalence of early initiation of breastfeeding was 43.9% (95% CI, 41.6, 46.2). More than half (56%) of the mothers gave prelacteal feeds. An urban residence (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval [CI] 1.25. 1.73) and antenatal care (AOR 1.41, 95% CI 1.24, 1.59) were correlated with early initiation of breastfeeding. Similarly, increased odds of timely initiation of breastfeeding were observed among mothers who didn’t give prelacteal feeds (AOR 5.72; 95% CI, 5.12, 6.40).

Conclusion

Delayed initiation of breastfeeding and prelacteal feeding still remain public health concerns in this community. The promotion of improved infant and young child feeding (IYCF) practices and the utilization of antenatal care services should be intensified.

Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study

Background

Correct measurement and continuous monitoring of exclusive breastfeeding are essential to promote exclusive breastfeeding. Measuring exclusive breastfeeding is a complex issue as rates can vary according to the definition, measurement period, questions asked, and infant’s age. This article reviewed the methodology of reporting exclusive breastfeeding in Nepal, and compared exclusive breastfeeding rates using data from a cohort study undertaken in western Nepal.

Methods

A literature review was first conducted on studies published during 2000–2014. In our cohort study, 735 mother-infant pairs were recruited within the first month postpartum and followed up during the fourth and sixth months.

Results

The majority of studies in Nepal, including national surveys, used the World Health Organization (WHO) recommended definition (only breastmilk with the exception of medicine and vitamin syrup), and the most common measurement period was a 24-h recall. Our data demonstrated that the exclusive breastfeeding rate during the sixth month was 8.9% using the recall-since-birth method but was 18.7% using the 24-h recall method. Substantial differences in rates were also found during the first (66.3% vs 83.9%) and fourth months (39.2% vs 61.1%).

Conclusion

We found that recent studies reporting exclusive breastfeeding in Nepal varied considerably in methodology. The most commonly used measurement, the 24-h recall, leads to over-estimation of the prevalence of exclusive breastfeeding when compared to the recall-since-birth method. A common standard of reporting exclusive breastfeeding is clearly needed for evidence-based decision making.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-1180-9) contains supplementary material, which is available to authorized users.

Early newborn ritual foods correlate with delayed breastfeeding initiation in rural Bangladesh

Background

Early and exclusive breastfeeding may improve neonatal survival in low resource settings, but suboptimal breastfeeding still exists in areas with high infant mortality. Prelacteal feeding, the practice of giving a non-breastmilk food as a neonate’s first food, has been associated with suboptimal breastfeeding practices. We examined the association of feeding a non-breastmilk food in the first three days of life (early neonatal food, or ENF) with time from birth to initiation of breastfeeding among 25,286 Bangladeshi mother-neonate pairs, in a secondary analysis of a randomized controlled trial in northwestern rural Bangladesh conducted from 2001–2007.

Methods

Trained interviewers assessed the demographic characteristics during pregnancy. At three months postpartum, the interviewers visited participants again and retrospectively assessed demographic and breastfeeding characteristics surrounding the birth. We assessed the relationship between ENF and time to initiation of breastfeeding in hours in both unadjusted and adjusted linear regression analyses. We also calculated reverse cumulative distribution curves for time to initiation of breastfeeding and analyses were stratified by an infant’s ability to breastfeed normally at birth.

Results

The mean ± SD time from birth to initiation of breastfeeding was 30.6 ± 27.9 hours. Only 2,535 (10.0%) of women reported initiating breastfeeding in the first hour after birth and 10,207 (40.4%) reported initiating breastfeeding in the first 12 hours after birth. In adjusted linear regression analyses, feeding ENF was associated with a significant increase in time, in hours, to breastfeeding initiation both among children not able to breastfeed at birth (37.4; 95% CI 33.3, 41.5) and among children able to breastfeed at birth (13.3; 95% CI 12.7, 14.0).

Conclusions

Feeding ENF was strongly associated with delayed initiation of breastfeeding, even after adjusting for other related factors and stratifying on the neonate’s ability to suckle normally after birth. More research is needed to understand the impact of these findings on optimal breastfeeding in this setting. It is possible that ENF feeding and the ability to breastfeed immediately after birth are interrelated in their respective associations to suboptimal breastfeeding initiation. This study in a large population representative of other populations in rural South Asia, demonstrates significantly longer times to breastfeeding initiation than previously appreciated, with a possible important role of ENF feeding.

Trial registration

The randomized controlled trial on which this analysis is based, “Impact of Maternal Vitamin A or Beta-Carotene Supplementation on Maternal and Infant Mortality in Bangladesh”, was registered with ClinicalTrials.gov as trial number ID GHS-A-00-03-00019-00 and identifier NCT00198822. The identifier was first received September 12, 2005 (retrospectively registered). The first participant was enrolled in August 2001.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0090-9) contains supplementary material, which is available to authorized users.

Barriers to Early Initiation and Continuation of Breastfeeding in a Tertiary care Institute of Haryana: A Qualitative Study in Nursing Care Providers

INTRODUCTION

Ever increasing institutional deliveries in India has shifted the responsibility of timely initiation and continuation of breastfeeding from peripheral health workers and families to the nursing care providers of health facilities where the births take place. While institutional deliveries have increased to 72.6%, only 44.6% of the newborns enjoy early breastfeeding in India.

AIM

To study the barriers to early initiation of breastfeeding in institutional delivery.

MATERIALS AND METHODS

A total 34 nursing care providers were selected randomly and five Focus Group Discussions (FGDs) were carried out. This Qualitative Study was conducted through FGDs among the nursing care providers of a tertiary care institute in the Indian State of Haryana, India.

STATISTICAL ANALYSIS

The analyses continued throughout the group discussions as the newly emerged themes were tested in the subsequent discussion. FGDs transcripts were analysed to enhance the robustness of the emerged domain.

RESULTS

Major barriers to initiation of breast feeding identified included: lack of awareness regarding proper technique of breastfeeding and benefits of colostrum; breast abnormality like inverted/retracted nipples; obstetric/neonatal complications requiring specialised care; and cultural practices like giving pre-lacteals and gender discrimination. It was further reported that the manpower has not been rationalised with ever increasing number of institutional deliveries. The respondents though willing to promote early initiation and continuation of breastfeeding felt excessive workload as one of the major barriers due to multi-tasking nature of their job.

CONCLUSION

The new challenges to the early initiation and continuation of breastfeeding are emerging due to change in the place of delivery which needs to be addressed at the policy level.

The supplemental use of infant formula in the context of universal breastfeeding practices in Western Nepal

Background

While the initiation of breastfeeding is universal in Nepal, little has been reported on formula feeding practices. This study aimed to report the prevalence of, and factors associated with, the use of infant formula as supplementary feeds in the Western region of Nepal.

Methods

A community-based cohort study was conducted to collect infant feeding information among 735 postpartum mothers using structured questionnaires. Complete formula feeding data were collected from 711 women in the first, fourth and sixth month postpartum. Factors independently associated with formula feeding were investigated using multiple logistic regression.

Results

All mothers were breastfeeding their infants at the time of recruitment. The prevalence of formula feeding was 7.5 % in the first month and 17 % in the sixth month. About a quarter of mothers (23.8 %) reported providing infant formula at least once during the first six months of life. Infant formula was used commonly as top-up food. Stepwise logistic regression showed that infants born to families residing in urban areas (adjusted odds ratio (aOR): 2.14; 95 % confidence interval (CI): 1.37 to 3.33), mothers with higher education (aOR: 2.08; 95 % CI: 1.14 to 3.80), and infants born by caesarean section (aOR: 1.96; 95 % CI: 1.21 to 3.18) were at greater risk of formula feeding.

Conclusion

The current findings indicate that health workers should support mothers to initiate and continue exclusive breastfeeding particularly after caesarean deliveries. Furthermore, urban health programs in Nepal should incorporate breastfeeding programs which discourage the unnecessary use of formula feeding. The marketing of formula milk should be monitored more vigilantly especially in the aftermath of the April 2015 earthquakes or other natural disasters.

Determinants of early initiation of breastfeeding in Amibara district, Northeastern Ethiopia: a community based cross-sectional study

BACKGROUND

Early initiation of breastfeeding has lifetime benefits for the mother and the child. It has a positive impact on the duration of exclusive breastfeeding. Hence, the initiation of breastfeeding within the first hour of life lays the foundation for optimal breastfeeding. This study aimed to assess early and timely initiation of breastfeeding practices and associated factors among mothers of children aged less than 24 months in Amibara district of Northeast Ethiopia during April 2015.

METHODS

A quantitative community based cross-sectional study was employed on 407 mothers of children aged less than 24 months in Amibara district. Descriptive statistics, binary and multivariable logistic regression analysis were employed to identify the factors associated with early initiation of breastfeeding. The strength of the association was measured by odds ratio, and p-value < 0.05 was considered statistically significant.

RESULTS

Three hundred eighty one (94.5 %) of the respondents had ever breastfed their index child. Of those who had ever breastfed, 151, 39.6 % (95 % Confidence Interval [CI] 35.0 %, 45.0 %) of mothers initiated breastfeeding within 1 h after birth. In multivariable logistic regression analysis mothers living in urban areas (Adjusted Odds Ratio [AOR] 3.8; 95 % CI 2.32, 6.06) and who attended formal education (AOR 2.0; 95 % CI 1.21, 3.46) were associated with increased odds of early initiation of breastfeeding. The factors associated with decreased odds of timely initiation of breastfeeding were caesarean section delivery (AOR 0.46; 95 % CI 0.22, 0.97) and mothers with two or three children (AOR 0.59; 95 % CI 0.35, 0.99).

CONCLUSION

This study showed that four in ten infants were breastfed within the first hour after birth. Therefore, providing proper support and guidance of health professionals during cesarean section delivery and breastfeeding education programs at the village level for girls and young women without formal education are important interventions to promote early initiation of breastfeeding in the study area.