Breastfeeding practices and health facility births in South Sudan

Abstract

Introduction: Studies on the determinants of breastfeeding practices and health facility utilization have not been conducted in South Sudan. This thesis assessed the prevalence and determinants of suboptimal breastfeeding practices especially delayed initiation of breastfeeding and pre-lacteal feeding. We also assessed the effect of the Baby-Friendly Hospital Initiative training on breastfeeding practices. Methods: The work in thesis consist of three surveys. The first was a cross-sectional study among 806 mothers in Juba Teaching Hospital in South Sudan. This assessed the prevalence and factors associated with delayed initiation of breastfeeding using bivariable and multivariable logistic regression analysis. The second survey among 806 mothers in the same hospital – together with the first survey – became a “before and after study” assessing the effect of the Baby-Friendly Hospital Initiative training on early initiation of breastfeeding using a modified Poisson model. In the third survey, we interviewed 810 mothers in a rural community in Jubek State in South Sudan. We assessed the prevalence and determinants of pre-lacteal feeding and the level and determinants of health facility utilization at birth. Results: In the first survey in the hospital, the prevalence of delayed initiation of breastfeeding was 52% and factors associated with delayed initiation of breastfeeding included caesarean section, discarding of colostrum, single mother, exposure to advertisement of infant formula and lack of house ownership. In the second survey in the hospital after the Baby-Friendly Hospital Initiative training, we found a high prevalence of early initiation of breastfeeding 91% compared to 48% before the training. Regardless of the mode of birth, the training intervention was effective in increasing early initiation of breastfeeding In third survey in the community, the prevalence of pre-lacteal feeding was 53 % and proportion of mothers giving birth at a health facility was 25.8%. The predictors of health facility birth included antenatal visits, mother’s education, socio-economic status, and first-time mothers. Conclusion: The findings in this thesis highlight the need for efforts to increase health facility births, breastfeeding counselling, promote the health benefits of early initiation of breastfeeding, and colostrum, roll out the Baby-Friendly Hospital Initiative training to other hospitals in the country and discourage discarding of colostrum and the use of pre-lacteal feeds.