Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses

Abstract

Objective: To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia.

Design: A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle-Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done.

Setting: All observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver's age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver's age (OR=1·09; 95 % CI 0·84, 1·41).

Conclusions: There was no association between maternal/caregiver's age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.

Keywords: Breast-feeding; Ethiopia; Infant; Maternal age; Meta-analysis; Review.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the literature screening and selection process for studies included in the present systematic review and meta-analysis on factors affecting timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia. Note ‘n’ in each stage represents the total number of studies that fulfilled a particular criterion

Fig. 2

Forest plot of ten studies on the association of maternal/caregiver’s age with timely initiation of breast-feeding (TIBF) in Ethiopia. The study-specific OR and 95 % CI are represented by the black square and horizontal line, respectively, with area of the square proportional to the specific-study weight to the overall meta-analysis. The centre of the black diamond represents the pooled OR and its width represents the pooled 95 % CI (LIBF, late initiation of breast-feeding; REM, random-effects model)

Fig. 3

Forest plot of six studies on the association of colostrum discarding with timely initiation of breast-feeding (TIBF) in Ethiopia. The study-specific OR and 95 % CI are represented by the black square and horizontal line, respectively, with area of the square proportional to the specific-study weight to the overall meta-analysis. The centre of the black diamond represents the pooled OR and its width represents the pooled 95 % CI (D, discarding; NotD, not discarding; LIBF, late initiation of breast-feeding; REM, random-effects model)

Fig. 4

Forest plot of thirteen studies on the association of maternal/caregiver’s age with exclusive breast-feeding (EBF) in Ethiopia. The study-specific OR and 95 % CI are represented by the black square and horizontal line, respectively, with area of the square proportional to the specific-study weight to the overall meta-analysis. The centre of the black diamond represents the pooled OR and its width represents the pooled 95 % CI (NEBF, non-exclusive breast-feeding; REM, random-effects model)

Fig. 5

Forest plot of eleven studies on the association of infant age with exclusive breast-feeding (EBF) in Ethiopia. The study-specific OR and 95 % CI are represented by the black square and horizontal line, respectively, with area of the square proportional to the specific-study weight to the overall meta-analysis. The centre of the black diamond represents the pooled OR and its width represents the pooled 95 % CI (NEBF, non-exclusive breast-feeding; REM, random effects model)

Fig. 6

Forest plot of thirteen studies on the association of discarding colostrum with exclusive breast-feeding (EBF) in Ethiopia. The study-specific OR and 95 % CI are represented by the black square and horizontal line, respectively, with area of the square proportional to the specific-study weight to the overall meta-analysis. The centre of the black diamond represents the pooled OR and its width represents the pooled 95 % CI (D, discarding; NotD, not discarding; NEBF, non-exclusive breast-feeding; REM, random-effects model)

Fig. 7

Forest plot showing the results from a cumulative meta-analysis of studies examining the effect of maternal age on timely initiation of breast-feeding in Ethiopia. The study-specific (first data point)/cumulative OR and 95 % CI are represented by the black square and horizontal line, respectively

Fig. 8

Forest plot showing the results from a cumulative meta-analysis of studies examining the effect of discarding colostrum on timely initiation of breast-feeding in Ethiopia. The study-specific (first data point)/cumulative OR and 95 % CI are represented by the black square and horizontal line, respectively

Fig. 9

Forest plot showing the results from a cumulative meta-analysis of studies examining the effect of maternal age on exclusive breast-feeding in Ethiopia. The study-specific (first data point)/cumulative OR and 95 % CI are represented by the black square and horizontal line, respectively

Fig. 10

Forest plot showing the results from a cumulative meta-analysis of studies examining the effect of discarding colostrum on exclusive breast-feeding in Ethiopia. The study-specific (first data point)/cumulative OR and 95 % CI are represented by the black square and horizontal line, respectively

Fig. 11

Forest plot showing the results from a cumulative meta-analysis of studies examining the effect of infant age on exclusive breast-feeding in Ethiopia. The study-specific (first data point)/cumulative OR and 95 % CI are represented by the black square and horizontal line, respectively