International Research Centre of Excellence, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria.
Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
J Health Popul Nutr. 2023 Nov 6;42(1):121. doi: 10.1186/s41043-023-00466-3.
Studies have connected newborn delivery settings and modality to optimal breastfeeding, but how it influences untimely initiation, mostly prevalent in sub-Saharan Africa is unknown. Hence, the role of home delivery on delay initiation of breastfeeding (DIBF) in Nigeria was investigated to inform evidence-based strategy for improved breastfeeding practice.
This is a secondary analysis of births (11,469 home and 7632 facility delivery) by 19,101 reproductive age women in the 2018 NDHS. DIBF is the outcome, home birth is the exposure, and explanatory variables were classified as: socio-demographics, obstetrics and economic factors. Descriptive statistics (frequencies and percentages) were reported, and bivariate (chi-square) analysis was carried out at 20% (p < 0.20) cutoff point. Multivariable logistic regression assessed the probability and significance of the outcome per place of birth. Multivariate decomposition further evaluated the endowment and coefficient effect contribution by independent factors to the outcome. Analysis was carried out at p < 0.05 (95% confidence level) on Stata.
56.6% of mothers DIBF, with 37.1% and 19.5% from home and facility delivery, respectively. Home delivery (AOR = 1.34, 95% CI 1.17-1.52) increase the chance of DIBF by 34%, while DIBF probability reduces by 26% in facility delivery (AOR = 0.74, 95% CI 0.65-0.85). DIBF is 5 times more likely in caesarian section delivery (AOR = 5.10, 95% CI 4.08-6.38) compared to virginal birth in facility delivery. Skilled antenatal provider, parity and wealth are negatively associated with DIBF in home birth, while undesired pregnancy, rural residency, partial/no skin-to-skin contact and large child size positively influence DIBF in both home and facility delivery. Skilled antenatal provider (C = - 66.3%, p < 0.01) and skin-to-skin contact (C = - 60.6%, p < 0.001) contributed most to reducing the negative DIBF effect with 69% and 31% overall characteristics and coefficient effect component, respectively. DIBF is more likely in Bauchi and Sokoto but less likely in Bayelsa.
High DIBF prevalent in Nigeria was largely due to elevated rate of home birth, positively associated with DIBF. Caesarian section delivery though heightens the chance of DIBF in facility delivery. Strengthening utilization of skilled provider and skin-to-skin contact can eliminate two-third of the adverse DIBF effect and improve early initiation rate. Adopting this strategy will bridge home-facility delivery gap to achieve optimal breastfeeding practice.
研究表明新生儿分娩环境和方式与最佳母乳喂养有关，但在撒哈拉以南非洲地区，这种方式如何影响母乳喂养开始时间过早（通常在产后一小时内开始）还不清楚。因此，本研究旨在调查尼日利亚家庭分娩对母乳喂养开始延迟（DIBF）的影响，为改进母乳喂养实践提供循证策略。
这是对 2018 年尼日利亚国家家庭健康调查中 19101 名育龄妇女（11469 名在家分娩和 7632 名在机构分娩）的二次分析。DIBF 是结局，家庭分娩是暴露，解释变量分为社会人口统计学、产科和经济因素。报告了描述性统计数据（频率和百分比），并在 20%（p<0.20）的截断点进行了两变量（卡方）分析。多变量逻辑回归评估了每个分娩地点发生结局的概率和显著性。多变量分解进一步评估了独立因素对结局的禀赋和系数效应贡献。在 Stata 上进行了 p<0.05（95%置信水平）的分析。
56.6%的母亲发生 DIBF，其中 37.1%和 19.5%分别来自家庭分娩和机构分娩。家庭分娩（AOR=1.34，95%CI 1.17-1.52）增加了 34%的 DIBF 发生机会，而机构分娩中 DIBF 的概率降低了 26%（AOR=0.74，95%CI 0.65-0.85）。与机构分娩中的阴道分娩相比，剖宫产分娩发生 DIBF 的可能性增加了 5 倍（AOR=5.10，95%CI 4.08-6.38）。在机构分娩中，有熟练的产前提供者、多胎次和富裕与 DIBF 呈负相关，而不想要的妊娠、农村居住、部分/无皮肤接触和较大的儿童体型与家庭分娩和机构分娩中的 DIBF 呈正相关。熟练的产前提供者（C=−66.3%，p<0.01）和皮肤接触（C=−60.6%，p<0.001）对降低 DIBF 的负面影响贡献最大，分别占总体特征和系数效应成分的 69%和 31%。在包奇和索科托，DIBF 更常见，但在巴耶尔萨则较少见。
尼日利亚 DIBF 发生率高，主要是由于家庭分娩率升高，与 DIBF 呈正相关。尽管剖宫产分娩增加了机构分娩中 DIBF 的发生机会。加强利用熟练提供者和皮肤接触可以消除三分之二的不利 DIBF 影响，提高早期启动率。采用这种策略将缩小家庭与机构分娩之间的差距，以实现最佳母乳喂养实践。
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