Determinants of timely initiation of breast milk and exclusive breastfeeding in Malawi: a population-based cross-sectional study

Owen Nkoka,Victor Kanje,Edith B Milanzi,Amit Arora,Peter A M Ntenda

doi:10.1186/s13006-019-0232-y

Abstract

BackgroundBreastfeeding practices such as early initiation of breast milk and exclusive breastfeeding are key to the reduction of childhood morbidity and mortality. Despite the importance of these practices, rates of timely initiation of breastfeeding and exclusive breastfeeding remain suboptimal in many sub-Saharan countries. This study aimed to examine the determinants of early initiation of breastfeeding and exclusive breastfeeding in the first 5 months in Malawi.MethodsThis study used the 2015–16 Malawi Demographic and Health Survey data. A total of 6351 children born during the last 24 months and 1619 children aged 0–5 months at the time of the survey were analyzed for early initiation of breastfeeding and exclusive breastfeeding outcomes, respectively. Socio-demographic and socio-economic factors including individual, household and community-level factors were tested for association with early initiation of breastfeeding and exclusive breastfeeding using logistic regression models.ResultsThe proportion of timely initiation of breast milk and exclusive breastfeeding were 76.9 and 61.2%, respectively. Delivering at a health facility (adjusted odds ratio [aOR] 1.77, 95% confidence interval [CI] 1.10, 2.87), vaginal delivery (aOR 3.15, 95% CI 2.40, 4.13), and singleton births (aOR 1.96, 95% CI 1.20, 3.21) were independent factors associated with the increased likelihood of timely initiation of breastfeeding. Age of children was associated with increased odds of exclusive breastfeeding, with children aged 3–5 months being less likely to be exclusively breastfed (aOR 0.24, 95% CI 0.18, 0.31).ConclusionsHealthcare providers and programs aimed at increasing rates of early initiation of breastfeeding should take into consideration women at risk such as those giving birth through caesarean section, giving birth at home, and having multiple births. Further, women with children aged 3–5 months should be targeted with health promotion interventions for exclusive breastfeeding.

Highlights

Breastfeeding practices such as early initiation of breast milk and exclusive breastfeeding are key to the reduction of childhood morbidity and mortality
exclusive breastfeeding (EBF) was associated with a child aged 0–2 months, having a mother with secondary or higher education, and multiparous women
Children aged 6–23 months had 32% higher odds of receiving breast milk in the first hour of birth compared to those aged 0–2 months

Summary

Introduction

Breastfeeding practices such as early initiation of breast milk and exclusive breastfeeding are key to the reduction of childhood morbidity and mortality. Despite the importance of these practices, rates of timely initiation of breastfeeding and exclusive breastfeeding remain suboptimal in many sub-Saharan countries. Appropriate breastfeeding practices are essential for the growth, survival, and development of infants [1]. The rates of early initiation and EBF globally remain low with approximately 50% of children under 2 years of age being breastfed within 1 h of birth [4, 6, 9]. 37% of infants under 6 months are exclusively breastfed in low and middle income countries [6]. Only 38.4% of mothers in Nigeria were reported to have initiated breastfeeding within the first hour of birth [10] while a 17% EBF rate was reported [11]

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