Prevalece and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago hospital
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Background: The MDG 4 aims at reducing U5MR by 2/3 by 2015 and currently U5MR is at 137/1000 per live birth. Exclusive breast feeding could prevent 15 million child death in 10 years. Breastfeeding within the first hour of life is a potential mechanism for health promotion. Early infant breastfeeding practices remain an important determinant of nutritional and health status of children. Evidence reveals that infants who start breastfeeding after 24 hours of age are 2.5 times more likely to die than those who start within the first hour of life. Objective: To determine the prevalence and factors associated with delayed initiation of breastfeeding among mother-infant pairs who delivered in Mulago hospital. Study design: A descriptive cross sectional study. Method: From January to February 2011 we consecutively enrolled 665 mother-infant pairs in Upper and Lower Mulago hospital. Information about mother’s and baby’s characteristics, pregnancy, birth and time of breastfeeding initiation was collected within the first 24 hours after delivery, through interview with mothers and hospital records. Focus group discussions were conducted with 4 groups of mothers and 1 group of caregivers/mothers-in-law each comprising 8-12. It was conducted in Luganda and mothers were selected to discuss the questions regarding the reasons for delaying initiation of breastfeeding and promoters for early initiation of breastfeeding. The data gathered was stored and analyzed using the Epidata version 3.1 and SPSS version 11. The chi-square test and binary logistic regression analysis were used to examine the relationship between delayed initiation of breastfeeding and different variables. The analysis of qualitative data was by identifying themes and sub-themes from the information obtained from focus group discussions. Direct quotations from the respondents were used in the presentation of the study findings. Results: The prevalence of delayed initiation of breast feeding was found to be, 31.4% (CI 27.7-35.1%). Factors independently associated with delayed initiation of breastfeeding were maternal HIV positive status (AOR 2.3; 95% CI 1.3-4.2 p=0.006), lack of prenatal guidance regarding the advantages of breastfeeding (AOR 3.6; 95% CI 1.9-6.8 p=<0.01), mother who didn’t receive professional assistance to initiate breastfeeding (AOR 1.8; 95% CI 1.2-2.8 p=0.005),lack of information about risks of bottle feeding during ANC (AOR 1.8 95% CI 1.1-2.8 p=0.013) and mothers who delivered by Caesarean section (AOR 8.6; 95% CI 4.7-16 p=<0.01). The reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, mother’s medical condition like HIV, that the mother and the baby need rest after birth, performing post birth activities such as bathing the baby or mother and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding and the belief in that putting the baby to the breast encourages the milk to come. Conclusions: The prevalence of delayed initiation of breast feeding among mother-infant pairs who delivered in Mulago hospital, Kampala, Uganda in this study was 31.4%.The reasons for late initiation of breast feeding include; inadequate information to mothers during ANC, HIV positive serostatus, Caesarian section delivery and cultural factors. Recommendations: There is need to emphasize the importance of early initiation of breast feeding during ANC sessions. There is also need to support HIV positive mothers and those undergoing Caesarian section to initiate breast feeding early.