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1.

Background

The World Health Organization (WHO) encourages early initiation of breastfeeding within the first hour after birth with the objective of saving children’s lives. There are few published research papers about factors associated with the initiation of breastfeeding in Sudan.The aim of this study was to investigate the prevalence of and factors associated with the timely initiation of breastfeeding among mothers with children two years and under in Kassala, Eastern Sudan.

Methods

A community-based cross-sectional study was conducted from December 2016 to March 2017. Mothers were interviewed using a structured questionnaire.

Results

A total of 250 mother-child pairs participated in the study. The mean (standard deviation) of maternal age and children’s age was 27.1 (5.68) years and 11.9 (6.9) months, respectively.Of the 250 mothers, 218 (87.2%) initiated breastfeeding within the first hour. In multivariable logistic regression analysis, factors associated with the delay of breastfeeding initiation were having a male baby (Adjusted Odds Ratio [AOR] 3.90, 95% Confidence Interval [CI]1.33, 11.47), and mothers with medical disorders (AOR 5.07, 95% CI 1.22, 21.16).

Conclusion

There was a high prevalence of early initiation of breastfeeding. An association with delayed initiation of breastfeeding was found amongst mothers who had medical disorders and those who had a male infant. Wherever possible, early initiation of breastfeeding should be promoted for all infants, regardless of gender.
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2.

Background

The objective of this study is to examine the effects of macro-level factors – welfare state policies and public health initiatives – on breastfeeding initiation among eighteen high-income countries.

Methods

This study utilizes fuzzy-set Qualitative Comparative Analysis methods to examine the combinations of conditions leading to both high and low national breastfeeding initiation rates among eighteen high-income countries.

Results

The most common pathway leading to high breastfeeding initiation is the combination of conditions including a high percentage of women in parliament, a low national cesarean section rate, and either low family spending, high rates of maternity leave, or high rates of women working part-time. The most common pathway leading to low breastfeeding initiation includes the necessary condition of low national adherence to the Baby-Friendly Hospital Initiative.

Conclusion

This research suggests that there is a connection between broad level welfare state polices, public health initiatives, and breastfeeding initiation. Compliance with the WHO/UNICEF initiatives depends on welfare regime policies and overall support for women in both productive and reproductive labor.
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3.

Background

Timely initiation of breastfeeding has been reported to reduce neonatal mortality by 19.1%. The World Health Organisation recommends early initiation of breastfeeding i.e. breastfeeding a newborn within the first hour of life. Knowledge on the rate and the determinants of early initiation of breastfeeding may help health program managers to design and implement effective breastfeeding promotion programs. The aim of this study was to determine the rate and the determinants of early initiation of breastfeeding in Nepal.

Methods

This study used the data from Nepal Demographic and Health Survey (NDHS) 2011 which is a nationally representative sample study. Chi square test and multiple logistic regression analysis were used to examine the factors associated with early initiation of breastfeeding (within one hour of birth).

Results

Of 4079 mothers, 66.4% initiated breastfeeding within one hour of delivery. Mothers with higher education (Odds Ratio (OR) 2.56; 95% CI : 1.26, 5.21), mothers of disadvantaged Janjati ethnicity (OR 1.43; 95% CI : 1.04, 1.94), mothers who were involved in agriculture occupation (OR 1.51; 95% CI : 1.16, 1.97), mothers who delivered in a health facility (OR 1.67; 95% CI : 1.25, 2.23), whose children were large at birth (OR 1.46; 95% CI : 1.07, 1.99) were more likely to initiate breastfeeding within the first hour of child birth.

Conclusions

Results suggest that two thirds of children in Nepal were breastfed within the first hour after birth. Although there was a higher prevalence of early initiation of breastfeeding among mothers who delivered in health facilities compared to mothers who delivered at home, universal practice of early initiation of breastfeeding should be a routine practice. The findings suggest the need of breastfeeding promotion programs among the mothers who are less educated, and not working. Such breastfeeding promotion programmes could be implemented via Nepal’s extensive network of community-based workers.
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4.

Background

The identification of the factors most closely associated with the initiation of breastfeeding is a vital first step in designing strategies to promote breastfeeding. The study therefore aimed to identify the factors that may be associated with the initiation of breastfeeding in the first 48 h after giving birth among mothers in Tabuk, Saudi Arabia.

Methods

This cross-sectional study was based on a sample of 671 mothers of infants aged up to 24 months at five primary healthcare centers between May and September 2015. A structured questionnaire was used to gather general sociodemographic data along with more detailed information on breastfeeding. A logistic regression analysis was then performed to establish the factors which were independently associated with the mothers’ initiation of breastfeeding.

Results

Breastfeeding was initiated by 92.7 % of mothers within the first 48 h after childbirth. Breastfeeding initiation within the first 48 h of childbirth was lower in women who gave birth by caesarean section (Adjusted Odds Ratio [AdjOR] 0.31, 95 % Confidence Interval [CI] 0.17, 0.57), and had preterm (AdjOR 0.29, 95 % CI 0.12, 0.70) or low birth weight infants (AdjOR 0.35, 95 % CI 0.17, 0.75).

Conclusions

Each variable presents an important barrier to breastfeeding initiation. Suitable hospital policies and staff training are needed to support mothers in quickly initiating breastfeeding, and to discourage the use of infant formula in hospital. To encourage higher rates of exclusive breastfeeding in Saudi Arabia, additional support is required for mothers at a higher risk of failing to initiate breastfeeding in a timely manner.
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5.
6.
7.

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.
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8.

Background

Timely initiation of breastfeeding is defined as putting the newborn to the breast within 1 h of birth. In Ethiopia, different studies have been conducted to assess the prevalence of timely initiation of breastfeeding and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of timely initiation of breastfeeding and its association with birth place in Ethiopia using the available studies.

Methods

Databases, including PubMed, Google scholar, Science direct and Cochrane library were systematically searched. All original studies reporting the prevalence of timely initiation of breastfeeding in Ethiopia were considered. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 11 statistical software was used to analyze the data. The Cochrane Q test statistics and I 2 test were used to assess the heterogeneity between the studies. A random effect model was computed to estimate the pooled prevalence of timely initiation of breastfeeding. In addition, the associations between timely initiation of breastfeeding and place of birth were determined.

Results

Sixteen studies were finally included in the meta-analysis. The findings of this meta-analysis revealed that, the pooled prevalence of timely initiation of breastfeeding in Ethiopia was 61.4% (CI: 51.4, 71.5%). The study also indicated that rural mothers had lower rate of initiating breastfeeding within the first 1 h after delivery as compared to their urban counterparts. Additionally, mothers who gave birth at health institution were almost 2.11 times more likely to initiate breastfeeding within 1 h as compared to mothers who did not give birth at health institution.

Conclusion

In this study, timely initiation of breastfeeding in Ethiopia was significantly low compared to the current global recommendation on breastfeeding. Women from rural area were less likely to initiate breastfeeding within 1 h as compared with women from urban areas. Mothers who give birth at health institution were more likely to initiate breastfeeding timely.
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9.

Background

Most child deaths are preventable and caused by behaviorally modifiable factors. By promoting optimal breastfeeding, we can reduce neonatal and child mortality risks by 45%. This paper provides new family and community based perspectives to identify factors interfering with the program impact on promoting early initiation of breastfeeding among the most vulnerable populations in rural Niger.

Methods

A secondary analysis of a retrospective cross-sectional study evaluated a UNICEF behavior change program on child healthcare. The study sample is based on a post-hoc constitution of two groups exposed and unexposed to the program. All women (n = 1026) aged 14–49 years having at least one child below 24 months of age were included. We measured crude and adjusted odds ratios with chi-square and multivariate logistic regression models.

Results

Independent variables shown to be associated with early breastfeeding include sales activities compared to household work with no direct income (AOR 7.7; 95% CI 1.3, 47.8) and mutual decision for harvest use (AOR 8.6; 95% CI 2.0, 36.8). Antenatal care did not modify the timing of breastfeeding initiation.

Conclusions

A high risk group of mothers with social and economic vulnerability are prone to suboptimal breastfeeding within the first hour of birth. Support from family and neighbors positively influenced early breastfeeding. Those who had no direct income and limited access to health services were a high-risk group, prone to delayed initiation of breastfeeding.
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10.

Background

Breastfeeding is one of the components of Primary Health Care in Ethiopia. In Ethiopia a wide range of harmful infant feeding practices has been documented despite the implementation of infant and young child feeding guidelines. However, there is no well documented study of women’s perception of breastfeeding patterns and factors associated with delayed initiation of breastfeeding (with timely initiation of breastfeeding being within the first hour) in rural communities of Arba Minch Zuria.

Methods

A community-based cross-sectional study was carried out in Arba Minch Zuria from January to February, 2012. Quantitative data were collected from a sample of 383 respondents supplemented by qualitative data generated using in-depth interviews of 10 key informants. A multivariate logistic regression analysis was used to identify the predictors of delayed initiation of breastfeeding practices. Qualitative data were analyzed using thematic frameworks.

Results

In the rural communities of Arba Minch Zuria almost all mothers (98.2%) have ever breastfed their children. More than three-fourth (89%) of mothers provided colostrum to their infants while others discarded the first milk until the white milk was produced. A large number of mothers (42.8%) started breastfeeding one hour after childbirth. Delayed initiation of breastfeeding was positively associated with lack of maternal education (AOR 1.91; 95% CI 1.02, 3.44). Maternal knowledge about the duration of exclusive breastfeeding (AOR 0.39; 95% CI 0.15, 0.93), attending a primary health education (AOR 0.74; 95% 0.15, 0.98) and health personnel support for women at delivery time (AOR 0.52; 95% CI 0.21, 0.58) were inversely associated with delayed initiation of breastfeeding practices.

Conclusions

A large number of mothers (42.8%) were short of the national and global recommendations about breastfeeding initiation. Therefore, sustained health and community based nutritional education is recommended for pregnant and lactating mothers to promote optimal breastfeeding for the initiation of breastfeeding practices using health extension workers and local community resource people as key actors.
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11.

Background

Despite the ongoing recommendations for breastfeeding, we continue to see a decrease in exclusive breastfeeding among Jordanian women during infant follow up visits at the pediatric outpatient clinic. The purpose of our study is to determine the prevalence, predictors and barriers to exclusive breastfeeding in north of Jordan.

Methods

We conducted a cross-sectional survey involving mothers with infants six to twelve months old, at two hospitals in Irbid city in north of Jordan, between December 2016 and March 2017. Questions included demographics, feeding pattern, and reasons for non-exclusive breastfeeding.

Results

Five hundred women were included. Twenty four percent of women were employed and 87% initiated breastfeeding within three hours of birth. The proportion of women with any breastfeeding and exclusive breastfeeding at six months was 76 and 33%. After multivariate logistic regression analysis, predictors of exclusive breastfeeding at six months include the mother’s previous experience (Adjusted Odds Ratio [AOR] 7.9, 95% CI 4.69, 13.36) and multiparity (AOR 2.26, 95% CI 1.2, 4.28), while barriers include maternal employment (AOR 0.4, 95% CI 0.22,0.72), Cesarean delivery (AOR 0.55, 95% CI 0.35, 0.86) and infant’s hospitalization (AOR 0.44, 95% CI 0.23,0.82). Inadequate breastmilk supply and short maternity leave were the main reported reasons for non-exclusive breastfeeding.

Conclusions

In north of Jordan, the majority of women initiate breastfeeding, half practice exclusive breastfeeding after birth while one third continue for six months, particularly those with previous experience. Cesarean delivery and infant’s hospitalization, together with maternal employment are among the main barriers. Implementing educational programs and lactation consultant counselling together with work environment support, should be helpful to improve the breastfeeding practice among Jordanian women.
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12.

Background

Early skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children’s Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling.

Methods

Data from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling.

Results

Of 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months.During FGD all primigravidae (n?=?17) intended to breastfeed and all multigravidae (n?=?33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is “good”. Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss of the spirit of the newborn or attract malevolent spirits.

Conclusions

In a population with a strong culture of breastfeeding and robust breastfeeding practices, high rates of initiation and duration of breastfeeding were found despite a lack of early skin-to-skin contact. Local preferences, traditions and practices that protect, support and maintain high rates of breastfeeding should be promoted.
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13.

Background

No large scale studies on breastfeeding onset patterns have been carried out in Spain. This work aims to explore the prevalence and the risk factors for not initiating breastfeeding in hospitals from Catalonia (CAT) and Valencia (V), two regions accounting approximately for 30% of the annual births in Spain.

Methods

The prevalence of not initiating breastfeeding was calculated by maternal/neonatal characteristics and type of hospital, and logistic regression models were used to estimate crude and adjusted risks of not breastfeeding in each region.

Results

Prevalence of breastfeeding initiation was 81.7% and 82.5% in Catalonia and Valencia, respectively. We identified conspicuous regional differences in the adjusted-risk of not breastfeeding, especially for multiple [CAT?=?3.12 (95% CI: 2.93, 3.31), V?=?2.44 (95% CI: 2.23, 2.67)] and preterm and low birth weight deliveries [very preterm and very low birth weight: CAT?=?7.61 (95% CI: 6.50, 8.92), V?=?4.03 (95% CI: 3.13, 5.19); moderate preterm and moderate low birth weight: CAT?=?4.28 (95% CI: 4.01, 4.57), V?=?2.55 (95% CI:2.34, 2.79)].

Conclusions

Our results suggest the existence of regional variations in breastfeeding initiation in Spain. Taking into account the known short and long-term benefits of breastfeeding it is recommended that further research should explore these differences in order to prevent potential inequities in neonatal, child and adult health.
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14.

Background

Although breastfeeding is almost universal in Ethiopia, only 52% newborns benefited from early initiation in 2011. Early initiation is one of the recommended interventions for saving newborn lives but its potential seems not yet realized for Ethiopian newborns and there is a need for continued efforts to increase coverage. To do so, it is also relevant to focus on consistent and accurate reporting of coverage in early initiation.WHO recommends the question “how long after birth did you first put [name] to the breast?” in order to assess coverage in early initiation. It is designed to measure the time after birth when the mother attempted to initiate breastfeeding regardless of whether breast milk had arrived or not. However, it is unclear how mothers perceive this question and what their responses of time refer to. In this study, we assessed Ethiopian mothers’ perception about the question assessing early initiation.

Methods

Cognitive interviews were conducted between April and May 2013 with eligible mothers in Basona and Debrebirhan woredas (districts), 120 km away from Addis Ababa, Ethiopia.

Results

A total of 49 mothers, most from Basona (n =?36) and the rest from Debrebirhan woredas (n =?13) were interviewed. No probes or follow on questions were required for mothers to understand what the WHO recommended question was about. However, further probing was needed to ascertain what maternal responses of time refer to. Accordingly, mothers’ response about the timing of early initiation was related to the first time the newborn received breast milk rather than their first attempt to initiate breastfeeding. In addition, considerable probing was required to approximate and code responses of time based on the WHO coding format because some mothers were unable to assess time in minutes or hours.

Conclusion

The existing question is not adequate to identify intended attempts of mothers to initiate breastfeeding. We recommend revising the question as “how long after birth did you first put [name] to the breast even if your breast milk did not arrive yet?” Standard probes or follow on questions are required to avoid subjective interpretation of the indicator.
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15.

Background

Since 2005, the national policy on breastfeeding in Sri Lanka is exclusive breastfeeding up to 6 months, as recommended by World Health Organization. The objective of this study was to assess the prevalence of exclusive breastfeeding and barriers for its’ continuation up to 6 months, in Kandy District, Sri Lanka.

Methods

A clinic based cross-sectional study was conducted from August to November 2016, in six randomly selected Medical Officer of Health areas in the Kandy District. The sample was selected proportionate to the population of each Medical Officer of Health area and 354 mothers with infants aged 6 months, attending the child welfare clinics were recruited. Data were collected by an interviewer administered questionnaire using mother recall data since birth. A focus group discussion was conducted on 21 mothers who discontinued exclusive breastfeeding early. The infant taking only breast milk and no additional food, water, or other fluids with the exception of medicines and vitamins or mineral drops for the first 6 months was used as the definition of exclusive breastfeeding.

Results

The prevalence of exclusive breastfeeding for 6 months was 50.8% (180/354) while the median duration was 6 months. Mother being employed (AOR 3.01; 95% CI 1.45, 6.29), mother’s poor knowledge on what she meant by exclusive breastfeeding (AOR 3.75; 95% CI 2.14, 6.54) and mother’s poor attitudes towards exclusive breastfeeding (AOR 2.98; 95% CI 1.76, 5.03) were independently associated with early cessation of exclusive breastfeeding. Unsupported environment in public places was not significantly associated with early cessation of exclusive breastfeeding. Focus group discussion revealed controversial health messages on exclusive breastfeeding delivered at different points of healthcare delivery, cultural practices which discouraged exclusive breastfeeding and difficulties in obtaining maternity leave as barriers for exclusive breastfeeding.

Conclusions

The prevalence of exclusive breastfeeding up to 6 months was not satisfactory and there were barriers identified in healthcare system, family and work places towards exclusive breastfeeding. For further improvement in the prevalence of exclusive breastfeeding these issues need to be addressed and necessary changes in legislation implemented.
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16.

Background

Mothers are encouraged to practice exclusive breastfeeding for the first six months of a child’s life. The general objective of the study was to assess the predictors of exclusive breastfeeding among mothers in Ghana.

Methods

This was a cross-sectional study using data from the 2008 Ghana Demographic and Health Survey (GDHS). The study sample (n = 316) was based on infants (0–5 months old) during the survey period; extracted from the individual (women) data set. Binary logistic regression was used to examine the association between selected independent variables.

Results

In general, the rate of exclusive breastfeeding was 64 percent. Marital status, region and place of delivery were found to be associated with the practice of exclusive breastfeeding. The logistic regression model illustrated mothers from the Volta Region, those who delivered in a government health facility, and mothers who perceived their infants to be average in size were more likely to practice exclusive breastfeeding.

Conclusion

Appropriate health education programmes by the Ministry of Health targeting mothers who are less likely to practice exclusive breastfeeding are recommended.
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17.

Background

To investigate and examine the factors associated with initiation of, and exclusive breastfeeding at hospital discharge of, late preterm (34 0/7 - 36 6/7 weeks) compared to 37 week gestation (37 0/7 - 37 6/7 week) mother and baby pairs.

Methods

A retrospective population-based cohort study using a Perinatal National Minimum Data Set and clinical medical records review, at the Royal Hobart Hospital, Tasmania, Australia in 2006.

Results

Late preterm and 37 week gestation infants had low rates of initiation of breastfeeding within one hour of birth, 31 (21.1%) and 61 (41.5%) respectively. After multiple regression analysis, late preterm infants were less likely to initiate breastfeeding within one hour of birth (OR 0.3 95% CI 0.1, 0.7 p = 0.009) and were less likely to be discharged exclusively breastfeeding from hospital (OR 0.4 95% CI 0.1, 1.0 p = 0.04) compared to 37 week gestation infants.

Conclusion

A late preterm birth is predictive of breastfeeding failure, with late preterm infants at greater risk of not initiating breastfeeding and/or exclusively breastfeeding at hospital discharge, compared with those infants born at 37 weeks gestation. Stratifying breastfeeding outcomes by gestational age groups may help to identify those sub-populations at greatest risk of premature cessation of breastfeeding.
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18.
19.

Background

The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups.

Methods

In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders.

Results

In our cohort of Latina mothers, breastfeeding a previous infant was associated with breastfeeding initiation (OR 8.29 [95% CI 1.00, 68.40] p = 0.05) and breastfeeding at 6 months (OR 18.34 [95% CI 2.01, 167.24] p = 0.01). College education was associated with increased exclusive breastfeeding at 6 months (OR 58.67 [95% CI 4.97, 692.08] p = 0.001) and having other children was associated with reduced breastfeeding at six months (OR 0.08 [95% CI 0.01, 0.70] p = 0.02). A higher IIFAS score was not associated with breastfeeding initiation, breastfeeding at 6 or 12 months or exclusive breastfeeding at 6 months of age.

Conclusions

Initial choices about breastfeeding will likely influence future breastfeeding decisions, so breastfeeding interventions should specifically target new mothers. Mothers with other children also need additional encouragement to maintain breastfeeding until 6 months of age. The IIFAS, while predictive of breastfeeding decisions in other population groups, was not associated with feeding decisions in our population of Latina mothers.
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20.

Background

A prelacteal feed is any food except mother’s milk provided to a newborn before initiating breastfeeding. Prelacteal feeding is a major barrier to exclusive breastfeeding. It is a prevalent practice in Nepal. Little is known about the factors associated with providing prelacteal feeds to the Nepalese newborn. This study explored the factors associated with providing prelacteal feeds to children under three years in Nepal using the Nepal Demographic and Health Survey (NDHS) 2011.

Methods

This study utilised the NDHS 2011 child dataset which is a nationally representative study. The rates of providing prelacteal feeds were reported as a proportion. Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multiple logistic regression were used to analyse the factors associated with providing prelacteal feeds.

Results

A sample of 3948 mothers were included in the study. A total of 841 [26.5% (95% CI: 23.1%–30.3%)] weighted proportion) of mothers reported of providing prelacteal feeds to their newborn infants. Plain water (n?=?75), sugar/glucose (n?=?35), gripe water (n?=?3), sugar/salt solution (n?=?3), fruit juice (n?=?3), infant formula (n?=?96), tea (n?=?3) and other milk other than breast milk (n?=?556) were some of the types of prelacteal feeds reported. The multiple regression analysis showed that the mothers who had no education, were not working, were from the middle wealth quintile, who had not attended four antenatal care visits, were first time mothers and who were from the Terai/Plain region were more likely to provide prelacteal feeds.

Conclusions

Given that one in four infants were provided with prelacteal feeds, there is a need to implement breastfeeding promotion programs to increase the practice of exclusive breastfeeding and reduce prelacteal feeding practices. Breastfeeding counseling at antenatal clinics and peer support for exclusive breastfeeding should be included as part of breastfeeding promotion programs. Mobilisation of female community health volunteers for peer counseling is also a feasible option for Nepal.
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