title: Early newborn ritual foods correlate with delayed breastfeeding initiation in rural Bangladesh.
abstract: BACKGROUND
  Early and exclusive breastfeeding may improve neonatal survival in low resource settings, but suboptimal breastfeeding still exists in areas with high infant mortality. Prelacteal feeding, the practice of giving a non-breastmilk food as a neonate's first food, has been associated with suboptimal breastfeeding practices. We examined the association of feeding a non-breastmilk food in the first three days of life (early neonatal food, or ENF) with time from birth to initiation of breastfeeding among 25,286 Bangladeshi mother-neonate pairs, in a secondary analysis of a randomized controlled trial in northwestern rural Bangladesh conducted from 2001-2007.
  
  
  METHODS
  Trained interviewers assessed the demographic characteristics during pregnancy. At three months postpartum, the interviewers visited participants again and retrospectively assessed demographic and breastfeeding characteristics surrounding the birth. We assessed the relationship between ENF and time to initiation of breastfeeding in hours in both unadjusted and adjusted linear regression analyses. We also calculated reverse cumulative distribution curves for time to initiation of breastfeeding and analyses were stratified by an infant's ability to breastfeed normally at birth.
  
  
  RESULTS
  The mean ± SD time from birth to initiation of breastfeeding was 30.6 ± 27.9 hours. Only 2,535 (10.0%) of women reported initiating breastfeeding in the first hour after birth and 10,207 (40.4%) reported initiating breastfeeding in the first 12 hours after birth. In adjusted linear regression analyses, feeding ENF was associated with a significant increase in time, in hours, to breastfeeding initiation both among children not able to breastfeed at birth (37.4; 95% CI 33.3, 41.5) and among children able to breastfeed at birth (13.3; 95% CI 12.7, 14.0).
  
  
  CONCLUSIONS
  Feeding ENF was strongly associated with delayed initiation of breastfeeding, even after adjusting for other related factors and stratifying on the neonate's ability to suckle normally after birth. More research is needed to understand the impact of these findings on optimal breastfeeding in this setting. It is possible that ENF feeding and the ability to breastfeed immediately after birth are interrelated in their respective associations to suboptimal breastfeeding initiation. This study in a large population representative of other populations in rural South Asia, demonstrates significantly longer times to breastfeeding initiation than previously appreciated, with a possible important role of ENF feeding.
  
  
  BACKGROUND
  The randomized controlled trial on which this analysis is based, "Impact of Maternal Vitamin A or Beta-Carotene Supplementation on Maternal and Infant Mortality in Bangladesh", was registered with ClinicalTrials.gov as trial number ID GHS-A-00-03-00019-00 and identifier NCT00198822. The identifier was first received September 12, 2005 (retrospectively registered). The first participant was enrolled in August 2001.
authors.affiliation: Department of Environmental Health, University of Minnesota School of Public Health, Minneapolis, MN USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Sundaram
authors.affiliation: The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Hasmot
authors.initials: H
authors.lastname: Ali
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Mehra
authors.affiliation: The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh ; SHIKHA Project, FHI 360, Durham, NC USA.
authors.forename: Abu Ahmed
authors.initials: AA
authors.lastname: Shamim
authors.affiliation: International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Barkat
authors.initials: B
authors.lastname: Ullah
authors.affiliation: The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rashid
authors.affiliation: The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh.
authors.forename: Saijuddin
authors.initials: S
authors.lastname: Shaikh
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Rolf D W
authors.initials: RD
authors.lastname: Klemm
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Alain
authors.initials: A
authors.lastname: Labrique
keywords: Breastfeeding; Early newborn food; Neonatal health; Prelacteal; South Asia