Prevalence and factors associated with timely initiation of breastfeeding among mothers who deliver by cesarean section at Kawempe National Referral Hospital, Uganda

Abstract

Breastfeeding is essential in reducing infant mortality and promoting growth and development. The World Health Organization recommends the timely initiation of breastfeeding to prevent neonatal mortality and provide babies with colostrum. Despite its benefits, many mothers who deliver by cesarean section do not timely breastfeed due to postoperative challenges and experiences, inadequate health care support, and socio-economic factors. The study aimed to determine the prevalence and factors associated with the timely initiation of breastfeeding among mothers who delivered by cesarean section at Kawempe Hospital in Uganda. A cross-sectional convergent mixed methods study design was employed. A total of 385 postnatal mothers who delivered by cesarean section were consecutively selected and interviewed using a structured questionnaire and review of medical records while seven in-depth interviews and four Key Informant interviews were purposively conducted. Data entry and analysis was done using STATA v14. Descriptive statistics was used to summarize the data. The modified Poisson model was used to determine the factors associated with the timely initiation of breastfeeding using the adjusted prevalence ratios at 95% confidence interval. Qualitative data was analyzed using Atlas.ti version 9. The prevalence of timely initiation of breastfeeding among mothers who delivered by cesarean section was 33.5%. Factors significantly associated with the timely initiation of breastfeeding included maternal knowledge, prenatal counselling, birthweight, emergency cesarean section, baby-mother separation, and health worker support. Postoperative pain, fear of breast milk inadequacy, prelacteal feeding negatively influenced maternal attitude to timely initiate breastfeeding. Timely initiation of breastfeeding remains low among mothers who deliver by cesarean section at Kawempe hospital. This was attributed to emergency cesarean sections, mother-baby separation, lack of prenatal counselling, limited maternal knowledge, and inadequate health worker support. Therefore, integrating breastfeeding messages in prenatal and antenatal health education, adequate health worker support and re-enforcing the Baby-Friendly Health Initiatives that encourage skin -to-skin contact and rooming-in may improve timely initiation of breastfeeding among mothers who deliver by cesarean section.