review · BMJ Open
This systematic review and meta-analysis synthesised observational research conducted in Ethiopia between 2000 and 2018 to evaluate factors affecting infant feeding. The analysis examined how antenatal care, postnatal care, and the gender of the newborn influence timely initiation of breastfeeding and exclusive breastfeeding practices. Across seventeen studies covering over twenty-six thousand mothers, antenatal care was significantly linked to the timely initiation of breastfeeding, while newborn gender showed no significant association. Across twenty-four studies covering over seventeen thousand mothers, antenatal care, postnatal care, and newborn gender were all significantly associated with exclusive breastfeeding. The pooled findings confirm that health service engagement during pregnancy and after delivery plays a critical role in supporting recommended breastfeeding practices, offering an updated evidence base to guide national maternal and child health improvement initiatives and cross-country comparisons.
Proper breastfeeding practices are fundamental for infant survival, growth, and long-term health. By identifying strong links between maternal healthcare visits and improved feeding practices, this analysis highlights where health systems can focus resources. Healthcare providers and policy planners can use these findings to design targeted interventions during pregnancy and the postpartum period to effectively encourage early and exclusive breastfeeding.
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Objectives The aim of this systematic review and meta-analysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding (TIBF) and exclusive breastfeeding (EBF) practices in Ethiopia. Design Systematic review and meta-analysis. Data sources To retrieve all available literature, PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases were systematically searched and complemented by manual searches. The search was done from August 2017 to September 2018. Eligibility criteria All observational studies including cross-sectional, case-control, cohort studies conducted in Ethiopia from 2000 to 2018 were included. Newcastle-Ottawa Scale was used for quality assessment of included studies. Data extraction and synthesis Study area, design, population, number of mothers (calculated sample size and participated in the study) and observed frequency data were extracted using Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis using weighted inverse variance random-effects model was performed. Cochran’s Q X 2 test, τ 2 and I 2 statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity, respectively. Mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Egger’s regression test at p value threshold ≤0.01 was used to examine publication bias. Furthermore, the trend of evidence over time was examined by performing a cumulative meta-analysis. Results Of 523 articles retrieved, 17 studies (n=26 146 mothers) on TIBF and 24 studies (n=17 819 mothers) on EBF were included in the final analysis. ANC (OR=2.24, 95% CI 1.65 to 3.04, p<0.001, I 2 =90.9%), PNC (OR=1.86, 95% CI 1.41 to 2.47, p<0.001, I 2 =63.4%) and gender of newborn (OR=1.31, 95% CI 1.01 to 1.68, p=0.04, I 2 =81.7%) significantly associated with EBF. ANC (OR=1.70, 95% CI 1.10 to 2.65, p=0.02, I 2 =93.1%) was also significantly associated with TIBF but not with gender of newborn (OR=1.02, 95% CI 0.86 to 1.21, p=0.82, I 2 =66.2%). Conclusions In line with our hypothesis, gender of newborn, ANC and PNC were significantly associated with EBF. Likewise, ANC was significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breast feeding. This meta-analysis study provided up-to-date evidence on breastfeeding practices and its associated factors, which could be useful for breastfeeding improvement initiative in Ethiopia and cross-country and cross-cultural comparison. Trial registration number CRD42017056768
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DOI: 10.1136/bmjopen-2018-023956
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