Proximal and distal factors predicting timely initiation of breast feeding in Ethiopia: a systematic review and meta-analysis

Abstract BackgroundIn Ethiopia, the current coverage of timely initiation of breast feeding (TIBF) has fallen short of the national Health Sector Transformation Plan 2016-2020, National Nutrition Program 2016–2020 and WHO global target. This calls for the need to assess relevant proximal and distal factors that affect the rate of TIBF in Ethiopia. ObjectiveThe aim of this meta-analysis was to investigate the association between TIBF and educational status, household income, marital status, media exposure, and parity in Ethiopia. MethodsDatabases used were PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library, and key terms were searched using interactive searching syntax. It was also supplemented by manual searching. Observational studies published between September 2000 and March 2019 were included. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Data were extracted using the Joanna Briggs Institute (JBI) data extraction tool. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran’s Q test, τ2, and I2 statistics. Additional analysis conducted includes Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis. ResultsOut of 553 studies retrieved, 25 studies fulfilled our inclusion criteria. Almost all studies were conducted on mothers with newborn less than 23 months. Maternal educational status (OR = 1.82; p < 0.001; 95% CI = 1.35 - 2.45; I2 = 84.96%), paternal educational status (OR = 2.72; p = 0.001, 95% CI = 1.49 - 4.97 I2 = 62.50%), income (OR = 1.16; p = 0.002; 95% CI = 1.05 - 1.27; I2 = 0.00%), marital status (OR = 1.39; p = 0.001; 95% CI = 1.14 - 1.69; I2 = 9.17%) and parity (OR = 1.39; p = 0.01; 95% CI = 1.07 - 1.81; I2 = 74.43%) were found to be significantly associated with TIBF. We also observed a direct dose-response relationship of TIBF with educational status and income. ConclusionsProximal and distal factors significantly predicting TIBF practice in Ethiopia, which needs integrated intervention by health professionals and healthcare policymakers. Health education, counselling and peer education targeting parents at antenatal and postnatal periods are needed. It is also relevant to improve the economic power of women and promote gender equality.