Impact of cesarean section on timely initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis

Temesgen Getaneh,Tadesse Getu,Ayenew Negesse,Melaku Desta,Habtamu Temesgen,Getenet Dessie,Kihinetu Gelaye

doi:10.1186/s13006-021-00399-9

Abstract

BackgroundTimely 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.MethodsThis 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.ResultsAccording 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).ConclusionsIn 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.

Highlights

Initiation of breastfeeding is feeding of breast milk within one hour of birth, three in five babies were not breastfed in the first hour of birth globally
17 primary studies were included to estimate the pooled impact of cesarean section on timely initiation of breastfeeding in Ethiopia (Fig. 1)
Seven of them were from Amhara region [19, 20, 24, 25, 30,31,32], two studies from each of the following; Tigray [22, 33], Oromo [34, 35], South Nation Nationality and Peoples region (SNNPR) [18, 36] and Ethiopian Demographic Health Survey (EDHS) data [21, 26] while the remaining two studies were contributed from Addis Ababa [37] and Afar region [38]

Summary

Introduction

Initiation of breastfeeding is feeding of breast milk within one hour of birth, three in five babies were not breastfed in the first hour of birth globally. Evidence from developing countries showed that the overall morbidity such as hospitalization and rate of acute illness and mortality were much lower among infants who initiated timely breastfeeding [4, 5]. It has familial and societal benefits in terms of reduction in expenses of infant formula fed and hospitalization [6]. Despite this paramount short- and long-term advantages of timely initiated breastfeeding, it is still unacceptably low especially in developing countries including our country Ethiopia. Evidence from secondary analysis of WHO global survey showed that only 39.7% of infants delivered through cesarean section initiated breastfeeding within one hour of birth [11]

Methods

Results

Discussion

Conclusion