Determinants of Timing of Breastfeeding Initiation at Pumwani Maternity Hospital in Kenya: A Hospital-Based Cross-Sectional Study.

OBJECTIVE: To assess the determinants of the timing of breastfeeding initiation and analyze those that are associated with delayed breastfeeding initiation among mothers delivering at Pumwani Maternity Hospital, Nairobi, Kenya. BACKGROUND: Breastfeeding initiation within the first hour of birth is vital because of the benefits of colostrum, which is highly concentrated in immunological and nutritional factors shortly after parturition. The 2014 KDHS revealed that approximately 62% of the sampled children were breastfed within the first hour of birth, with 60.8% in Nairobi County, falling short of the 2030 collective target of at least 70%. DESIGN: This study employed a hospital-based cross-sectional design. METHODS: A total of 363 postpartum women who had initiated breastfeeding at the time of the survey and had given birth within 24 h were consecutively recruited. Recruitment was conducted daily from the postnatal ward until the target sample size was reached. Data were collected using a structured, open-ended questionnaire and analyzed in R Version 4.3.3. Both descriptive and inferential statistics were used. The chi-square and Fisher's exact tests were then used to assess the association between the grouping variables and the outcome of breastfeeding initiation. All significant factors were fitted in unadjusted binary logistic regression models and further in the multiple-adjusted binary logistic regression model. RESULTS: Of the 363 participants recruited into the study, 344 mothers were included in the final analysis because they could recall the timing of breastfeeding initiation. Among these mothers, more than half (201/344; 58.4%) initiated breastfeeding within the first hour of birth. Mothers who gave birth through the cesarean section (aOR: 7.92; 95% CI: 4.54-14.27, p < 0.001), had low birth weight (aOR: 2.97; 95% CI: 1.26-7.13, p = 0.013), and were without knowledge of the need to introduce a newborn to breast milk within the first hour of birth (aOR: 1.69; 95% CI: 1.06-8.86, p = 0.040) had significantly higher odds of breastfeeding initiation after the first hour of birth. Additionally, giving birth to more than one child (aOR: 3.77; 90% CI: 0.89-19.62, p = 0.083) and lack of support to initiate breastfeeding (aOR: 1.58; 90% CI: 0.96-2.61, p = 0.069) demonstrated suggestive evidence of an association with breastfeeding initiation after the first hour of birth but did not meet the study's threshold for statistical significance at the 95% confidence level. CONCLUSION: The study's findings highlight that although more than half (58.4%) of the mothers included in the final analysis had initiated breastfeeding within an hour of birth, this proportion still falls short of the World Health Organization's collective target of achieving at least a 70% timely breastfeeding initiation rate by 2030. The study further identified several determinants associated with breastfeeding initiation after the first hour of birth. These include low birth weight (less than 2.5 kg), birth through the cesarean section, and the lack of prior knowledge among mothers on the importance of timely breastfeeding initiation. Additionally, giving birth to more than one child and healthcare workers failing to provide breastfeeding initiation support shortly after birth demonstrated suggestive evidence of an association with delayed breastfeeding initiation and may be considered important barriers to timely breastfeeding initiation within the first hour of birth. RELEVANCE TO CLINICAL PRACTICE: The results of this study underscore the need for Pumwani Maternity Hospital and the County Government of Nairobi to conduct periodic training sessions for all hospital healthcare workers, equipping them with the necessary skills to strengthen adherence to the "Ten Steps to Successful Breastfeeding" outlined in the Baby-Friendly Hospital Initiative. Further research is required to generate additional evidence that can improve breastfeeding practices.