First Hour Initiation of Breast Feeding & Associated Factors, among Mothers at Post Natal Ward in Fort Portal Referral Hospital, Uganda

Background: Breast milk is recommended as the best feeding option to neonates and infants for it confers immunological benefits that help to reduce neonatal and infant morbidities and mortalities. WHO recommends that all infants should start breast feeding within one hour of birth i.e. early initiation of breast feeding (EIBF). Unfortunately, studies show that less than 40% of infants in resource limited settings Uganda inclusive are initiated on breast feeding practice, with no documented study done in Kabarole district to assess the problem. This study therefore, set out to establish the prevalence and associated factors with the practice of first hour initiation of breast feeding at Fort Portal Regional Hospital, Kabarole district, Uganda. Methods: With a cross-sectional design, we collected data from 330 post natal mothers and their live-born infants at Fort Portal Regional Referral hospital from 5th-20th August 2019. With a standard interviewer administered tool, mothers who initiated breast feeding within the first hour after delivery of their newly born babies responded with yes and those that did not with a no. Prevalence of one hour initiation was got considering infants that were initiated on breast within one hour over the total live birth times 100 to get the percent prevalence. With Stata version 13 software, statistically significant relationships of the predisposing factors were determined at a p-value (p ≤ 0.05) at bivariate and at multivariate regression coefficient. Results: A total of 330 postnatal mothers targeted for this study, 100% response rate was covered. Mothers’ age ranged from 18 - 45 years with mean age 31 SD ± 6. The prevalence of initiation of breast feeding in the first hour of birth was 68%, a third of (32%) mothers had not initiated breast feeding in the first hour. A half (50%) of the direct predisposing factors for non-initiation of timely breastfeeding were due to birth asphyxia, almost a quarter 23% due to mother’s ill health and 7% due mother not being guided by the health worker on what to do. In this study mothers’ knowledge and awareness of the practice were very low at 20% while that of health workers was fair at 53%. Social demographic factors that influence 1st hour breast feeding practice were; young maternal age being less than 34 years, mothers occupation being self-employed (83%) or unemployed (73%) with 3 times higher odds of initiating breastfeeding within 1st (OR = 3, p = 0.003) than working class mothers (civil servants). Marital status of mothers being married (73%) significantly influenced early breastfeeding practice (p = 0.001). Health workers’ knowledge of the practice was significantly associated (OR = 2.7, X2 = 11.32, *p = 0.00078) with enforcement of mother initiation of breast feeding in first hour compared to the less knowledgeable ones. Conclusion: The practice of timely initiation of breastfeeding at Fort Portal Regional Referral hospital at 68.2% was sub-optimal against WHO universal practice recommendations. Mothers’ low knowledge on timely initiation of breast feeding practice was the most deterrent factor for first hour initiation of breastfeeding practice. Providing breastfeeding counselling to all mothers during ANC and training on best breastfeeding practices and counselling skills for health staff at Fort Portal Referral hospital are urgent recommendation in this study to improve the practice.