title: Determinants of breastfeeding initiation among mothers in Kuwait.
abstract: BACKGROUND
  Exclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding.
  
  
  METHODS
  A sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.
  
  
  RESULTS
  In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery.
  
  
  CONCLUSIONS
  The reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.
authors.affiliation: Human Nutrition Section, Division of Developmental Medicine, University of Glasgow, Glasgow, UK. C.A.Edwards@clinmed.gla.ac.uk.
authors.forename: Manal
authors.initials: M
authors.lastname: Dashti
authors.forename: Jane A
authors.initials: JA
authors.lastname: Scott
authors.forename: Christine A
authors.initials: CA
authors.lastname: Edwards
authors.forename: Mona
authors.initials: M
authors.lastname: Al-Sughayer