title: Factors associated with early initiation of breastfeeding among Nepalese mothers: further analysis of Nepal Demographic and Health Survey, 2011.
abstract: BACKGROUND
  Timely initiation of breastfeeding has been reported to reduce neonatal mortality by 19.1%. The World Health Organisation recommends early initiation of breastfeeding i.e. breastfeeding a newborn within the first hour of life. Knowledge on the rate and the determinants of early initiation of breastfeeding may help health program managers to design and implement effective breastfeeding promotion programs. The aim of this study was to determine the rate and the determinants of early initiation of breastfeeding in Nepal.
  
  
  METHODS
  This study used the data from Nepal Demographic and Health Survey (NDHS) 2011 which is a nationally representative sample study. Chi square test and multiple logistic regression analysis were used to examine the factors associated with early initiation of breastfeeding (within one hour of birth).
  
  
  RESULTS
  Of 4079 mothers, 66.4% initiated breastfeeding within one hour of delivery. Mothers with higher education (Odds Ratio (OR) 2.56; 95% CI : 1.26, 5.21), mothers of disadvantaged Janjati ethnicity (OR 1.43; 95% CI : 1.04, 1.94), mothers who were involved in agriculture occupation (OR 1.51; 95% CI : 1.16, 1.97), mothers who delivered in a health facility (OR 1.67; 95% CI : 1.25, 2.23), whose children were large at birth (OR 1.46; 95% CI : 1.07, 1.99) were more likely to initiate breastfeeding within the first hour of child birth.
  
  
  CONCLUSIONS
  Results suggest that two thirds of children in Nepal were breastfed within the first hour after birth. Although there was a higher prevalence of early initiation of breastfeeding among mothers who delivered in health facilities compared to mothers who delivered at home, universal practice of early initiation of breastfeeding should be a routine practice. The findings suggest the need of breastfeeding promotion programs among the mothers who are less educated, and not working. Such breastfeeding promotion programmes could be implemented via Nepal's extensive network of community-based workers.
authors.affiliation: Women's Health Project, Population Services International, Nawalparasi, Nepal.
authors.forename: Mandira
authors.initials: M
authors.lastname: Adhikari
authors.affiliation: Independent Consultant, Kathmandu, Nepal ; School of Public Health, Curtin University, Perth, Australia.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Khanal
authors.affiliation: School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Karkee
authors.affiliation: Centre for International Health, Curtin University, Perth, Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Gavidia
keywords: Breastfeeding; Breastfeeding initiation; Determinants; Nepal