title: Determinants of delayed initiation of breastfeeding in rural Ethiopia: programmatic implications.
abstract: BACKGROUND
  A number of studies have examined the possible adverse impact of services offered by health workers and community members on postpartum infant feeding practices. The present analysis utilized extant data collected previously through the baseline surveys of two related child health and nutrition projects implemented in rural Ethiopia and explored key risk factors associated with delayed initiation of breastfeeding for more than 1 hour after birth.
  
  
  OBJECTIVE
  To investigate the most important determinants of delayed initiation of breastfeeding.
  
  
  METHODS
  Multivariate logistic regression was performed to analyze data from baseline cross-sectional surveys carried out in 2003 and 2004 in selected districts across three regions in Ethiopia.
  
  
  RESULTS
  Attendance at delivery by a health worker was found to be an important risk factor for the delayed initiation of breastfeeding, whereas attendance by traditional birth attendants or family and/or friends represented a protective factor for early initiation of breastfeeding. Additional analysis suggests that targeting of behavior change interventions on optimal infant feeding to these health workers could reverse the risk relationship and lead to improvements in the rate of early initiation of breastfeeding.
  
  
  CONCLUSIONS
  Provision of inadequate breastfeeding information in the health system and attendance at delivery by health workers are associated with a delay in the initiation of breastfeeding. Births attended by trained traditional birth attendants and family members are associated with better practices. Targeting health workers, community members, families, and women to promote optimal infant feeding practices is likely to hold much potential to increase the adoption of early initiation of breastfeeding.
authors.affiliation: UNICEF, Niamey, Niger.
authors.forename: Naoko
authors.initials: N
authors.lastname: Horii
authors.forename: Agnès B
authors.initials: AB
authors.lastname: Guyon
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Quinn
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology / Q000523:psychology; D000328:Adult; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005002:Ethiopia; D005190:Family / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006293:Health Promotion; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior / Q000208:ethnology / Q000523:psychology; D008875:Middle Aged; D008880:Midwifery / Q000193:education; D009749:Nutrition Surveys; D052756:Nutritional Sciences / Q000193:education; D049590:Postpartum Period / Q000208:ethnology / Q000523:psychology; D012189:Retrospective Studies; D012423:Rural Health / Q000208:ethnology; D055815:Young Adult