https://orcid.org/0000-0002-6283-9114
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ABSTRACT
Background: Initiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality.
Objective: To determine the prevalence and factors associated with delayed initiation of breastfeeding.
Methods: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software (https://opendatakit.org). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding.
Results: Almost half [48.2%, 95% confidence interval (CI) (44.3–52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breastfeeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73–33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41–2.88)], home delivery [AOR 1.43 95% CI (1.04–1.97)] and mother being responsible for initiating breastfeeding as compared to a health worker or relative [AOR 1.73 95% CI (1.33–2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30–0.96)] to delay initiation of breastfeeding as compared to those with no education.
Conclusion: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.
Responsible Editor Nawi Ng, Umeå University, Sweden
Responsible Editor Nawi Ng, Umeå University, Sweden
Acknowledgments
We acknowledge Survival Pluss project (no. UGA-13-0030) at Makerere University. Survival Pluss project is funded under NORHED by NORAD; Norway.
We also acknowledge Prof. Peter Waiswa and the Iganga-Mayuge DHSS for availing us with various study instruments, which we borrowed from when designing our study. In a special way we acknowledge the District Health Office of Lira district, and the various district, sub county, parish and village leaders for their assistance in this study. Finally, we acknowledge the participants and research assistants in our study for their cooperation.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics and consent
We obtained ethical approval from the School of Medicine Research and Ethics committee and from the Uganda National Council of Science and Technology. Written informed consent was obtained from the participants prior to participation in the study. For participants who could not write, a thumbprint was obtained. No compensation was given to the participants. Participant’s questions regarding health-related issues were addressed at the end of the interview.
Paper context
Breastfeeding initiation patterns vary across different contexts. This study was done in Lira district, situated in post conflict northern Uganda, to inform the conduct of a randomized controlled study. Our study showed that delayed initiation is common in this region associated with factors such as caesarean delivery, home delivery, lack of education and discarding of initial milk. This study also showed that importance of persons other than the mother in initiating breastfeeding.
Additional information
Funding
Notes on contributors
David Mukunya
DM, JKT, VN, GN, TT conceived, designed, supervised the study, analyzed the data and wrote the first draft of manuscript. IO, JT, JBT, AN, VA, BO, were instrumental in the design and supervision of the study, and drafting of the manuscript. SK contributed in the analysis of the data and critical revision of the manuscript. All authors read and approved the final version to be published.
