Date of Award

12-6-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Iqbal Azam

Second Advisor

Dr. Shiyam sunder Tikmani

Third Advisor

Dr Amna Rehana Siddiqui

Department

Community Health Sciences

Abstract

Background:The World Health Organization (WHO) supports the Early Initiation of Breastfeeding (EIBF) as a critical time when a mother gives birth to her child and begins nursing within the first hour of life, Despite WHO recommendation for EIBF globally, a reasonable ratio of infants is not provided with breast milk initially after birth. Moreover, Timely initiation helps in the prevention of neonatal mortality through enhanced immunity and decreased incidences of infections. Globally, less than half (42%) of newborns are breastfed within the first hour, and the rate is even lower in many low- and middle-income countries (LMIC). While EIBF remains 40% in South Asia, Pakistan reports the lowest rate in the region at just 20%. This study examines the prevalence of EIBF and its association with Place of delivery (POD) among women who had normal deliveries, utilizing data from the Pakistan Demographic and Health Survey (PDHS) 2017-2018.
Methods: A secondary data analysis was conducted using Pakistan Demographic & Health Survey (PDHS) data. The study population included Pakistani women aged 15-49 who had a live birth within five years preceding the survey. The data extraction was done with the Individual recode (IR) file of Demographic health survey (DHS) 2017-18, from the women’s questionnaire. Some variables were directly utilized as presented in the DHS data files. However, variables such as the mother's age at childbirth and birth order were derived by merging data within the Individual Respondent (IR) file. The primary exposure variable was the place of delivery, categorized as home, private hospital, and government hospital, while the outcome variable was EIBF. Descriptive, univariate, and multivariable analyses were performed to explore associations between socio-demographic and birth related factors with EIBF. Data analysis was conducted using STATA version 17. The data analysis accounted for sampling design.
Findings: Of the 4,461 women included, EIBF was observed in 34.1% (95% CI 31.1% to 37.2%). In multivariable analysis, place of delivery, size of the neonate and maternal education significantly influenced EIBF. Women who delivered at private facilities had lower odds of EIBF (AOR 0.95, 95% CI 0.72–1.23 for normal-size infants) compared to home deliveries. Large neonates delivered in private facilities had higher odds of EIBF (AOR 2.28, 95% CI 1.08–4.79) than those born at home. Mothers without formal education exhibited higher odds of EIBF (AOR 1.46, 95% CI 1.00–2.14) compared to highly educated mothers.
Conclusion: The study depicts diverse disparities in EIBF based on place of delivery, size of the neonate, and mother’s education. To combat these gaps requires tailored interventions, including establishing lactation clinics, to improve awareness, enhance healthcare infrastructure at POD, and prioritize early breastfeeding practices, especially among high-risk groups in Pakistan.

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