Early feeding practices and associated factors in Sudan: a cross-sectional analysis from multiple Indicator cluster survey

In efforts to reduce neonatal mortality, the World Health Organization (WHO) has included breastfeeding among its recommended packages of interventions. Early initiation of breastfeeding and avoidance of prelacteal feeding are key contributors to optimal feeding practices. This study aims to assess the prevalence and associated factors of early breastfeeding practices in Sudan. This study utilises the cross-sectional nationally-representative Sudan Multiple Indicator Cluster Survey (MICS) conducted in 2014. The sample includes women who had a live birth in the two years before the survey and their self-report on early breastfeeding practices, namely early initiation and prelacteal feeding. Percentages of these early breastfeeding practices indicators were estimated accounting for the complex survey design. Multivariable logistic regression analyses were used to examine the factors associated with these outcomes. Of 5622 mothers, 69% initiated breastfeeding within one hour of birth, 72% avoided prelacteal feeding in the first three days after birth, and 51% met the criteria for both (i.e. practised optimal early feeding practice). Optimal early feeding varied across regions of Sudan. Birth by caesarean section (Adjusted Odds Ratio [AOR] 0.34; 95% CI 0.25, 0.47) and at a health facility (AOR 0.75; 95% CI 0.60, 0.94) were negatively associated with optimal early feeding practice. Mothers with secondary education (AOR 1.62; 95% CI 1.30, 2.02), those who desired their pregnancy at the time (AOR 1.31; 95% CI 1.08, 1.60), those who were assisted by a skilled birth attendant at birth (AOR 1.48; 95% CI 1.19, 1.83), and those who gave birth to female infants (AOR 1.16; 95% CI 1.02, 1.33) had higher odds of use optimal early feeding practice. Similarly, the odds of optimal early feeding increased with parity and maternal age. Only half of Sudanese mothers practised optimal early feeding practice, with important differences between regions in the country. Early feeding practices in Sudan are associated with various maternal, child and community level factors. The findings suggest the need to develop breastfeeding promotion programs with consideration of regional variations and healthcare system interventions.Other Information Published in: International Breastfeeding Journal License: http://creativecommons.org/licenses/by/4.0/See article on publisher's website: http://dx.doi.org/10.1186/s13006-020-00288-7</p

Interaction between maternal age and parity.

<p>Interaction between maternal age and parity.</p

Obstetric and neonatal outcomes by maternal age category.

<p>Obstetric and neonatal outcomes by maternal age category.</p

Maternal characteristics by maternal age category.

<p>Maternal characteristics by maternal age category.</p

Sensitivity, specific, PPV and NPV for specified BMI cut-offs, by ethnic group.

<p>Sensitivity, specific, PPV and NPV for specified BMI cut-offs, by ethnic group.</p

Prevalence of overweight/obesity by ethnic group, using conventional and Asian-specific thresholds.

<p>Prevalence of overweight/obesity by ethnic group, using conventional and Asian-specific thresholds.</p

ROC curves for diabetes in pregnancy by BMI, by ethnic group.

<p>ROC curves for diabetes in pregnancy by BMI, by ethnic group.</p

Descriptive characteristics and univariate analysis of factors associated with diabetes in pregnancy.

<p>Descriptive characteristics and univariate analysis of factors associated with diabetes in pregnancy.</p

Unadjusted and adjusted risk ratios for the association between maternal age and obstetric and neonatal outcome¹.

<p>Unadjusted and adjusted risk ratios for the association between maternal age and obstetric and neonatal outcome<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164462#t003fn001" target="_blank">¹</a>.</p

Risk of Adverse Obstetric and Neonatal Outcomes by Maternal Age: Quantifying Individual and Population Level Risk Using Routine UK Maternity Data

<div><p>Objective</p><p>The objective of this study was to investigate whether moderately increased maternal age is associated with obstetric and neonatal outcome in a contemporary population, and to consider the possible role of co-morbidities in explaining any increased risk.</p><p>Study Design</p><p>Secondary analysis of routinely collected data from a large maternity unit in London, UK. Data were available on 51,225 singleton deliveries (≥22 weeks) occurring to women aged ≥20 between 2004 and 2012. Modified Poisson regression was used to estimate risk ratios for the association between maternal age and obstetric and neonatal outcome (delivery type, postpartum haemorrhage, stillbirth, low birthweight, preterm birth, small for gestational age, neonatal unit admission), using the reference group 20–24 years. Population attributable fractions were calculated to quantify the population impact.</p><p>Results</p><p>We found an association between increasing maternal age and major postpartum haemorrhage (≥1000ml blood loss) (RR 1.36 95% CI 1.18–1.57 for age 25–29 rising to 2.41 95% CI 2.02–2.88 for age ≥40). Similar trends were observed for caesarean delivery, most notably for elective caesareans (RR 1.64 95% CI 1.36–1.96 for age 25–29 rising to 4.94 95% CI 4.09–5.96 for age ≥40). There was evidence that parity modified this association, with a higher prevalence of elective caesarean delivery in older nulliparous women. Women aged ≥35 were at increased risk of low birthweight and preterm birth. We found no evidence that the risk of stillbirth, small for gestational age, or neonatal unit admission differed by maternal age.</p><p>Conclusions</p><p>Our results suggest a gradual increase in the risk of caesarean delivery and postpartum haemorrhage from age 25, persisting after taking into account maternal BMI, hypertension and diabetes. The risk of low birthweight and preterm birth was elevated in women over 35. Further research is needed to understand the reasons behind the high prevalence of elective caesarean delivery in nulliparous older mothers.</p></div