Currently submitted to: JMIR Pediatrics and Parenting
Date Submitted: Jun 6, 2026
Open Peer Review Period: Jun 10, 2026 - Aug 5, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Timely initiation of breastfeeding and associated factors in 20 Sub-Saharan Africa countries: evidence from the recent Demographic and Health Survey
ABSTRACT
Background:
An important strategy to decrease infant morbidity and mortality is timely initiation of breastfeeding (EIBF), which is defined as putting the newborn to the breast within one hour of delivery. Delayed initiation of breastfeeding may contribute to high neonatal and infant mortality in Sub-Saharan Africa. This study assessed the prevalence timely breastfeeding initiation and associated factors using the recent DHS data from 20 sub-Saharan African countries.
Objective:
To assess the prevalence of timely breastfeeding initiation and associated factors using the recent DHS data from 20 sub-Saharan African countries.
Methods:
Using the recent east African countries DHS data, a cross-sectional study was carried out. A total of 177,988 weighted were children were used. The data's hierarchical structure was taken into consideration by doing a multilevel logistic regression analysis. Reports were presented using adjusted odds ratios (AORs) with 95% CIs. To evaluate cluster-level variance, random effect measures such as the median odds ratio (MOR) and intra-class correlation coefficient (ICC) were reported. To evaluate cluster-level variance, random effect measures such as the median odds ratio (MOR) and intra-class correlation coefficient (ICC) were calculated.
Results:
Among 177,988 weighted children, 59.05% (95% CI: 58.82%–59.28%) initiated breastfeeding within one hour of birth. Timely initiation was more likely among rural residents (AOR = 1.25), mothers with primary (AOR = 1.48), secondary (AOR = 1.22), and higher education (AOR = 1.22), institutional delivery (AOR = 1.40), multiparous (AOR = 1.19), and grand multiparous mothers (AOR = 1.10). Lower odds were observed among cesarean births (AOR = 0.31), twin births (AOR = 0.87), delayed antenatal care initiation (AOR = 0.84), female children (AOR = 0.90), and mothers with a history of child death (AOR = 0.90).
Conclusions:
Timely initiation of breastfeeding remains suboptimal in sub-Saharan Africa and is influenced by maternal, obstetric, and healthcare factors. Enhancing antenatal counseling and postnatal breastfeeding support, particularly after cesarean delivery and among vulnerable groups, may improve timely initiation practices.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.