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Observational Study
. 2020 Aug;5(8):e002581.
doi: 10.1136/bmjgh-2020-002581.

Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

Zhao Li  1 , Priya Mannava  1 , John Charles Scott Murray  1 , Howard Lawrence Sobel  2 , Annie Jatobatu  3 , Anthony Calibo  4 , Baldan Tsevelmaa  5 , Bounnack Saysanasongkham  6 , Divinal Ogaoga  3 , Edward Joseph Waramin  7 , Elizabeth Mary Mason  8 , Hiromi Obara  9 , Hoang Thi Tran  10 , Hoang Anh Tuan  11 , Jacqueline Kitong  12 , Jessica Mara Yaipupu  13 , Kannitha Cheang  14 , Maria Asuncion Silvestre  15 , Outhevanh Kounnavongsa  16 , Pamela Putney  17 , Pham Thi Quynh Nga  18 , Rathavy Tung  19 , Sano Phal  14 , Shogo Kubota  16 , Sidonn Krang  20 , Simon Burggraaf  21 , Sommana Rattana  6 , Tao Xu  22 , Tuohong Zhang  23 , Ulziikhutag Enkhmaa  5 , Vanya Delgermaa  24 , Y Meng Chhour  25 ; Western Pacific Region Early Essential Newborn Care Working Group
Collaborators, Affiliations
Observational Study

Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study

Zhao Li et al. BMJ Glob Health. 2020 Aug.

Abstract

Objective: To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes.

Design: Cross-sectional observational study.

Setting: 150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific.

Participants: 1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017.

Main outcome measures: Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation.

Results: Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose-response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30-59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60-89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF.

Conclusion: EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.

Keywords: child health; cross-sectional survey; maternal health; paediatrics; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Bivariate analysis of the relationship between SSC duration after birth and early initiation of breastfeeding, assessments of 150 hospitals, eight countries, 2016–2017. SSC, skin-to-skin contact.
See this image and copyright information in PMC

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