Background
Methods
Study design and setting
Participants
Ethics review
Data collection procedures
Statistical analyses
Outcomes
Analysis
Results
Early initiation of breastfeeding
Enrollment Flow Diagram (Figure 1)
Demographic characteristics
African Sites | Indian Sites | Latin America Sites | ||||||
---|---|---|---|---|---|---|---|---|
Kenya | Zambia | Belgaum | Nagpur | Pakistan | Argentina | Guatemala | Total | |
Maternal age, N (%) | ||||||||
< 20 | 7,503 (21.7) | 6,712 (25.2) | 7,250 (9.5) | 725 (1.9) | 1,694 (3.9) | 2,636 (27.3) | 4,663 (16.4) | 31,183 (12.1) |
20-35 | 25,575 (74.1) | 17,832 (67.0) | 68,858 (90.3) | 36,634 (97.8) | 39,804 (90.7) | 6,293 (65.1) | 20,837 (73.3) | 215,833 (84.0) |
> 35 | 1,421 (4.1) | 2,086 (7.8) | 124 (0.2) | 97 (0.3) | 2,389 (5.4) | 738 (7.6) | 2,942 (10.3) | 9,797 (3.8) |
Education, N (%) | ||||||||
No formal education | 1,048 (3.0) | 2,789 (10.5) | 15,611 (20.6) | 1,140 (3.0) | 36,256 (82.7) | 243 (2.5) | 5,454 (19.2) | 62,541 (24.4) |
Primary | 24,636 (71.4) | 14,573 (55.0) | 25,060 (33.1) | 6,440 (17.2) | 3,398 (7.7) | 5,993 (62.5) | 17,943 (63.1) | 98,043 (38.3) |
Secondary | 7,581 (22.0) | 8,669 (32.7) | 28,003 (37.0) | 22,260 (59.5) | 2,648 (6.0) | 3,201 (33.4) | 4,759 (16.7) | 77,121 (30.1) |
University+ | 1,243 (3.6) | 473 (1.8) | 7,045 (9.3) | 7,596 (20.3) | 1,554 (3.5) | 149 (1.6) | 288 (1.0) | 18,348 (7.2) |
Parity, N (%) | ||||||||
0 | 8,609 (24.9) | 7,170 (26.9) | 32,203 (42.5) | 17,953 (47.9) | 9,041 (20.6) | 3,165 (32.9) | 7,950 (27.9) | 86,091 (33.6) |
1-2 | 13,403 (38.8) | 10,037 (37.7) | 38,592 (50.9) | 18,553 (49.5) | 14,259 (32.5) | 3,746 (38.9) | 10,259 (36.1) | 108,849 (42.4) |
> 2 | 12,496 (36.2) | 9,438 (35.4) | 5,041 (6.6) | 970 (2.6) | 20,624 (47.0) | 2,723 (28.3) | 10,242 (36.0) | 61,534 (24.0) |
Trimester for first ANC visit, N (%) | ||||||||
First | 1,232 (3.8) | 2,169 (8.3) | 46,710 (63.1) | 28,973 (77.5) | 8,575 (24.1) | 3,213 (37.3) | 11,429 (41.5) | 102,301 (42.3) |
Second | 19,101 (58.8) | 18,823 (71.9) | 23,144 (31.2) | 7,317 (19.6) | 11,425 (32.1) | 3,873 (45.0) | 12,146 (44.1) | 95,829 (39.6) |
Third | 12,133 (37.4) | 5,182 (19.8) | 4,209 (5.7) | 1,075 (2.9) | 15,606 (43.8) | 1,525 (17.7) | 3,994 (14.5) | 43,724 (18.1) |
Delivery mode, N (%) | ||||||||
Vaginal | 33,666 (97.4) | 26,173 (98.1) | 65,197 (85.4) | 29,568 (78.9) | 37,468 (85.1) | 6,294 (64.9) | 23,118 (81.2) | 221,484 (86.1) |
Vaginal assisted | 410 (1.2) | 235 (0.9) | 208 (0.3) | 417 (1.1) | 2,428 (5.5) | 13 (0.1) | 24 (0.1) | 3,735 (1.5) |
C-section | 477 (1.4) | 271 (1.0) | 10,902 (14.3) | 7,498 (20.0) | 4,144 (9.4) | 3,394 (35.0) | 5,313 (18.7) | 31,999 (12.4) |
Birth attendant, N (%) | ||||||||
Physician | 596 (1.7) | 546 (2.0) | 44,515 (58.3) | 22,495 (60.0) | 11,140 (25.3) | 7,011 (72.3) | 12,246 (43.0) | 98,549 (38.3) |
Nurse/Midwife/HW | 14,002 (40.5) | 14,916 (55.9) | 27,615 (36.2) | 13,736 (36.6) | 11,691 (26.5) | 2,641 (27.2) | 511 (1.8) | 85,112 (33.1) |
TBA | 15,749 (45.6) | 6,954 (26.1) | 1,867 (2.4) | 1,015 (2.7) | 20,400 (46.3) | 2 (0.0) | 15,616 (54.9) | 61,603 (24.0) |
Family/Other | 4,206 (12.2) | 4,263 (16.0) | 2,310 (3.0) | 237 (0.6) | 810 (1.8) | 42 (0.4) | 83 (0.3) | 11,951 (4.6) |
Live births (neonates), N | 34,931 | 26,875 | 76,782 | 37,714 | 44,472 | 9,763 | 28,624 | 259,161 |
Multiple birth, N (%) | 740 (2.1) | 398 (1.5) | 940 (1.2) | 474 (1.3) | 878 (2.0) | 124 (1.3) | 345 (1.2) | 3,899 (1.5) |
Male gender, N (%) | 17,653 (50.5) | 14,126 (52.6) | 39,775 (51.8) | 19,612 (52.0) | 23,220 (52.2) | 5,040 (51.7) | 14,549 (50.8) | 133,975 (51.7) |
Birth weight | 34,902 | 26,871 | 76,770 | 37,700 | 44,413 | 9,756 | 28,621 | 259,033 |
< 1000g | 3 (0.0) | 11 (0.0) | 33 (0.0) | 5 (0.0) | 14 (0.0) | 16 (0.2) | 16 (0.1) | 98 (0.0) |
1000-1499g | 24 (0.1) | 42 (0.2) | 289 (0.4) | 152 (0.4) | 209 (0.5) | 34 (0.3) | 81 (0.3) | 831 (0.3) |
1500-2499g | 836 (2.4) | 1,151 (4.3) | 9,396 (12.2) | 5,128 (13.6) | 5,990 (13.5) | 483 (5.0) | 3,355 (11.7) | 26,339 (10.2) |
≥ 2500g | 34,039 (97.5) | 25,667 (95.5) | 67,052 (87.3) | 32,415 (86.0) | 38,200 (86.0) | 9,223 (94.5) | 25,169 (87.9) | 231,765 (89.5) |
Bag and mask resuscitation, N (%) | 531 (1.5) | 460 (1.7) | 2,688 (3.5) | 1,034 (2.8) | 2,027 (4.6) | 369 (3.8) | 285 (1.0) | 7,394 (2.9) |
Baby placed on mother's chest after delivery, N (%) | 20,231 (58.2) | 20,853 (78.6) | 43,337 (58.6) | 23,066 (62.5) | 2,920 (6.6) | 7,563 (78.5) | 14,602 (51.4) | 132,572 (52.1) |
Factors associated with lack of EIBF (Table 2)
African Sites | Indian Sites | The Pakistan Site | Latin American Sites | |||||
---|---|---|---|---|---|---|---|---|
% | RR (95% CI), P value | % | RR (95% CI), P value | % | RR (95% CI), P value | % | RR (95% CI), P value | |
Maternal Age | 0.0052 | NS | NS | NS | ||||
< 20 | 23.4 | 1.02 (0.97, 1.08), 0.4577 | 5.7 | 3.9 | 21.8 | |||
20-35 | 70.6 | 1.0 | 94.0 | 90.7 | 69.2 | |||
> 35 | 6. 0 | 1.09 (1.03, 1.15), 0.0014 | 0.3 | 5.4 | 9.0 | |||
Education | <.0001 | 0.0003 | 0.0121 | NS | ||||
No formal education | 6.8 | 1.19 (0.99, 1.43), 0.0668 | 11.8 | 0.95 (0.76, 1.17), 0.6094 | 82.7 | 1.05 (1.01, 1.08), 0.0057 | 10.8 | |
Primary | 63.2 | 1.16 (1.03, 1.30), 0.0124 | 25.1 | 1.24 (0.92, 1.67), 0.1511 | 7.8 | 1.04 (1.0, 1.07),0.0250 | 62.9 | |
Secondary | 27.3 | 1.06 (0.94, 1.20), 0.3487 | 48.3 | 1.03 (0.95, 1.12), 0.4557 | 6.0 | 1.0 (0.97, 1.04),0.7766 | 25.0 | |
University or higher | 2.7 | 1.0 | 14.8 | 1.0 | 3.5 | 1.0 | 1.3 | |
Parity | 0.0013 | 0.0236 | <.0017 | <.0001 | ||||
0 | 25.9 | 1.15 (1.01, 1.31), 0.0294 | 45.2 | 1.04 (1.0, 1.08), 0.0353 | 20.5 | 1.02 (1.01, 1.04), <.0006 | 30.4 | 1.19 (1.09, 1.29), <.0001 |
1-2 | 38.3 | 1.0 | 50.2 | 1.0 | 32.5 | 1.0 | 37.5 | 1.0 |
> 2 | 35.8 | 0.94 (0.91, 0.98), 0.0013 | 4.6 | 1.16 (1.0, 1.35), 0.0489 | 47.0 | 1.02 (1.00, 1.03), <.0610 | 32.1 | 0.94 (0.90, 0.99), <.0245 |
Trimester of first ANC | NS | 0.0279 | NS | NS | ||||
First | 6.1 | 70.3 | 1.0 | 24.1 | 39.4 | |||
Second | 65.3 | 25.4 | 0.76 (0.58, 0.99), 0.0420 | 32.1 | 44.5 | |||
Third | 28.6 | 4.3 | 0.49 (0.29, 0.84), 0.0093 | 43.8 | 16.1 | |||
Delivery mode | <.0001 | <.0001 | <.0001 | <.0001 | ||||
Vaginal | 97.8 | 1.0 | 82.2 | 1.0 | 85.1 | 1.0 | 73.0 | 1.0 |
Vaginal assisted | 1.0 | 1.26 (0.97, 1.62), 0.0796 | 0.7 | 0.75 (0.33, 1.71), 0.4892 | 5.5 | 1.07 (1.03, 1.11), 0.0002 | 0.1 | 1.24 (0.71, 2.17), 0.4480 |
C-section | 1.2 | 2.06 (1.67, 2.54), <.0001 | 17.1 | 3.76 (1.77, 7.99), 0.0006 | 9.4 | 1.21 (1.13, 1.29), <.0001 | 26.9 | 2.26 (1.74, 2.93), <.0001 |
Birth attendant | NS | 0.0001 | 0.0020 | <.0001 | ||||
Physician | 1.9 | 59.1 | 1.0 | 25.3 | 1.0 | 57.6 | 1.0 | |
Nurse/Midwife/HW | 48.2 | 36.5 | 0.75 (0.55, 1.04), 0.0819 | 26.6 | 1.02 (0.97, 1.06), 0.4955 | 14.6 | 0.95 (0.69, 1.30), 0.7309 | |
TBA | 35.8 | 2.6 | 0.87 (0.43, 1.78), 0.7077 | 46.3 | 0.95 (0.91, 1.00), 0.0410 | 27.5 | 0.56 (0.41, 0.77), <.0004 | |
Family/Other | 14.1 | 1.8 | 2.22 (1.04, 4.71), 0.0385 | 1.8 | 1.0 (0.94, 1.06), 0.9867 | 0.3 | 1.37 (1.14, 1.64), 0.0008 | |
Multiple birth | <.0001 | NS | <.0001 | NS | ||||
Yes | 1.8 | 1.65 (1.47, 1.86), <.0001 | 1.2 | 2.0 | 1.08 (1.04, 1.11), <.0001 | 1.2 | ||
No | 98.2 | 1.0 | 98.8 | 98.0 | 1.0 | 98.8 | ||
Gender | 0.0077 | <0.0008 | ||||||
Male | 51.6 | 1.04 (1.01, 1.07), 0.0077 | 51.9 | NS | 52.2 | NS | 51.2 | 1.07 (1.03, 1.12), <.0008 |
Female | 48.4 | 1.0 | 48.1 | 47.8 | 48.8 | 1.0 | ||
Birth weight | <.0001 | <.0001 | <.0001 | <.0001 | ||||
< 1000g | 0.0 | 3.07 (2.09, 4.51), <.0001 | 0.0 | 3.32 (1.57, 6.99), 0.0016 | 0.0 | 1.29 (1.17, 1.41), <.0001 | 0.1 | 2.03 (1.60, 2.57), <.0001 |
1000-1499g | 0.1 | 2.42 (1.94, 3.02), <.0001 | 0.4 | 2.63 (1.83, 3.77), <.0001 | 0.5 | 1.08 (0.99, 1.18), 0.0707 | 0.3 | 2.25 (1.90, 2.66), <.0001 |
1500-2499g | 3.4 | 1.48 (1.32, 1.65), <.0001 | 12.9 | 1.33 (1.06, 1.68), 0.0134 | 13.5 | 1.05 (1.03, 1.08), <.0001 | 8.4 | 1.35 (1.23, 1.47), <.0001 |
≥ 2500g | 96.5 | 1.0 | 86.7 | 1.0 | 86.0 | 1.0 | 91.2 | 1.0 |
Bag and mask resuscitation | <.0001 | <.0001 | <.0001 | <.0001 | ||||
Yes | 1.6 | 2.15 (1.78, 2.61), <.0001 | 3.1 | 2.22 (1.84, 2.69), <.0001 | 4.6 | 1.10 (1.05, 1.15), <.0001 | 2.4 | 2.05 (1.74, 2.41), <.0001 |
No | 98.4 | 1.0 | 96.9 | 1.0 | 95.4 | 1.0 | 97.6 | 1.0 |
Baby on mother's chest after delivery | <.0001 | <0.0001 | <.0001 | <.0001 | ||||
Yes | 68.4 | 1.0 | 60.6 | 1.0 | 6.6 | 1.0 | 64.9 | 1.0 |
No | 31.6 | 1.98 (1.65, 2.37), <.0001 | 39.4 | 4.34 (2.67, 7.05), <.0001 | 93.4 | 1.67 (1.46, 1.91), <.0001 | 35.1 | 3.30 (2.32, 4.68), <.0001 |
Exclusive breastfeeding on day 42 of life
Rates of exclusive breastfeeding on day 42 of life (Figure 3)
Factors associated with lack of exclusive breastfeeding on day 42 of life (Table 3)
African Sites | Indian Sites | The Pakistan Site | The Guatemalan Site | |||||
---|---|---|---|---|---|---|---|---|
% | RR (95% CI), P value | % | RR (95% CI), P value | % | RR (95% CI), P value | % | RR (95% CI), P value | |
Maternal Age | 0.0025 | NS | 0.0086 | <.0001 | ||||
< 20 | 24.3 | 1.15 (1.01, 1.31), 0.0390 | 5.1 | 3.9 | 0.90 (0.76, 1.06), 0.2009 | 16.1 | 0.81 (0.75, 0.89), <.0001 | |
20-35 | 70.0 | 1.0 | 94.6 | 90.2 | 1.0 | 73.6 | 1.0 | |
> 35 | 5.7 | 1.15 (1.01, 1.31), 0.0290 | 0.3 | 5.9 | 1.15 (1.05, 1.26), 0.0038 | 10.3 | 1.45 (1.30, 1.62),<.0001 | |
Maternal education | <.0001 | NS | NS | <.0001 | ||||
No formal education | 6.2 | 1.81 (1.05, 3.12), 0.0333 | 11.3 | 80.7 | 16.0 | 0.37(0.29, 0.48), <.0001 | ||
Primary | 60.9 | 1.41 (0.86, 2.31), 0.1745 | 24.5 | 8.1 | 63.6 | 0.37(0.29, 0.48), <.0001 | ||
Secondary | 29.6 | 1.18 (0.73, 1.90), 0.4939 | 48.1 | 7.0 | 19.2 | 0.60 (0.51, 0.70), <.0001 | ||
University or higher | 3.3 | 1.0 | 16.1 | 4.2 | 1.3 | 1.0 | ||
Parity | 0.0055 | NS | 0.0070 | <.0001 | ||||
0 | 27.2 | 0.85 (0.66, 1.10), 0.2220 | 43.9 | 20.2 | 1.10 (1.03, 1.16), 0.0019 | 28.6 | 1.20 (1.14, 1.26), <.0001 | |
1-2 | 38.7 | 1.0 | 51.7 | 31.9 | 1.0 | 37.1 | 1.0 | |
> 2 | 34.1 | 1.22 (1.07, 1.39), 0.0032 | 4.4 | 47.9 | 1.04 (0.97, 1.12), 0.2469 | 34.4 | 1.06 (0.97, 1.15), 0.1942 | |
Trimester of first ANC | NS | 0.0654 | 0.0699 | 0.0090 | ||||
First | 8.6 | 82.6 | 1.0 | 32.4 | 1.0 | 45.2 | 1.0 | |
Second | 59.7 | 14.9 | 1.33 (1.04, 1.70), 0.0213 | 27.7 | 0.93 (0.87, 1.00), 0.0629 | 41.3 | 0.94 (0.89, 0.99), 0.0127 | |
Third | 31.7 | 2.5 | 0.73 (0.34, 1.56), 0.4211 | 39.9 | 0.99 (0.92, 1.07), 0.8923 | 13.5 | 0.88 (0.79, 0.98), 0.0227 | |
Birth attendant | 0.0350 | 0.0027 | NS | <.0001 | ||||
Physician | 2.0 | 1.0 | 62.4 | 1.0 | 30.0 | 51.3 | 1.0 | |
Nurse/Midwife/HW | 55.8 | 1.21 (0.84, 1.72), 0.3056 | 35.1 | 1.06 (0.87, 1.29), 0.5487 | 26.6 | 1.7 | 0.96 (0.71, 1.30), 0.7892 | |
TBA | 28.7 | 1.41 (0.92, 2.16), 0.1143 | 0.8 | 2.60 (1.47, 4.60), 0.0010 | 41.3 | 46.7 | 0.69 (0.64, 0.74), <.0001 | |
Family/Other | 13.5 | 1.43 (0.97, 2.09), 0.0674 | 1.7 | 0.67 (0.37, 1.20),0.1794 | 2.0 | 0.4 | 1.12 (0.67, 1.89) 0.6651 | |
Multiple birth | <.0001 | <.0001 | <.0001 | <.0001 | ||||
Yes | 1.8 | 2.27 (1.61, 3.19), <.0001 | 1.3 | 3.60 (2.17, 5.97), <.0001 | 2.0 | 1.99 (1.70, 2.34), <.0001 | 1.2 | 3.25 (2.75, 3.84), <.0001 |
No | 98.2 | 1.0 | 98.7 | 1.0 | 98.0 | 1.0 | 98.8 | 1.0 |
Birth weight | NS | 0.0378 | NS | <.0001 | ||||
< 2500 g | 3.7 | 14.8 | 1.29 (1.01, 1.64), 0.0378 | 16.0 | 12.2 | 1.19 (1.11, 1.28), <.0001 | ||
≥ 2500 g | 96.3 | 85.2 | 1.0 | 84.0 | 87.8 | 1.0 | ||
Bag and mask resuscitation | NS | NS | 0.0657 | 0.0233 | ||||
Yes | 1.4 | 3.0 | 6.8 | 0.89 (0.79, 1.01), 0.0657 | 1.2 | 1.09 (1.01, 1.18), 0.0233 | ||
No | 98.6 | 97.0 | 93.2 | 1.0 | 98.8 | 1.0 | ||
Timely initiation of breastfeeding | NS | 0.0001 | NS | 0.0030 | ||||
Yes | 88.1 | 84.0 | 1.0 | 18.4 | 72.6 | 1.0 | ||
No | 11.9 | 16.0 | 1.60 (1.25, 2.04 ), 0.0001 | 81.6 | 27.4 | 1.22 (1.07, 1.40), 0.0030 |