title: Determinants of early initiation of breastfeeding in rural Tanzania.
abstract: BACKGROUND
  Breastfeeding is widely known for its imperative contribution in improving maternal and newborn health outcomes. However, evidence regarding timing of initiation of breastfeeding is limited in Tanzania. This study examines the extent of and factors associated with early initiation of breastfeeding in three rural districts of Tanzania.
  
  
  METHODS
  Data were collected in 2011 in a cross-sectional survey of random households in Rufiji, Kilombero and Ulanga districts of Tanzania. From the survey, 889 women who had given birth within 2 years preceding the survey were analyzed. Both descriptive and inferential statistical analyses were conducted. Associations between the outcome variable and each of the independent variables were tested using chi-square. Logistic regression was used for multivariate analysis.
  
  
  RESULTS
  Early initiation of breastfeeding (i.e. breastfeeding initiation within 1 h of birth) stood at 51 %. The odds of early initiation of breastfeeding was significantly 78 % lower following childbirth by caesarean section than vaginal birth (adjusted odds ratio (OR) = 0.22; 95 % confidence interval (CI) 0.14, 0.36). However, this was almost twice as high for women who gave birth in health facilities as for those who gave birth at home (OR = 1.75; 95 % CI 1.25, 2.45). Furthermore, maternal knowledge of newborn danger signs was negatively associated with early initiation of breastfeeding (moderate vs. high: OR = 1.73; 95 % CI 1.23, 2.42; low vs. high: OR = 2.06; 95 % CI 1.43, 2.96). The study found also that early initiation of breastfeeding was less likely in Rufiji compared to Kilombero (OR = 0.52; 95 % CI 0.31, 0.89), as well as among ever married than currently married women (OR = 0.46; 95 % CI 0.25, 0.87).
  
  
  CONCLUSIONS
  To enhance early initiation of breastfeeding, using health facilities for childbirth must be emphasized and facilitated among women in rural Tanzania. Further, interventions to promote and enforce early initiation of breastfeeding should be devised especially for caesarean births. Women residing in rural locations and women who are not currently married should be specifically targeted with interventions aimed at enhancing early initiation of breastfeeding to ensure healthy outcomes for newborns.
authors.affiliation: Ifakara Health Institute, Plot 463, Kiko Avenue, P.O. Box 78373, Mikocheni, Dar es Salaam Tanzania.
authors.forename: Amon
authors.initials: A
authors.lastname: Exavery
authors.affiliation: Ifakara Health Institute, Plot 463, Kiko Avenue, P.O. Box 78373, Mikocheni, Dar es Salaam Tanzania ; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Almamy Malick
authors.initials: AM
authors.lastname: Kanté
authors.affiliation: Ifakara Health Institute, Plot 463, Kiko Avenue, P.O. Box 78373, Mikocheni, Dar es Salaam Tanzania.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hingora
authors.affiliation: Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Phillips
keywords: Breastfeeding; Early initiation; Kilobero; Predictors; Prevalence; Rufiji; Tanzania; Timely initiation; Ulanga