College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH, USA.
Int Breastfeed J. 2022 Jul 23;17(1):54. doi: 10.1186/s13006-022-00496-3.
Enhancing timely breastfeeding initiation within the first hour postpartum is a goal the WHO's Early Essential Newborn Care (EENC) and Baby-friendly Hospital Initiative (BFHI) aim to achieve globally. However, many health professionals and facilities have yet to adopt these guidelines in Cambodia, impeding timely initiation progress and maternal-infant health goals.
This secondary data analysis used the 2014 Cambodia Demographic and Health Survey (CDHS) data of 2,729 women who gave birth in the two years preceding the survey to examine the association between place of birth and timely breastfeeding initiation. Descriptive statistics, chi-square test and multivariable logistic regression were performed. Pairwise interaction terms between place of birth and each covariate were included in the regression model to examine the presence of multiplicative effect modification.
The prevalence of timely breastfeeding initiation was 62.9 percent. Most women gave birth in public health facilities (72.8%) followed by private health facilities (15.9%) and at home (11.2%). The proportions of timely breastfeeding initiation differ by place of birth (p < 0.001). In the multivariable model, there was a significant interaction between place of birth and household wealth index and between place of birth and residence on timely initiation. Among women who reside in poor households, the odds of timely initiation were lower among women who gave birth at home compared to those who gave birth in public health facilities, adjusted odds ratio (95% confidence interval) 0.43 (0.21, 0.88). For urban settings, the odds of timely breastfeeding initiation were lower among women who gave birth in private health facilities compared to those who gave birth in public health facilities 0.52 (0.36, 0.75). For rural settings, the odds of timely breastfeeding initiation were lower among women who gave birth at home compared to those who gave birth in public health facilities 0.55 (0.31, 0.97).
Wealth index and residence moderated the association between place of birth and timely breastfeeding initiation in Cambodia. To improve breastfeeding outcomes and eliminate practices impeding timely initiation, breastfeeding advocacy programs need greater integration and follow-up in Cambodia's health systems, including among home birth attendants and private health facilities.
世卫组织的早期基本新生儿护理（EENC）和爱婴医院倡议（BFHI）旨在全球范围内实现产后第一小时内及时开始母乳喂养。然而，在柬埔寨，许多卫生专业人员和设施尚未采用这些指南，这阻碍了及时启动的进展和母婴健康目标的实现。
本二次数据分析使用了 2014 年柬埔寨人口与健康调查（CDHS）的数据，该数据包括了调查前两年内分娩的 2729 名妇女，以检查分娩地点与及时开始母乳喂养之间的关联。进行了描述性统计、卡方检验和多变量逻辑回归。在回归模型中纳入了分娩地点与每个协变量之间的成对交互项，以检查是否存在乘法效应修饰。
及时开始母乳喂养的比例为 62.9%。大多数妇女在公立卫生机构（72.8%）分娩，其次是私立卫生机构（15.9%）和在家中（11.2%）。分娩地点不同，及时开始母乳喂养的比例也不同（p<0.001）。在多变量模型中，分娩地点与家庭财富指数之间以及分娩地点与居住地之间存在显著的交互作用。在居住在贫困家庭的妇女中，与在公立卫生机构分娩的妇女相比，在家分娩的妇女及时开始的可能性较低，调整后的比值比（95%置信区间）为 0.43（0.21，0.88）。对于城市地区，与在公立卫生机构分娩的妇女相比，在私立卫生机构分娩的妇女及时开始母乳喂养的可能性较低，比值比（95%置信区间）为 0.52（0.36，0.75）。对于农村地区，与在公立卫生机构分娩的妇女相比，在家分娩的妇女及时开始母乳喂养的可能性较低，比值比（95%置信区间）为 0.55（0.31，0.97）。
财富指数和居住地调节了柬埔寨分娩地点与及时开始母乳喂养之间的关联。为了改善母乳喂养结果并消除阻碍及时启动的做法，母乳喂养倡导计划需要在柬埔寨卫生系统中得到更大程度的整合和跟进，包括在家分娩的助产妇和私立卫生机构。
