title: Rates and determinants of early initiation of breastfeeding and exclusive breast feeding at 42 days postnatal in six low and middle-income countries: A prospective cohort study.
abstract: BACKGROUND
  Early initiation of breastfeeding after birth and exclusive breastfeeding through six months of age confers many health benefits for infants; both are crucial high impact, low-cost interventions. However, determining accurate global rates of these crucial activities has been challenging. We use population-based data to describe: (1) rates of early initiation of breastfeeding (defined as within 1 hour of birth) and of exclusive breastfeeding at 42 days post-partum; and (2) factors associated with failure to initiate early breastfeeding and exclusive breastfeeding at 42 days post-partum.
  
  
  METHODS
  Prospectively collected data from women and their live-born infants enrolled in the Global Network's Maternal and Newborn Health Registry between January 1, 2010-December 31, 2013 included women-infant dyads in 106 geographic areas (clusters) at 7 research sites in 6 countries (Kenya, Zambia, India [2 sites], Pakistan, Argentina and Guatemala). Rates and risk factors for failure to initiate early breastfeeding were investigated for the entire cohort and rates and risk factors for failure to maintain exclusive breastfeeding was assessed in a sub-sample studied at 42 days post-partum.
  
  
  RESULTS
  A total of 255,495 live-born women-infant dyads were included in the study. Rates and determinants for the exclusive breastfeeding sub-study at 42 days post-partum were assessed from among a sub-sample of 105,563 subjects. Although there was heterogeneity by site, and early initiation of breastfeeding after delivery was high, the Pakistan site had the lowest rates of early initiation of breastfeeding. The Pakistan site also had the highest rate of lack of exclusive breastfeeding at 42 days post-partum. Across all regions, factors associated with failure to initiate early breastfeeding included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and failure to place baby on the mother's chest after delivery. Factors associated with failure to achieve exclusive breastfeeding at 42 days varied across the sites. The only factor significant in all sites was multiple gestation.
  
  
  CONCLUSIONS
  In this large, prospective, population-based, observational study, rates of both early initiation of breastfeeding and exclusive breastfeeding at 42 days post-partum were high, except in Pakistan. Factors associated with these key breastfeeding indicators should assist with more effective strategies to scale-up these crucial public health interventions.
  
  
  BACKGROUND
  Registration at the Clinicaltrials.gov website (ID# NCT01073475).
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Sherri
authors.initials: S
authors.lastname: Bucher
authors.forename: Yamini
authors.initials: Y
authors.lastname: Pusdekar
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.forename: Bhalachandra S
authors.initials: BS
authors.lastname: Kodkany
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.forename: Bhala
authors.initials: B
authors.lastname: Kodkany
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: K
authors.initials: K
authors.lastname: Hambidge
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.forename: Mabel
authors.initials: M
authors.lastname: Berrueta
authors.forename: Janet L
authors.initials: JL
authors.lastname: Moore
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
mesh_terms: D000367:Age Factors; D001724:Birth Weight; D001942:Breast Feeding / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D011446:Prospective Studies; D012042:Registries