Timely Initiation of Breastfeeding and Associated Factors in 20 Sub-Saharan African Countries: Cross-Sectional Multilevel Analysis of Recent Demographic and Health Surveys.
8 affiliations
- 1Department of Health Promotion and Behavioral Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, 273, Ethiopia, +251 936987005.
- 2Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 3Public Health Department, College of Medicine and Health Science, Debre Markos University, Amhara, Ethiopia.
- 4School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 5College of Medicine and Health Science, Debre Markos University, Amhara, Ethiopia.
- 6Debre Markos University, Debre Markos, Amhara, Ethiopia.
- 7Injibara University, Injibara, Amhara, Ethiopia.
- 8Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
Abstract
Background
An important strategy to decrease infant morbidity and mortality is timely initiation of breastfeeding (TIBF), which is defined as putting the newborn to the breast within 1 hour of delivery. Delayed initiation of breastfeeding may contribute to high neonatal and infant mortality in sub-Saharan Africa.Objective
This study assessed the prevalence of TIBF and associated factors using recent Demographic and Health Survey data from 20 sub-Saharan African countries.Methods
Using recent Demographic and Health Survey data from sub-Saharan African countries, a cross-sectional study was conducted. Data were accessed on January 27, 2026. The analysis included 177,988 children after application of sampling weights. The hierarchical structure of the data was taken into consideration by conducting a multilevel logistic regression analysis. Results were presented using adjusted odds ratios (AORs) with 95% CIs. To evaluate cluster-level variance, random-effects measures such as the median odds ratio and intraclass correlation coefficient were reported.Results
Among 177,988 weighted samples, 59.05% (95% CI 58.82%-59.28%) initiated breastfeeding within 1 hour of birth. TIBF was more likely among rural residents (AOR 1.25, 95% CI 1.21-1.28), mothers with primary (AOR 1.48, 95% CI 1.45-1.52), secondary (AOR 1.22, 95% CI 1.19-1.26), and higher education (AOR 1.22, 95% CI 1.15-1.28), institutional delivery (AOR 1.40, 95% CI 1.36-1.43), multiparous (AOR 1.19, 95% CI 1.15-1.23), and grand multiparous mothers (AOR 1.10, 95% CI 1.05-1.14). Lower odds were observed among cesarean births (AOR 0.31, 95% CI 0.30-0.33), twin births (AOR 0.87, 95% CI 0.82-0.92), delayed antenatal care initiation (AOR 0.84, 95% CI 0.82-0.85), female children (AOR 0.90, 95% CI 0.88-0.91), and mothers with a history of child death (AOR 0.90, 95% CI 0.86-0.94).Conclusions
TIBF remains suboptimal in sub-Saharan Africa and is influenced by maternal, obstetric, and health care factors. Enhancing antenatal counseling and postnatal breastfeeding support, particularly after cesarean delivery and among vulnerable groups, may improve timely initiation practices.
Related
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BibTeX
@article{kassie2026timely,
title = {{Timely Initiation of Breastfeeding and Associated Factors in 20 Sub-Saharan African Countries: Cross-Sectional Multilevel Analysis of Recent Demographic and Health Surveys.}},
author = {Tadele Derbew Kassie and Getnet Gedif and Mequanent Dessie Bitewa and Atsede Alle Ewunetie and Tewodros Shibabaw and Menberu Gete and Melkamu Siferih and Mikias Getahun Molla and Tirusew Wondie Wodie and Daniel Mulat Eshetu and Abebaw Abeje Muluneh and Aysheshim Asnake Abneh},
journal = {JMIR pediatrics and parenting},
year = {2026},
month = oct,
doi = {10.2196/103827},
url = {https://europepmc.org/article/MED/42896126},
note = {CC BY},
}
RIS
TY - JOUR
TI - Timely Initiation of Breastfeeding and Associated Factors in 20 Sub-Saharan African Countries: Cross-Sectional Multilevel Analysis of Recent Demographic and Health Surveys.
AU - Tadele Derbew Kassie
AU - Getnet Gedif
AU - Mequanent Dessie Bitewa
AU - Atsede Alle Ewunetie
AU - Tewodros Shibabaw
AU - Menberu Gete
AU - Melkamu Siferih
AU - Mikias Getahun Molla
AU - Tirusew Wondie Wodie
AU - Daniel Mulat Eshetu
AU - Abebaw Abeje Muluneh
AU - Aysheshim Asnake Abneh
PY - 2026
DA - 2026/10/19
JO - JMIR pediatrics and parenting
DO - 10.2196/103827
UR - https://europepmc.org/article/MED/42896126
AB - Background An important strategy to decrease infant morbidity and mortality is timely initiation of breastfeeding (TIBF), which is defined as putting the newborn to the breast within 1 hour of delivery. Delayed initiation of breastfeeding may contribute to high neonatal and infant mortality in sub-Saharan Africa.Objective This study assessed the prevalence of TIBF and associated factors using recent Demographic and Health Survey data from 20 sub-Saharan African countries.Methods Using recent Demographic and Health Survey data from sub-Saharan African countries, a cross-sectional study was conducted. Data were accessed on January 27, 2026. The analysis included 177,988 children after application of sampling weights. The hierarchical structure of the data was taken into consideration by conducting a multilevel logistic regression analysis. Results were presented using adjusted odds ratios (AORs) with 95% CIs. To evaluate cluster-level variance, random-effects measures such as the median odds ratio and intraclass correlation coefficient were reported.Results Among 177,988 weighted samples, 59.05% (95% CI 58.82%-59.28%) initiated breastfeeding within 1 hour of birth. TIBF was more likely among rural residents (AOR 1.25, 95% CI 1.21-1.28), mothers with primary (AOR 1.48, 95% CI 1.45-1.52), secondary (AOR 1.22, 95% CI 1.19-1.26), and higher education (AOR 1.22, 95% CI 1.15-1.28), institutional delivery (AOR 1.40, 95% CI 1.36-1.43), multiparous (AOR 1.19, 95% CI 1.15-1.23), and grand multiparous mothers (AOR 1.10, 95% CI 1.05-1.14). Lower odds were observed among cesarean births (AOR 0.31, 95% CI 0.30-0.33), twin births (AOR 0.87, 95% CI 0.82-0.92), delayed antenatal care initiation (AOR 0.84, 95% CI 0.82-0.85), female children (AOR 0.90, 95% CI 0.88-0.91), and mothers with a history of child death (AOR 0.90, 95% CI 0.86-0.94).Conclusions TIBF remains suboptimal in sub-Saharan Africa and is influenced by maternal, obstetric, and health care factors. Enhancing antenatal counseling and postnatal breastfeeding support, particularly after cesarean delivery and among vulnerable groups, may improve timely initiation practices.
SN - 2561-6722
ER -