Abstract
Initiation of
breast-feeding within 1 h after birth has been associated with reduced neonatal
mortality in a rural Ghanaian population. In South Asia, however,
breast-feeding patterns and low birth weight rates differ and this relationship
has not been quantified. Data were collected during a community-based
randomized trial of the impact of topical chlorhexidine antisepsis
interventions on neonatal mortality and morbidity in southern Nepal. In-home
visits were conducted on d 1–4, 6, 8, 10, 12, 14, 21, and 28 to collect
longitudinal information on timing of initiation and pattern of breast-feeding.
Multivariable regression modeling was used to estimate the association between
death and breast-feeding initiation time. Analysis was based on 22,838
breast-fed newborns surviving to 48 h. Within 1 h of birth, 3.4% of infants
were breast-fed and 56.6% were breast-fed within 24 h of birth. Partially
breast-fed infants (72.6%) were at higher mortality risk [relative risk (RR) =
1.77; 95% CI = 1.32–2.39] than those exclusively breast-fed. There was a trend
(P = 0.03) toward higher mortality with increasing
delay in breast-feeding initiation. Mortality was higher among late (≥24 h)
compared with early (<24 h) initiators (RR = 1.41; 95% CI = 1.08–1.86) after
adjustment for low birth weight, preterm birth, and other covariates.
Improvements in breast-feeding practices in this setting may reduce neonatal
mortality substantially. Approximately 7.7 and 19.1% of all neonatal deaths may
be avoided with universal initiation of breast-feeding within the first day or
hour of life, respectively. Community-based breast-feeding promotion programs
should remain a priority, with renewed emphasis on early initiation in addition
to exclusiveness and duration of breast-feeding.(deniaprianichan)
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